Amendments for HB19-1269
House Journal, April 8
22 HB19-1269 be amended as follows, and as so amended, be referred to
23 the Committee on Appropriations with favorable
24 recommendation:
25
26 Amend printed bill, page 4, line 13, strike "(5.5)(c), (18)(b)(I), and
27 (18)(d);" and substitute "(5.5)(b), (5.5)(c), and (18)(b)(I);".
28
29 Page 5, strike lines 18 and 19 and substitute "DISORDERS, THE SERVICE
30 CONTINUES TO BE A COVERED SERVICE UNTIL".
31
32 Page 5, line 24, strike "QUANTITATIVE AND".
33
34 Page 5, line 26, strike "(c)(4)(I)," and substitute "(c)(4),".
35
36 Page 6, strike line 2 and substitute "TO THE LIMITATIONS AND EXAMPLES
37 LISTED IN 45 CFR 146.136 (c)(4)(ii) AND (c)(4)(iii), OR ANY".
38
39 Page 6, after line 7 insert:
40
41 "(B) COMPLY WITH THE FINANCIAL REQUIREMENTS AND
136 42 QUANTITATIVE TREATMENT LIMITATIONS SPECIFIED IN 45 CFR 146.
43 (c)(2) AND (c)(3), OR ANY SUCCESSOR REGULATION;".
44
45 Reletter succeeding sub-subparagraphs accordingly.
46
47 Page 6, strike lines 12 through 19.
48
49 Reletter succeeding sub-subparagraphs accordingly.
50
51 Page 7, line 2, strike "REIMBURSE" and substitute "IF A COVERED PERSON
52 OBTAINS A COVERED SERVICE FROM A NONPARTICIPATING PROVIDER
53 BECAUSE THE COVERED SERVICE IS NOT AVAILABLE WITHIN ESTABLISHED
54 TIME AND DISTANCE STANDARDS, REIMBURSE".
55
1 Page 7, after line 8 insert:
2
3 "(b) The commissioner may adopt rules as necessary to ensure that
4 this subsection (5.5) is implemented and administered in compliance with
5 federal law AND SHALL ADOPT RULES TO ESTABLISH REASONABLE TIME
6 PERIODS FOR VISITS WITH A PROVIDER FOR TREATMENT OF A BEHAVIORAL,
7 MENTAL HEALTH, OR SUBSTANCE USE DISORDER AFTER AN INITIAL VISIT
8 WITH A PROVIDER.".
9
10 Page 8, strike lines 17 through 27.
11
12 Page 9, strike lines 1 through 3.
13
14 Page 9, line 22, after "MHPAEA." add "THE COMMISSIONER SHALL
15 ADOPT RULES TO ESTABLISH THE PROCESS AND TIMELINE FOR CARRIERS TO
16 DEMONSTRATE COMPLIANCE WITH THE MHPAEA IN ESTABLISHING THEIR
17 RATES.".
18
19 Page 9, line 27, strike "ALL DENIALS OF" and substitute "UNLESS A DENIAL
20 IS BASED ON NONPAYMENT OF PREMIUMS, A DENIAL OF".
21
22 Page 10, line 1, strike "REQUESTS FOR".
23
24 Page 10, line 3, after "DISORDERS" insert "UNDER A HEALTH BENEFIT
25 PLAN".
26
27 Page 10, line 16, strike "CARRIER," and substitute "CARRIER AND FREE OF
28 CHARGE,".
29
30 Page 11, lines 15 and 16, strike "FOR AN ANNUAL MENTAL WELLNESS
31 CHECKUP THAT" and substitute "AND REIMBURSEMENT FOR BEHAVIORAL
32 HEALTH SCREENINGS USING A VALIDATED SCREENING TOOL FOR
33 BEHAVIORAL HEALTH, WHICH COVERAGE AND REIMBURSEMENT".
34
35 Page 11, line 17, after "COVERAGE" insert "AND REIMBURSEMENT".
36
37 Page 15, line 3, after "10-16-148" insert "and 10-16-149".
38
39 Page 15, line 9, strike "SHALL:" and substitute "SHALL, FOR PRESCRIPTION
40 MEDICATIONS THAT ARE ON THE CARRIER'S FORMULARY:".
41
42 Page 15, line 14, strike "TO AUTHORIZING" and substitute "FOR".
43
44 Page 15, line 17, strike "ALL" and substitute "AT LEAST ONE" and strike
45 "MEDICATIONS" and substitute "MEDICATION".
