Annual Mental Health Wellness Examination — Coverage Criteria
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Requires Colorado health plans to cover an annual mental health wellness examination (up to 60 minutes) by a qualified mental health care provider as a preventive benefit, with no cost-sharing and parity with physical exams under MHPAEA.
Coverage must include an annual mental health wellness examination of up to sixty minutes performed by a qualified mental health care provider.
The coverage must be comparable to coverage of a physical examination, comply with federal mental health parity laws, and not require deductibles, copayments, or coinsurance for the exam.
Requires coverage to include an annual mental health wellness examination of up to sixty minutes performed by a qualified mental health care provider.
Coverage for the annual mental health wellness examination must be no less extensive than coverage provided for a physical examination and must comply with MHPAEA requirements.
"Mental health wellness examination" is defined to include behavioral health screening, education, and consultation on healthy lifestyle.
Defines 'mental health wellness examination' to include behavioral health screening, education and consultation on healthy lifestyle changes, referrals to ongoing treatment and supports, and discussion of medication options.
Specifies the exam is sixty minutes performed by a 'qualified mental health care provider'.
Coverage Criteria — Annual Mental Health Wellness Examination
Mandatory preventive coverage — Annual Mental Health Wellness Examination
Covered when ALL of the following are met
Derived from subsections (18) and (b.7) in the bill excerpts
Annual Mental Health Wellness Examination (Preventive)
Covered when ALL of the following are met
Performed annually by a qualified mental health care provider; parity requirement applies
Annual Mental Health Wellness Examination (preventive)
Covered when ALL of the following are met:
Coverage must be no less extensive than coverage provided for a physical examination and must comply with MHPAEA.
Annual Mental Health Wellness Examination (Initial/Preventive)
Covered when ALL of the following are met
Exact statutory definition of 'qualified mental health care provider' and additional sub-conditions appear elsewhere in the statute.
Annual Mental Health Wellness Examination (initial/coverage)
Covered when ALL of the following are met:
Derived from repeated statutory language in this excerpt; exact scope and service components partially unspecified.
Annual Mental Health Wellness Examination (Initial/Preventive)
Covered when ALL of the following are met:
Chunk support: 90,99
Chunk support: 90,107
Chunk support: 90,93
Annual Mental Health Wellness Examination (Covered when meeting definition)
Covered when the service meets the defined scope and provider requirement
Coverage must be no less extensive than coverage for a physical examination and must comply with the MHPAEA.
Annual Mental Health Wellness Examination
Covered when ALL of the following are met:
Coverage must be no less extensive than coverage for a physical examination and must comply with MHPAEA.
Annual Mental Health Wellness Examination — Covered with criteria
Covered when ALL of the following are met:
Coverage requirement / Parity
Covered when the following condition is met:
Must comply with MHPAEA requirements
The provided excerpts do not identify any explicit coverage exclusions for the annual mental health wellness examination. The bill language focuses on establishing mandatory preventive coverage—an annual exam up to 60 minutes performed by a qualified mental health care provider—and on parity and cost-sharing (no deductibles, copayments, or coinsurance). No separate list of excluded diagnoses, settings, patient populations, or services is present in the cited material.
This excerpt requires coverage of an annual mental health wellness examination up to 60 minutes by a qualified provider but does not specify any explicit exclusions. The statutory text in these chunks sets coverage obligations and effective-date mechanics rather than listing services or circumstances that would be excluded from coverage.
The material reiterates that the coverage must include an annual mental health wellness examination and that coverage must be no less extensive than for a physical examination, but it contains no explicit exclusions. The excerpt centers on required coverage scope and parity with medical preventive services.
These chunks emphasize parity with physical examinations and compliance with MHPAEA for the annual mental health wellness examination and do not present any explicit exclusions. The focus is on the minimum extent of coverage and statutory compliance rather than exceptions.
This section defines the requirement for the annual mental health wellness examination and its components but does not enumerate exclusions. The language establishes required elements of the examination and parity obligations but contains no exclusion list in the provided excerpt.
The excerpt supplies the definition elements for the mental health wellness examination (for example, behavioral health screening and education) and reiterates parity obligations; it does not identify any explicit exclusions to coverage for the annual exam.
This chunk restates the exam definition and parity requirement and specifies included services (screening, education, consultation). No explicit exclusions or conditions rendering the exam ineligible for coverage appear in this excerpt.
The statutory language here describes the exam components (screening, referrals, discussion of options) and the requirement that coverage be at least equivalent to a physical exam; it does not list exclusions for the annual mental health wellness examination in the provided text.
