Struck = removed from the bill ยท
added = the amendment's new text.
SecondHB1007_S_SA.001 RegularNOT SessionAMENDED Seventy-firstSENATE GeneralCOMMITTEE AssemblyOF STATEREFERENCE OFREPORT COLORADO_______________________________ REENGROSSEDMay This1, Version2018 IncludesChairman Allof AmendmentsCommittee AdoptedDate inCommittee on State, Veterans, & Military Affairs After consideration on the Housemerits, ofthe IntroductionCommittee LLSrecommends NO.the following:
18-0257.01HB18-1007 Britabe Darlingreferred x2241to HOUSEthe BILLCommittee 18-1007of HOUSEthe SPONSORSHIPWhole Kennedywith andfavorable Singer,recommendation Pettersen SENATE SPONSORSHIP Lambert and Jahn,with Aguilar,a Taterecommendation Housethat Committeesit Senatebe Committeesplaced Publicon Healththe Careconsent &calendar. Human Services A BILL FOR AN ACT C ONCERNING PAYMENT ISSUES RELATED TO SUBSTANCE USE DISORDERS .
Bill** Summary*** (Note:** *** ** *HB1007_S_SA.001*
This summary applies to this bill as introduced and does notreflectanyamendmentsthatmaybesubsequentlyadopted.Ifthisbill e n passes third reading in the house of introduction, a bill summary that m 1 applies to the reengrossed version of this bill will be available at E n 2 U U 0 http://leg.colorado.gov/.) O i i H a p R A Opioid and Other Substance Use Disorders Interim Study r Committee.
The bill requires all individual and group health benefit 3 plans to provide coverage without prior authorization for a five-day supply of buprenorphine for a first request within a 12-month period.
Additionally, all individual and group health benefit plans that i a 1 cover physical therapy, acupuncture, or chiropractic services shall not E e 2 U d 9 O 2 i Shading denotes HOUSE amendment.
Double underlining denotes SENATE amendment.
H d p Capital letters or bold & italic numbers indicate new material to be added to existing statude.
Dashes through the words indicate deletions from existing statute.
e A subject those services to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable than those applicable to primarycareservicesundertheplanifthecoveredpersonhasadiagnosis of chronic pain and has or has had a substance use disorder diagnosis.
The bill prohibits carriers from taking adverse action against a provider or from providing financial incentives or disincentives to a provider based solely on a patient satisfaction survey relating to the patient's satisfaction with pain treatment.
The bill clarifies that an "urgent prior authorization request" to a carrier includes a request for authorization of medication-assisted treatment for substance use disorders.
Thebillpermitsapharmacistwhohasenteredintoacollaborative pharmacy practice agreement with one or more physicians to administer injectable medication-assisted treatment for substance use disorders and receive an enhanced dispensing fee for the administration.
The bill prohibits carriers from requiring a covered person to undergo step therapy using a prescription drug or drugs that include an opioid before covering a non-opioid prescription drug recommended by the covered person's provider.
The bill requires the Colorado medical assistance program to authorizereimbursementforaready-to-useversionofintranasalnaloxone hydrochloride without prior authorization.
The bill prohibits the requirement that a recipient of medical assistance undergo a step-therapy protocol using a prescription drug containinganopioidpriortoauthorizingreimbursementforanon-opioid prescription drug recommended by the person's health care provider.
Thebillpermitsapharmacistwhohasenteredintoacollaborative pharmacy practice agreement with one or more physicians to administer injectable medication-assisted treatment for substance use disorders and receive an enhanced dispensing fee under the Colorado medical assistance program for the administration.
The bill requires the department of health care policy and financing and the office of behavioral health in the departmentof human services to establish rules that standardize utilization management authority timelines for the non-pharmaceutical components of medication-assisted treatment for substance use disorders.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1.
In Colorado Revised Statutes, 10-16-104, amend (5.5)(a)(III) as follows:
10-16-104.
Mandatory coverage provisions - definitions - -2- 1007 rules.
(5.5) Behavioral, mental health, and substance use disorders -rules.(a)(III)(A)XCEPTASPROVIDEDINSUBSECTION (5.5)(a)(III)(B) OF THIS SECTIO, any preauthorization or utilization review mechanism used in the determination to provide the coverage required by this paragraph (a)SUBSECTION (5.5)(a) must be the same as, or no more restrictive than, that used in the determination to provide coverage for a physical illness.
The commissioner shall adopt rules as necessary to implement and administer this subsection (5.5).
(B) A HEALTH BENEFIT PLAN SUBJECT TO THIS SUBSECTIO(5.5) MUST PROVIDE COVERAGE WITHOUT PRIOR AUTHORIZATION FOR A FIVE-DAY SUPPLY OF AT LEAST ONE OF THE FEDERAL FOOD AND DRUG ADMINISTRATION -APPROVED DRUGS FOR THE TREATMENT OF OPIOID DEPENDENCE ;
EXCEPT THAT THIS REQUIREMENT IS LIMITED TO A FIRST REQUEST WITHIN A TWELVE-MONTH PERIOD .
SECTION 2.
In Colorado Revised Statutes, 10-16-121, add (1)(e) as follows:
10-16-121.
Requiredcontractprovisionsincontractsbetween carriers and providers - definitions.