46
47 Page 16, after line 1 insert:
48
49 "10-16-149. Commissioner report - parity effects on premiums
50 - repeal. (1) BY DECEMBER 1, 2022, THE COMMISSIONER SHALL SUBMIT
51 A REPORT TO THE SENATE HEALTH AND HUMAN SERVICES COMMITTEE AND
52 THE HOUSE OF REPRESENTATIVES HEALTH AND INSURANCE COMMITTEE
53 AND PUBLIC HEALTH CARE AND HUMAN SERVICES COMMITTEE, OR THEIR
54 SUCCESSOR COMMITTEES, REGARDING THE EFFECTS ON PREMIUMS
55 RESULTING FROM CHANGES ENACTED BY HOUSE BILL 19-1269 IN
1 REQUIRED HEALTH CARE COVERAGE FOR THE PREVENTION OF, SCREENING
2 FOR, AND TREATMENT OF BEHAVIORAL, MENTAL HEALTH, AND SUBSTANCE
3 USE DISORDERS AND NETWORK ADEQUACY REQUIREMENTS FOR PROVIDING
4 THOSE SERVICES PURSUANT TO SECTION 10-16-104 (5.5) AND (18)(b)(I)
5 AND PRESCRIPTION DRUG FORMULARY REQUIREMENTS PURSUANT TO
6 SECTION 10-16-148.
7 (2) THIS SECTION IS REPEALED, EFFECTIVE MARCH 1, 2023.".
8
9 Page 17, line 4, strike "DAYS," and substitute "DAYS".
10
11 Page 17, line 10, strike "DIAGNOSIS, AND PROHIBIT" and substitute
12 "SERVICE; AND
13 (i) PROHIBIT".
14
15 Page 17, line 12, strike "DISORDER DIAGNOSIS" and substitute "DISORDER
16 OR SUBSTANCE USE DISORDER DIAGNOSIS SOLELY".
17
18 Page 17, line 13, strike "ETIOLOGY; AND" and substitute "ETIOLOGY.".
19
20 Page 17, strike lines 14 through 17.
21
22 Page 17, line 19, before "PUBLIC." insert "AND THE STATE DEPARTMENT'S
23 REPORT REQUIRED BY SECTION 25.5-5-421 READILY AVAILABLE TO THE".
24 Page 17, line 25, strike "PROVIDERS;" and substitute "PROVIDERS WHEN
25 NECESSARY;".
26
27 Page 18, line 27, strike "ANY" and substitute "A".
28
29 Page 19, line 1, after "BENEFITS" insert "FOR BEHAVIORAL HEALTH
30 SERVICES THAT ARE COVERED UNDER THE MEDICAL ASSISTANCE
31 PROGRAM".
32
33 Page 19, strike lines 9 through 27.
34
35 Renumber succeeding sections accordingly.
36
37 Page 20, after line 14 insert:
38 "(a) DATA THAT DEMONSTRATES PARITY COMPLIANCE FOR
39 ADVERSE DETERMINATIONS REGARDING CLAIMS FOR BEHAVIORAL,
40 MENTAL HEALTH, OR SUBSTANCE USE DISORDER SERVICES AND INCLUDES
41 THE TOTAL NUMBER OF ADVERSE DETERMINATIONS FOR SUCH CLAIMS;".
42
43 Reletter succeeding paragraphs accordingly.
44
45 Page 21, line 4, strike "(1)(a)" and substitute "(1)(b)".
46
47 Page 21, line 6, strike "(1)(b)" and substitute "(1)(c)".
48
49 Page 21, line 18, strike "(1)(c)" and substitute "(1)(d)".
50
51 Page 22, line 24, strike "CONVENE A COMMITTEE OF" and substitute "SEEK
52 INPUT FROM".
53
54 Page 22, lines 24 and 25, strike "THAT INCLUDES MEMBERS WITH" and
55 substitute "WHO MAY HAVE".