These chunks further describe exam content (behavioral health screening, referrals, medication discussion) and reiterate parity and MHPAEA compliance, but they do not present explicit exclusions to coverage for the annual mental health wellness examination.
This excerpt reiterates that coverage must comply with MHPAEA and be no less extensive than coverage for a physical examination. It contains no explicit exclusions; the text establishes minimum coverage standards and parity rather than carve-outs.
The provided section enumerates categories of licensed behavioral health providers who may qualify as a qualified mental health care provider (for example, clinical social workers, marriage and family therapists, professional counselors) but does not state any coverage exclusions. The excerpt is limited to listing eligible provider categories and does not identify disallowed services or populations.
This excerpt lists additional licensed provider types (including addiction counselors) that qualify as performers of the exam; it does not include explicit coverage exclusions. The focus remains on eligible provider categories and licensure references.
The statute names advanced practice nurses with psychiatric training among qualified providers and specifies the act's effective-date mechanism, but it does not provide explicit exclusions to coverage for the annual mental health wellness examination in the excerpted language.
The text explains the act's effective date (the day following the ninety-day period after final adjournment) and notes an exception if a referendum petition is filed. This referendum provision may alter the timing or applicability of the statute but does not create substantive coverage exclusions for the annual mental health wellness examination in the provided excerpts.
Across the provided excerpts there are no statements designating the annual mental health wellness examination as "not medically necessary" under any conditions. The statutory fragments establish a mandatory preventive benefit and list required content, provider types, duration, and parity requirements, but they do not articulate circumstances that would render the exam noncovered for medical necessity reasons in these excerpts.
Coding — Procedure Codes, Duration, and Frequency
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Provider Actions — Authorization, Documentation, Denial Risk
Prior authorization not specified
The statute requires coverage of an annual mental health wellness examination but the provided text does not specify any prior authorization requirement for that benefit.
No prior authorization described in statute excerpts
The bill mandates coverage of the annual mental health wellness examination but the excerpts do not describe any prior authorization process or rule for this service.
No prior authorization requirement stated
Prior authorization requirements are not present in the provided excerpt; coverage is described as mandatory without describing an authorization workflow.
Prior authorization not specified
The text requires coverage of the annual mental health wellness examination but does not specify any prior authorization condition for the exam in these excerpts.
Prior authorization absent in excerpt
No prior authorization requirement for the annual mental health wellness examination is stated in the provided text.
No prior auth procedures specified
Although the statute requires coverage without cost-sharing, the excerpts do not define any prior authorization procedures for the annual exam.
Prior authorization not stated
The section requires coverage of the annual mental health wellness examination but does not state any prior authorization requirement in this text.
No prior authorization in excerpt
The excerpt does not include language imposing prior authorization for the annual mental health wellness examination.
No prior authorization described; parity noted
The coverage must be no less extensive than a physical exam and comply with MHPAEA; the excerpt does not include prior authorization rules that would limit access.
Prior authorization not specified
The provided bill language mandates coverage but does not specify prior authorization requirements for the annual mental health wellness examination.
No prior authorization present
The excerpt lacks any prior authorization provisions for the annual mental health wellness examination.
Qualified provider types listed; no prior auth
The statute enumerates licensed provider types (e.g., clinical social worker; marriage and family therapist; professional counselor; addiction counselor; advanced practice nurse) as qualifying performers of the exam, and does not state prior authorization language in this portion.
- Clinical social worker (Part 4, Article 245, Title 12)
- Marriage and family therapist (Part 5, Article 245, Title 12)
- Professional counselor (Part 6, Article 245, Title 12)
- Addiction counselor (Part 8, Article 245, Title 12)
- Advanced practice nurse with psychiatric training (12-255-104(1))
Prior authorization not described
No prior authorization process or requirement is described in these excerpts; coverage and provider categories are listed without an authorization workflow.
No prior authorization requirements specified
The provided text sets coverage and qualifying provider categories but includes no prior authorization rules for the annual exam.
Prior authorization — none specified
No prior authorization requirement is specified in the excerpt; it only sets effective date mechanics and applicable license categories.
- Act effective 90 days after adjournment (example date provided)
No step therapy or prerequisites specified
The statute does not include any step therapy, prerequisite treatment, or sequencing requirements for the annual mental health wellness examination in the provided text.
Step therapy not specified
No step therapy requirements are described for the annual mental health wellness examination in the provided excerpts.
No step therapy rules present
The excerpts do not impose any step therapy or sequencing rules for access to the annual mental health wellness examination.
No step therapy referenced
No step therapy or prerequisite treatment requirements are specified in these statutory excerpts for the preventive annual exam.
