HB19-1269: Behavioral Health Care Coverage Modernization Act

• Requires health benefit plans to provide coverage for prevention, screening, and treatment of behavioral, mental health, and substance use disorders that is no less extensive than coverage for physical illness and complies with the federal Mental Health Parity and Addiction Equity Act (MHPAEA).

• Eliminates prior authorization and step therapy requirements for FDA-approved medications treating substance use disorders and requires at least one such medication on the lowest drug formulary tier, effective January 1, 2020.

• Establishes network adequacy standards requiring carriers to authorize treatment with out-of-network providers when in-network services are unavailable within time and distance standards, with no greater cost to covered persons.

• Requires detailed parity compliance reporting by carriers and managed care entities to the state commissioner, including medical necessity criteria comparisons and analyses of nonquantitative treatment limitations between behavioral health and medical/surgical benefits.

• Appropriates $167,000 to the Department of Health Care Policy and Financing and $88,248 to the Division of Insurance for implementation and enforcement, with anticipated federal funding of $167,001.