Colorado Code
Part 1 - General Provisions
§ 10-16-104. Mandatory Coverage Provisions - Definitions - Rules

(1.3) Early intervention services.





























(1.4) Autism spectrum disorders.













































(1.5) (Deleted by amendment, L. 2009, (HB 09-1204), ch. 344, p. 1802, § 2, effective January 1, 2010.)
(1.7) Therapies for congenital defects and birth abnormalities.





























(5.5) Behavioral, mental health, and substance use disorders - rules.










































(6.5) Adopted child - dependent coverage.





(6.7) Medical assistance recipients - denial of coverage - liability to state.














































































(B) The division shall submit to the federal department of health and human services its determination as to whether the benefit specified in this subsection (18)(b)(XI) is in addition to essential health benefits and would be subject to defrayal by the state pursuant to 42 U.S.C. sec. 18031 (d)(3)(B) and a request that the federal department confirm the division's determination within sixty days after receipt of the division's request and submission of its determination.
(C) This subsection (18)(b)(XI) applies to large employer policies or contracts issued or renewed on or after January 1, 2022, and to individual and small group policies and contracts issued on or after January 1, 2023, and the division shall implement the requirements of this subsection (18)(b)(XI) if the division receives confirmation from the federal department of health and human services that the coverage specified in this subsection (18)(b)(XI) does not constitute an additional benefit that requires defrayal by the state pursuant to 42 U.S.C. sec. 18031 (d)(3)(B); the federal department of health and human services has otherwise informed the division that the coverage does not require state defrayal pursuant to 42 U.S.C. sec. 18031 (d)(3)(B); or more than three hundred sixty-five days have passed since the division submitted its determination and request for confirmation that the coverage specified in this subsection (18)(b)(XI) is not an additional benefit that requires state defrayal pursuant to 42 U.S.C. sec. 18031 (d)(3)(B), and the federal department of health and human services has failed to respond to the request within that period, in which case the division shall consider the federal department's unreasonable delay a preclusion from requiring defrayal by the state.

























(III.5) "Breast cancer screening study" and "breast imaging" mean:


(III.7) "Mental health wellness examination" means an examination that seeks to identify any behavioral or mental health needs and appropriate resources for treatment. The examination may include:
(A) Observation; a behavioral health screening; education and consultation on healthy lifestyle changes; referrals to ongoing treatment, mental health services, and other necessary supports; and discussion of potential options for medication; and
(B) Age-appropriate screenings or observations to understand a covered person's mental health history, personal history, and mental or cognitive state and, when appropriate, relevant adult input through screenings, interviews, and questions.
(III.9) "Qualified mental health-care provider" means:
(A) A physician licensed to practice medicine pursuant to article 240 of title 12 who has specific board certification or training in psychiatry or other mental or behavioral health-care areas;
(B) A physician assistant licensed pursuant to article 240 of title 12 who has training in psychiatry or mental health;
(C) A psychologist licensed pursuant to part 3 of article 245 of title 12;













(18.1) Contraception. [ Editor's note: For the applicability of this subsection (18.1) on or after January 1, 2023, see the editor's note following this section.]





















































































(b) At the time of a covered person's initial visit for treatment, a physical therapist, occupational therapist, chiropractor, or acupuncturist shall notify the covered person's carrier that the covered person has started treatment with the provider.
(c) (I) The division shall submit to the federal department of health and human services:

(II) This subsection (25) applies to large employer policies or contracts issued or renewed on or after January 1, 2022, and to individual and small group policies and contracts issued on or after January 1, 2023, and the division shall implement the requirements of this subsection (25), if:
(A) The division receives confirmation from the federal department of health and human services that the coverage specified in this subsection (25) does not constitute an additional benefit that requires defrayal by the state pursuant to 42 U.S.C. sec. 18031 (d)(3)(B);
(B) The federal department of health and human services has otherwise informed the division that the coverage does not require state defrayal pursuant to 42 U.S.C. sec. 18031 (d)(3)(B); or

(d) The division shall conduct an actuarial study to determine the effect, if any, the cost-sharing benefit required by this subsection (25) has on premiums.