1 Page 22, line 27, strike the first "AND" and substitute "OR".
2
3 Page 23, strike lines 1 and 2 and substitute "THE INPUT RECEIVED IN
4 CONDUCTING THE ANALYSES AND DEVELOPING".
5
6
House Journal, April 16
46 HB19-1269 be amended as follows, and as so amended, be referred to
47 the Committee of the Whole with favorable
48 recommendation:
49
50 Amend the Public Health Care and Human Services Committee Report,
51 dated April 5, 2019, page 3, strike lines 22 through 30 and substitute:
52
53 "Page 16 of the printed bill, lines 4 and 5, strike "provisions. (4)" and
54 substitute "provisions - rules. (4) (a)".
55
1 Page 16 of the bill, strike line 15 and substitute "BOARD SHALL
2 ESTABLISH, BY RULE, A PROCEDURE TO ALLOW FOR REIMBURSEMENT OF
3 MEDICALLY NECESSARY STATE PLAN SERVICES UNDER".
4
5 Page 16 of the bill, lines 16 and 17, strike "PROGRAM THROUGH A
6 PROCEDURE ESTABLISHED BY STATE BOARD RULE." and substitute
7 "PROGRAM.".
8
9 Page 16 of the bill, after line 18 insert:
10 "(b) THE STATE BOARD SHALL ADOPT RULES ESTABLISHING THE
11 PROCEDURES FOR REIMBURSEMENT PURSUANT TO THIS SUBSECTION (4) BY
12 JANUARY 1, 2020.".
13
14 Page 16 of the bill, line 20, strike "and (16)" and substitute "(16), and
15 (17)".
16
17 Page 16 of the bill, line 21, strike "definition." and substitute "definition
18 - rules.".
19
20 Page 17 of the bill, strike line 4 and substitute "A REASONABLE PERIOD
21 WHERE MEDICALLY NECESSARY".
22
23 Page 17 of the bill, line 5, strike "MEDICALLY NECESSARY,", and strike
24 INTERVALS;" and substitute "INTERVALS, AS DETERMINED BY STATE
25 BOARD RULE;".
26
27 Page 17 of the bill, strike lines 10 through 17 and substitute "SERVICE;
28 AND
29 (i) REQUIRE AN MCE TO COVER ALL MEDICALLY NECESSARY
30 COVERED TREATMENTS FOR COVERED BEHAVIORAL HEALTH DIAGNOSES,
31 REGARDLESS OF ANY CO-OCCURRING CONDITIONS.
32 (15) ON OR BEFORE JULY 1, 2020, THE STATE DEPARTMENT SHALL
33 INCLUDE UTILIZATION MANAGEMENT GUIDELINES FOR THE MCES IN THE
34 STATE BOARD'S MANAGED CARE RULES.".
35
36 Renumber succeeding subsections accordingly.".
37
38 Page 4 of the committee report, strike line 1 and substitute:
39
40 "Page 17 of the bill, line 18, strike "MAKE EACH MCE ANNUAL" and
41 substitute "PROVIDE INFORMATION ON ITS WEBSITE SPECIFYING HOW THE
42 PUBLIC MAY REQUEST THE".
43
44 Page 17 of the bill, line 19, strike "PUBLIC." and substitute "AND
45 QUARTERLY NETWORK REPORTS FOR AN MCE.".".
46
47 Page 4 of the committee report, after line 3 insert:
48
49 "Page 18 of the bill, line 1, strike "THE" and substitute "IF THE", and
50 strike "SHALL EXAMINE ALL COMPLAINTS" and substitute "RECEIVES A
51 COMPLAINT".
52
53 Page 18 of the bill, line 4, strike "RELATE" and substitute "RELATES", and
54 strike "OR (15)".
55
56 Page 18 of the bill, line 5, strike "MHPAEA" and substitute "MHPAEA,
1 THE STATE DEPARTMENT SHALL EXAMINE THE COMPLAINT, AS REQUESTED
2 BY THE OFFICE,".
3
4 Page 18 of the bill, line 6, strike "REGARDING" and substitute "ANY".
5
6 Page 18 of the bill, lines 6 and 7, strike "THESE COMPLAINTS." and
7 substitute "THE COMPLAINT.".".