(1) A contract between a carrier and a provider or its representative concerning the delivery, provision, payment, or offering of care or services covered bya managed care plan must make provisions for the following requirements:
(e) THECONTRACTMUSTCONTAINAPROVISIONTHATSTATESTHE CARRIER SHALL NOT TAKE AN ADVERSE ACTION AGAINST A PROVIDER OR PROVIDEFINANCIALINCENTIVESORSUBJECTTHEPROVIDERTOFINANCIAL DISINCENTIVES BASED SOLELY ON A PATIENT SATISFACTION SURVEY OR OTHER METHOD OF OBTAINING PATIENT FEEDBACK RELATING TO THE PATIENT'S SATISFACTION WITH PAIN TREATMEN.
-3- 1007 SECTION3.
InColoradoRevisedStatutes,10-16-124.5,amend (8)(b) as follows:
10-16-124.5.
Prior authorization form - drug benefits - rules of commissioner - definitions.
(8) As used in this section:
(b) "Urgent prior authorization request" means:
(I) A request for prior authorization of a drug benefit that, based on the reasonable opinion of the prescribing provider with knowledge of thecoveredperson'smedicalcondition,ifdeterminedinthetimeallowed for nonurgent prior authorization requests, could:
(I) (A) Seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function;
or (II) (B) Subject the covered person to severe pain that cannot be adequately managed without the drug benefit that is the subject of the prior authorization requORt;
(II) A REQUEST FOR PRIOR AUTHORIZATION FOR MEDICATION ASSISTED TREATMENT FOR SUBSTANCE USE DISORDERS.
SECTION 4.
In Colorado Revised Statutes, add 10-16-143.5 as follows:
10-16-143.5.
Pharmacy reimbursement - substance use disorder - injections.
F A PHARMACY HAS ENTERED INTO A COLLABORATIVE PHARMACY PRACTICE AGREEMENT WITH ONE OR MORE PHYSICIANS PURSUANT TO SECTION 12-42.5-602 TO ADMINISTER INJECTABLE ANTAGONIST MEDICATION FOR MEDICATION ASSISTED TREATMENT FOR SUBSTANCE USE DISORDERS, THE PHARMACY ADMINISTERINGTHEDRUGSHALLRECEIVEANENHANCEDDISPENSINGFEE .
SECTION 5.
In Colorado Revised Statutes, 25.5-5-411, amend -4- 1007 (4)(b) as follows:
25.5-5-411.
Medicaid community mental health services - legislative declaration - administration - rules.
(4) (b) (I) The state department shall establish cost-effective, capitated rates for community mental health services in a manner that includes cost containment mechanisms.
These cost containment mechanisms may include, but are not limited to, restricting average per member per month utilization growth, restricting unit cost growth, limiting allowable administrative cost,establishingminimummedicallossratios,orestablishingothercost containment mechanisms that the state department determines appropriate.
(II) THE STATE DEPARTMENT AND THE OFFICE OF BEHAVIORAL HEALTH IN THE DEPARTMENT OF HUMAN SERVICES ,IN COLLABORATION WITHCOMMUNITYMENTALHEALTHSERVICESPROVIDERSANDSUBSTANCE USE DISORDER PROVIDERS,SHALL ESTABLISH RULES THAT STANDARDIZE UTILIZATION MANAGEMENT AUTHORITY TIMELINES FOR THE NONPHARMACEUTICAL COMPONENTS OF MEDICATION -ASSISTED TREATMENT FOR SUBSTANCE USE DISORDERS.
SECTION 6.
In Colorado Revised Statutes, add 25.5-5-509 as follows:
25.5-5-509.
Substance use disorder - prescription drugs.
N OTWITHSTANDING ANY PROVISIONS OF THIS PAR5TO THE CONTRARY , FOR THE TREATMENT OF A SUBSTANCE USE DISORDE,IN PROMULGATING RULES,AND SUBJECT TO ANY NECESSARY FEDERAL AUTHORIZATION,THE STATE BOARD SHALL AUTHORIZE REIMBURSEMENT FOR AT LEAST ONE FEDERAL FOOD AND DRUG ADMINISTRATION -APPROVED READY -TO-USE OPIOID OVERDOSE REVERSAL DRUG WITHOUT PRIOR AUTHORIZATION.
-5- 1007 SECTION 7.
In Colorado Revised Statutes, add 25.5-5-510 as follows:
25.5-5-510.
Pharmacyreimbursement-substanceusedisorder - injections.F A PHARMACY HAS ENTERED INTO A COLLABORATIVE PHARMACY PRACTICE AGREEMENT WITH ONE OR MORE PHYSICIANS PURSUANT TO SECTION 12-42.5-602 TO ADMINISTER INJECTABLE ANTAGONIST MEDICATION FOR MEDICATION -ASSISTED TREATMENT FOR SUBSTANCE USE DISORDERS,THE PHARMACY ADMINISTERING THE DRUG SHALL RECEIVE AN ENHANCED DISPENSING FEE THAT ALIGNS WITH THE ADMINISTRATION FEE PAID TO A PROVIDER IN A CLINICAL SET.ING SECTION 8.
Act subject to petition - effective date.
This act takes effect January1, 2019;
except that, if a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within the ninety-day period after final adjournment of the general assembly, then the act, item, section, or part will not take effect unless approved by the people at the generalelectiontobeheldinNovember2018 and, in such case,willtake effect on January1, 2019, or on the date of the official declaration of the vote thereon by the governor, whichever is later.
-6- 1007