Source: L. 92: Entire article R&RE, p. 1621, § 1, effective July 1; (4)(a) amended, p. 1499, § 32, effective July 1; (4) amended, p. 1752, § 7, effective July 1. L. 93: (5)(h) added, p. 956, § 2, effective May 28; (10) added, p. 2090, § 1, effective June 9. L. 94: (1.5), (6.5), (6.7) added and (6) amended, p. 1591, § 1, effective July 1; (5)(a), (5)(b)(I), (6), (8)(a), (8)(c), (8)(d), (9)(a)(I), (9)(b)(II), (9)(b)(III), and (9)(c) amended, pp. 2724, 2636, 2604, §§ 321, 77, 2, effective July 1. L. 95: IP(4)(a), (4)(a)(II), (4)(a)(III), and (4)(b) amended, p. 486, § 1, effective May 16; (11) added, p. 590, § 1, effective May 22; (10) amended, p. 1389, § 1, effective June 5. L. 96: (1)(a) and (1)(b) amended, p. 123, § 1, effective August 7. L. 97: (7)(a)(I)(A) amended, p. 1131, § 3, effective May 28; (5.5) added, p. 193, § 1, effective January 1, 1998. L. 98: (1)(b) RC&RE and (3)(a) amended, pp. 52, 53, §§ 1, 2, effective March 23; (5)(b)(II), (5)(b)(III), and (7)(a)(I)(B) amended, p. 1157, § 27, effective July 1; (13) added, p. 329, § 2, effective July 1; (12) added, p. 472, § 2, effective September 1; (6)(c) and (6)(d) amended, p. 1391, § 22, effective February 1, 1999. L. 99: (1)(c)(I) and (1)(c)(II)(A) amended and (1)(g) and (1.7) added, pp. 1045, 1046, §§ 1, 2, effective January 1, 2000. L. 2000: (14) added, p. 1588, § 1, effective January 1, 2001. L. 2001: (5.5)(a)(I) amended, p. 984, § 1, effective August 8; (1)(c)(I) amended and (1)(c)(III) added, p. 931, § 1, effective January 1, 2002. L. 2003: (8)(a)(II) amended, p. 700, § 5, effective July 1; (15) added, p. 1774, § 9, effective July 1. L. 2004: (5)(c) amended, p. 981, § 4, effective August 4. L. 2006: (6.7)(a), (6.7)(b), and (8)(a)(I) amended, p. 1998, § 34, effective July 1; (15) amended, p. 1077, § 3, effective January 1, 2007. L. 2007: (17) added, p. 1348, § 3, effective May 29; (16) added, p. 378, § 1, effective August 3; (1.3) added and (1.7)(a) amended, p. 889, § 3, effective January 1, 2008; (5.5)(a) amended and (5.5)(c) added, pp. 1369, 1370, §§ 1, 2, effective January 1, 2008; (15) amended, p. 451, § 3, effective January 1, 2008. L. 2008: (1.3)(a) amended, p. 1467, § 12, effective August 5; (6)(a) amended, p. 386, § 2, effective August 5; (7)(a)(I)(B) and (7)(b)(II)(B) amended and (7)(c) added, p. 425, § 24, effective August 5; (19) added, p. 2005, § 1, effective January 1, 2009; (15) amended and (18) added, p. 2074, § 2, effective January 16, 2009. L. 2009: (1.3)(a)(VI), (1.3)(b), and (1.3)(e) amended and (1.3)(d.5) and (1.3)(f) added, (HB 09-1237), ch. 216, p. 977, § 1, effective May 2; IP(5), (5)(e), (5)(f), (5)(g), and (5.5)(b) amended, (HB 09-1338), ch. 353, p. 1844, § 4, effective July 1; (1.5), (6)(a), and (6.7)(a) amended, (SB 09-292), ch. 369, p. 1944, § 16, effective August 5; (20) added, (HB 09-1059), ch. 214, p. 969, § 1, effective August 5; (1.5), (4), (15), and (18) amended, (HB 09-1204), ch. 344, p. 1802, § 2, effective January 1, 2010; (1.3)(g) and (1.4) added, (SB 09-244), ch. 391, pp. 2113, 2114, §§ 2, 3, effective July 1, 2010. L. 2010: (1.4)(a)(II)(A), (1.4)(a)(VIII), and (1.4)(a)(IX) amended, (HB 10-1260), ch. 403, p. 1978, § 