8
9 Page 4 of the committee report, strike lines 10 through 18.
10
11 Page 4 of the committee report, after line 25 insert:
12
13 "Page 23 of the bill, after line 6 insert:
14 "(4) THE STATE DEPARTMENT SHALL CONTRACT WITH AN
15 EXTERNAL QUALITY REVIEW ORGANIZATION AT LEAST ANNUALLY TO
16 MONITOR MCES' UTILIZATION MANAGEMENT PROGRAMS AND POLICIES,
17 INCLUDING THOSE THAT GOVERN ADVERSE DETERMINATIONS, TO ENSURE
18 COMPLIANCE WITH THE MHPAEA. THE QUALITY REVIEW REPORT MUST
19 BE READILY AVAILABLE TO THE PUBLIC.".
20
21 Page 24 of the bill, after line 4 insert:
22
23 "SECTION 17. Appropriation. (1) For the 2019-20 state fiscal
24 year, $181,751 is appropriated to the department of health care policy
25 and financing. Of this appropriation $123,590 is from the general fund
26 and $58,161 is from the healthcare affordability and sustainability fee
27 cash fund created in section 25.5-4-402.4 (5)(a), C.R.S. To implement
28 this act, the department may use this appropriation as follows:
29 (a) $84,771, which consists of $57,644 from the general fund and
30 $27,127 from the healthcare affordability and sustainability fee cash
31 fund, for use by the executive director's office for personal services,
32 which amount is based on an assumption that the department will require
33 an additional 3.0 FTE;
34 (b) $8,480, which consists of $5,766 from the general fund and
35 $2,714 from the healthcare affordability and sustainability fee cash fund,
36 for use by the executive director's office for operating expenses; and
37 (c) $88,500, which consists of $60,180 from the general fund and
38 $28,320 from the healthcare affordability and sustainability fee cash fund,
39 for use by the executive director's office for general professional services
40 and special projects.
41 (2) For the 2019-20 state fiscal year, the general assembly
42 anticipates that the department of health care policy and financing will
43 receive $181,750 in federal funds to implement this act, which amount
44 is included for informational purposes only. The appropriation in
45 subsection (1) of this section is based on the assumption that the
46 department will receive this amount of federal funds to be used as
47 follows:
48 (a) $84,771 for use by the executive director’s office for personal
49 services;
50 (b) $8,479 for use by the executive director’s office for operating
51 expenses; and
52 (c) $88,500 for use by the executive director’s office for general
53 professional services and special projects.
54 (3) For the 2019-20 state fiscal year, $88,248 is appropriated to
55 the department of regulatory agencies for use by the division of insurance.
56 This appropriation is from the division of insurance cash fund created in
1 section 10-1-103 (3), C.R.S. To implement this act, the division may use
2 this appropriation as follows:
2 (a) $82,500 for personal services, 3 which amount is based on an
4 assumption that the division will require an additional 1.1 FTE; and
5 (b) $5,748 for operating expenses.".
6
7 Renumber succeeding sections accordingly.
8
9 Page 1, line 102, strike "PRACTICES." and substitute "PRACTICES, AND,
10 IN CONNECTION THEREWITH, MAKING AN APPROPRIATION.".".
11
12
Senate Journal, April 24
After consideration on the merits, the Committee recommends that HB19-1269 be
amended as follows, and as so amended, be referred to the Committee of the Whole with
favorable recommendation and with a recommendation that it be placed on the Consent
Calendar.
Amend reengrossed bill, page 24, line 13, strike "$181,751" and
substitute "$167,000".
Page 24, line 14, strike "$123,590" and substitute "$113,560".
Page 24, line 15, strike "$58,161" and substitute "$53,440".
Page 24, line 26, strike "$88,500" and substitute "$73,749" and strike
"$60,180" and substitute "$50,150".
Page 24, line 27, strike "$28,320" and substitute "$23,599".
Page 25, line 5, strike "$181,750" and substitute "$167,001".
Page 25, line 13, strike "$88,500" and substitute "$73,751".
Appro-
priations