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ColoradoHB25-10022025 Regular SessionHouseWALLET

Medical Necessity Determination Insurance Coverage

Sponsored By: Byron Pelton (Republican), Judy Amabile (Democratic), Kyle Brown (Democratic), Lindsay Gilchrist (Democratic)

Signed by Governor

Health Care & Health Insurance

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 3 benefits, 0 costs, 0 mixed.

Stronger safeguards for mental health approvals

Covered plans must pay for medically necessary behavioral health, mental health, and substance use treatment under accepted care standards. Care must fit the patient's needs in type, frequency, location, extent, and duration—not mainly cost or convenience. Reviews must use current, relevant guidelines from independent national nonprofit clinical specialty groups. Substance use reviews must follow the latest American Society of Addiction Medicine criteria. The insurance commissioner can approve another national nonprofit standard only when those criteria are unavailable, outdated, or inconsistent with best practices. Plans cannot add stricter or conflicting review criteria and must approve the care level supported by the assessment. When denying care or disagreeing with an assessment, plans must share full assessment details and the criteria used. Reviews outside the guidelines' scope must meet accepted standards; purchased criteria require verification and documentation before use. These rules also cover review contractors. Plans cannot reverse medical-necessity decisions through later reviews, audits, or claim-code changes, except for fraud or an invalid policy on the service date.

In-network costs when outside care is needed

Covered plans must arrange medically necessary outside-network care when covered services are unavailable within required travel and reasonable waiting limits. The outside provider must be accessible and qualified to deliver age-appropriate treatment. Patients pay no more than the in-network share, including deductibles, copayments, and coinsurance. Those payments count toward the plan's in-network yearly cost-sharing limits.

Stronger mental health coverage for Coloradans

Covered Colorado plans must cover behavioral health, mental health, and substance use care as fully as physical health care. Federal parity rules apply to patient costs, treatment limits, and network access practices. Plans cannot discriminate based on current or predicted disorders or limit chronic care to short-term symptom relief. Covering a mental health or substance use condition in one benefit group requires meaningful coverage across all medical/surgical benefit groups. This includes core treatments where they exist and the plan covers core medical/surgical treatments. Insurers cannot weaken these protections through policy terms, provider contracts, or operating practices. These rules cover Article 16, parts 2–4 plans, except those excluded by C.R.S. 10-16-102(32)(b), without expanding the state's essential health benefits benchmark. The law sets January 1, 2026, as its start date unless a valid referendum petition is filed within 90 days after final legislative adjournment. Such a petition delays the law until voters approve it in November 2026 and the governor declares the result.

Sponsors & Cosponsors

Sponsors

  • Byron Pelton

    Republican • Senate

  • Judy Amabile

    Democratic • Senate

  • Kyle Brown

    Democratic • House

  • Lindsay Gilchrist

    Democratic • House

Cosponsors

  • Andrew Boesenecker

    Democratic • House

  • Amy Paschal

    Democratic • House

  • Alex Valdez

    Democratic • House

  • Bob Marshall

    Democratic • House

  • Brianna Titone

    Democratic • House

  • Chad Clifford

    Democratic • House

  • Eliza Hamrick

    Democratic • House

  • Emily Sirota

    Democratic • House

  • Gretchen Rydin

    Democratic • House

  • Jennifer Bacon

    Democratic • House

  • Jamie Jackson

    Democratic • House

  • Junie Joseph

    Democratic • House

  • Javier Mabrey

    Democratic • House

  • Julie McCluskie

    Democratic • House

  • Katie Stewart

    Democratic • House

  • Lorena Garcia

    Democratic • House

  • Lesley Smith

    Democratic • House

  • Monica Duran

    Democratic • House

  • Meg Froelich

    Democratic • House

  • Mandy Lindsay

    Democratic • House

  • Meghan Lukens

    Democratic • House

  • Manny Rutinel

    Democratic • House

  • Naquetta Ricks

    Democratic • House

  • Regina English

    Democratic • House

  • Rebekah Stewart

    Democratic • House

  • Rick Taggart

    Republican • House

  • Rep. S. Bird

    Affiliation unavailable

  • Sean Camacho

    Democratic • House

  • Sheila Lieder

    Democratic • House

  • Steven Woodrow

    Democratic • House

  • Tammy Story

    Democratic • House

  • Cathy Kipp

    Democratic • Senate

  • Chris Kolker

    Democratic • Senate

  • Dafna Michaelson Jenet

    Democratic • Senate

  • Sen. F. Winter

    Affiliation unavailable

  • Iman Jodeh

    Democratic • Senate

  • Jeff Bridges

    Democratic • Senate

  • James Coleman

    Democratic • Senate

  • Julie Gonzales

    Democratic • Senate

  • Janice Marchman

    Democratic • Senate

  • Kyle Mullica

    Democratic • Senate

  • Lisa Cutter

    Democratic • Senate

  • Lindsey Daugherty

    Democratic • Senate

  • Matt Ball

    Democratic • Senate

  • Marc Snyder

    Democratic • Senate

  • Mike Weissman

    Democratic • Senate

  • Nick Hinrichsen

    Democratic • Senate

  • Tony Exum

    Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 209 • No: 29

House vote • 2/28/2025

Senate amendments: Repass

Yes: 50 • No: 10

House vote • 2/28/2025

Senate amendments: Concur

Yes: 51 • No: 9

Senate vote • 2/26/2025

Third reading: Bill

Yes: 32 • No: 1

Senate vote • 2/20/2025

Refer House Bill 25-1002, as amended, to the Committee of the Whole and with a recommendation that it be placed on the consent calendar.

Yes: 9 • No: 0

House vote • 2/10/2025

Third reading: Bill

Yes: 54 • No: 9

House vote • 1/29/2025

Refer House Bill 25-1002, as amended, to the Committee of the Whole.

Yes: 13 • No: 0

Actions Timeline

  1. Governor Signed

    3/20/2025House

  2. Signed by the President of the Senate

    3/13/2025Senate

  3. Sent to the Governor

    3/13/2025House

  4. Signed by the Speaker of the House

    3/12/2025House

  5. House Considered Senate Amendments - Result was to Concur - Repass

    2/28/2025House

  6. House Considered Senate Amendments - Result was to Laid Over Daily

    2/27/2025House

  7. Senate Third Reading Passed - No Amendments

    2/26/2025Senate

  8. Senate Second Reading Passed with Amendments - Committee

    2/25/2025Senate

  9. Senate Committee on Health & Human Services Refer Amended - Consent Calendar to Senate Committee of the Whole

    2/20/2025Senate

  10. Introduced In Senate - Assigned to Health & Human Services

    2/12/2025Senate

  11. House Third Reading Passed - No Amendments

    2/10/2025House

  12. House Second Reading Special Order - Passed with Amendments - Committee, Floor

    2/7/2025House

  13. House Second Reading Laid Over Daily - No Amendments

    1/31/2025House

  14. House Committee on Health & Human Services Refer Amended to House Committee of the Whole

    1/29/2025House

  15. Introduced In House - Assigned to Health & Human Services

    1/8/2025House

Bill Text

  • Engrossed

    PDF

  • Final Act

    PDF

  • House Health & Human Services Preamend

    PDF

  • Introduced

    PDF

  • Reengrossed

    PDF

  • Rerevised

    PDF

  • Revised

    PDF

  • Senate Health & Human Services Preamend

    PDF

  • Signed Act

    PDF

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