50, effective July 1; (3)(a)(I) amended, (HB 10-1021), ch. 297, p. 1402, § 1, effective January 1, 2011; (18)(b)(III)(D) added, (HB 10-1252), ch. 226, p. 983, § 1, effective January 1, 2011; (21) added, (HB 10-1202), ch. 91, p. 310, § 2, effective January 1, 2011. L. 2011: IP(5) and (5)(b)(III) amended, (SB 11-187), ch. 285, p. 1326, § 65, effective July 1; (7)(a)(I)(A) amended, (HB 11-1186), ch. 97, p. 284, § 1, effective January 1, 2012. L. 2013: (5)(d)(I) repealed, (HB 13-1015), ch. 38, p. 109, § 2, effective March 15; (1.3)(b)(II), IP(1.3)(b)(IV), (1.3)(d.5), (1.4)(a)(IV), (1.4)(b), (5.5), IP(12)(a), IP(18)(a)(I), (18)(a)(III), IP(18)(b), (18)(b)(III), (18)(b)(VI), (18)(b)(VIII), (18)(b)(IX), and (21)(b) amended, (1.7)(c), (5), (7), (9), (11), (15), (16), and (18)(a)(II) repealed, and (18)(b)(X) added, (HB 13-1266), ch. 217, pp. 920, 978, §§ 3, 28, 27, effective May 13; IP(19)(b) amended, (SB 13-039), ch. 288, p. 1536, § 4, effective May 24; (1.4)(a)(XI) amended, (SB 13-180), ch. 411, p. 2443, § 13, effective June 30; (1.4)(a)(VII) amended, (HB 13-1314), ch. 323, p. 1800, § 18, effective March 1, 2014. L. 2015: IP(1.4)(a)(II), (1.4)(a)(II)(E), (1.4)(a)(III), IP(1.4)(a)(XII), (1.4)(b)(I), and (5.5)(a)(IV)(B) amended and (1.4)(a)(II)(F) added, (SB 15-015), ch. 106, p. 308, § 2, effective January 1, 2017. L. 2016: (22) added, (HB 16-1095), ch. 12, p. 28, § 1, effective January 1, 2017; (1)(c)(III)(A) and (1)(c)(III)(C) amended, (HB 16-1387), ch. 203, p. 717, § 1, effective January 1, 2018. L. 2017: (5.5)(a)(I), (5.5)(a)(IV), and (18)(b)(I) amended, (SB 17-242), ch. 263, p. 1264, § 35, effective May 25; (3)(a)(I) amended, (HB 17-1186), ch. 324, p. 1746, § 2, effective January 1, 2019. L. 2018: (1.3)(b)(II)(B) amended, (HB 18-1375), ch. 274, p. 1695, § 3, effective May 29; (6)(b) amended, (SB 18-095), ch. 96, p. 752, § 3, effective August 8; (5.5)(a)(III) amended, (HB 18-1007), ch. 225, p. 1431, § 1, effective January 1, 2019. L. 2019: (5.5)(a)(I), (5.5)(a)(IV), (5.5)(b), (5.5)(c), and (18)(b)(I) amended and (5.5)(a)(V) and (5.5)(d) added, (HB 19-1269), ch. 195, p. 2125, § 3, effective May 16; (18)(b)(III) repealed and (18)(b.5) and (18)(c)(III.5) added, (HB 19-1301), ch. 192, p. 2112, § 2, effective August 2; (1.4)(a)(VIII), (1.4)(a)(IX), (1.4)(a)(X), (1.4)(a)(XI), and IP(19)(b) amended, (HB 19-1172), ch. 136, p.1653, § 41, effective October 1. L. 2020: (23) added, (HB 20-1158), ch. 106, p. 416, § 2, effective April 1; (5.5)(a)(I) and (5.5)(a)(III)(A) amended and (5.5)(a)(III)(C) added, (SB 20-007), ch. 286, pp. 1389, 1392, §§ 1, 10, effective July 13; (18)(e) added, (HB 20-1061), ch. 281, p. 1375, § 2, effective July 13. L. 2021: IP(18)(a)(I) amended and (18)(b.7), (18)(c)(III.7), and (18)(c)(III.9) added, (HB 21-1068), ch. 439, p. 2906, § 2, effective July 6; IP(18)(a)(I) and (18)(a)(III)(A) amended and (18)(b)(XI) and (18.1) added, (SB 21-016), ch. 428, p. 2833, § 1, effective July 6; (3)(d) added, (SB 21-194), ch. 434, p. 2868, § 1, effective September 7; (24) added, (HB 21-1140), ch. 447, p. 2946, § 1, effective September 7; (25) added, (HB 21-1276), ch. 364, p. 2395, § 2, effective January 1, 2023.












