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Legislation Passes to Include Small Group Claims in Colorado's APCD

Colorado’s All Payer Claims Database will soon be able to collect claims from the small group (insurance for businesses with fewer than 50 employees) market, now that HB 13-1015 has passed both chambers and is on its way to the governor for signature.

The bill passed the Colorado Senate today on a unanimous vote, after passing the Colorado House with strong bipartisan support. It repeals a 40-year-old provision of state law that restricts the purposes for which mental health claims data may be shared. Originally, those restrictions applied to all types of commercial insurance. Subsequent legislation to create parity between mental health and behavioral health coverage, and conform Colorado law with federal law, eliminated this restriction for the large group and individual markets – leaving small group as the only market segment still subject to these pre-HIPAA limitations.

Because health insurers’ claims process systems don’t necessarily differentiate between physical and behavioral health claims – and it’s not always easy to say what’s “physical” and what’s “mental – the practical impact of this law was that health insurers could not submit ANY small group claims data to the APCD.

Colorado’s behavioral health provider and consumer community strongly supported our efforts to change the law. They want to eliminate false distinctions between “mental health” and “health.” The health plans also strongly supported this change.

With the passage of HB 1015, the APCD will be able to present a more complete picture of health care spending and utilization in Colorado. Once the bill passes into law, CIVHC will work with health insurers to begin submitting their small group claims data. CIVHC anticipates that the new claims will be added to the Colorado APCD by the end of the year.

CIVHC gratefully acknowledges the lobbying support of the Colorado Behavioral Health Council, Mental Health America of Colorado and the Colorado Association of Health Plans.