Cross references: (1) For limitations concerning medical or health insurance under the "Colorado Medical Treatment Decision Act", see § 15-18-111; for section 607 of the "Employee Retirement Income Security Act of 1974", see 29 U.S.C. § 1167.
(2) For the legislative declaration contained in the 1993 act adding subsection (5)(h), see section 1 of chapter 211, Session Laws of Colorado 1993. For the legislative declaration contained in the 1998 act adding subsection (12), see section 1 of chapter 162, Session Laws of Colorado 1998. For the legislative declaration contained in the 2006 act amending subsection (15), see section 1 of chapter 236, Session Laws of Colorado 2006. For the legislative declaration contained in the 2008 act amending subsection (15) and adding subsection (18), see section 1 of chapter 411, Session Laws of Colorado 2008. For the legislative declaration contained in the 2009 act adding subsections (1.3)(g) and (1.4), see section 1 of chapter 391, Session Laws of Colorado 2009. For the legislative declaration contained in the 2009 act amending subsections (1.5), (4), (15), and (18), see section 1 of chapter 344, Session Laws of Colorado 2009. For the legislative declaration contained in the 2010 act adding subsection (21), see section 1 of chapter 91, Session Laws of Colorado 2010. For the legislative declaration contained in the 2013 act repealing subsection (5)(d)(I), see section 1 of chapter 38, Session Laws of Colorado 2013. For the legislative declaration in SB 15-015, see section 1 of chapter 106, Session Laws of Colorado 2015. For the legislative declaration in SB 17-242, see section 1 of chapter 263, Session Laws of Colorado 2017. For the legislative declaration in SB 18-095, see section 1 of chapter 96, Session Laws of Colorado 2018. For the legislative declaration in HB 19-1301, see section 1 of chapter 192, Session Laws of Colorado 2019. For the legislative declaration in HB 21-1068, see section 1 of chapter 439, Session Laws of Colorado 2021. For the legislative declaration in HB 21-1276, see section 1 of chapter 364, Session Laws of Colorado 2021.
(3) For the short title ("Behavioral Health Care Coverage Modernization Act") in HB 19-1269, see section 1 of chapter 195, Session Laws of Colorado 2019. For the short title ("Colorado Building Families Act") in HB 20-1158, see section 1 of chapter 106, Session Laws of Colorado 2020.

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