Step therapy not required
The law requires coverage of an annual exam but includes no step-therapy or sequencing requirements in the provided text.
No step therapy rules included
No step therapy or sequencing rules are described for this annual preventive mental health benefit in these excerpts.
Step therapy absent
These excerpts contain no step therapy requirements for the annual mental health wellness examination.
No step therapy specified
No step therapy or prerequisite treatment is specified for coverage of the annual mental health wellness examination in the provided text.
No step therapy or sequencing rules
No step therapy or sequencing rules are specified in the statutory text for this preventive exam.
Step therapy not present
No step therapy requirements are present in the provided excerpt for the annual mental health wellness examination.
Document visit identity, duration, and provider
The visit must be documented as the annual mental health wellness examination, including noting that it was up to sixty minutes and the qualified provider who performed it.
- Identify the visit as the annual mental health wellness examination
- Record the duration (up to 60 minutes)
- Document the qualified mental health care provider who performed the exam
Required documentation: annual exam, duration, provider, parity
Providers must document that an annual mental health wellness examination up to sixty minutes was performed by a qualified mental health care provider and include sufficient content to show the exam is comparable to a physical exam.
- Document that the exam was annual and up to 60 minutes
- Document the qualified provider who performed the exam
- Include clinical content demonstrating parity with a physical exam
Document that exam was performed by a qualified provider
Clinical notes should support that the annual mental health wellness examination (up to 60 minutes) was performed by a qualified mental health care provider.
- Note that the service was the annual MH wellness exam
- Record exam duration (up to 60 minutes)
- Identify the qualified mental health care provider
Document provider qualification, duration, and exam components
Documentation must support that the service was performed by a qualified mental health care provider, was up to sixty minutes, and that coverage parity requirements (MHPAEA) are met.
- Evidence of provider qualification (licensure/type)
- Documentation of exam length (≤ 60 minutes)
- Clinical content reflecting exam components (screening, education, referrals) to support parity
No specific billing or admin documentation specified
This section requires coverage but does not detail billing codes, forms, or administrative documentation procedures in the provided excerpts.
Document exam elements (screening, education, consultation)
Documentation should demonstrate the service was an annual mental health wellness examination up to sixty minutes and include elements such as behavioral health screening, education, and consultation on healthy lifestyle.
- Behavioral health screening documented
- Education/consultation on healthy lifestyle documented
- Notation that exam was annual and up to 60 minutes
Document exam scope, duration, and defined elements
The exam must be documented as performed by a qualified mental health care provider, recorded as an annual mental health wellness examination up to sixty minutes, and include the defined elements.
- State that the exam was an annual MH wellness exam
- Record duration (up to 60 minutes)
- Document included elements per definition (screening, referrals, discussion of options)
Document exam components: screening, referrals, treatment discussion
Clinical notes should support behavioral health screening, education/consultation, referrals to treatment/supports, and discussion of potential options (including medication) performed within the annual exam.
- Behavioral health screening results
- Education/consultation provided
- Referrals made (if any)
- Discussion of treatment or medication options
Document duration (~60 min), provider, and clinical content
Documentation should reflect an approximately sixty-minute mental health wellness examination performed by a qualified provider and include screening, education/consultation, referrals, and discussion of medication options as applicable.
- Approximate duration (≈60 minutes)
- Qualified provider identity
- Clinical elements performed and documented
Document parity: show mental/physical exam equivalence
Coverage must be no less extensive than for a physical examination and comply with MHPAEA; documentation should therefore support parity between mental health and physical preventive services.
- Clinical notes demonstrating service equivalence to a physical exam
- Records sufficient to evidence parity compliance
No additional documentation or administrative requirements specified
No specific documentation forms, administrative requirements, or payer authorization steps are included in these excerpts; only licensure categories and effective date language are provided.
Document APN psychiatric training / cite 12-255-104(1)
Statutory reference 12-255-104(1) is cited regarding the definition of an advanced practice nurse with specific training in psychiatric nursing; document the APN licensure/training when applicable.
- If performer is an APN with psychiatric training, note licensure per 12-255-104(1)
Definitions and Qualified Providers
Treatment Modalities / Components of the Exam
Preventive mental health wellness examination
Intended as analogous to an annual physical exam and subject to MHPAEA parity.
Preventive mental health wellness exam
Must comply with MHPAEA.
Behavioral health services
Full list present in statute: screening, education/consultation, referrals, discussion of options.
Preventive/Wellness examination
Statutory examples of exam components
Preventive mental health visit
Visit up to 60 minutes and performed by a qualified mental health care provider.
Mental health wellness exam components
These services define the content of the mental health wellness examination.
Annual mental health wellness examination
Defines the annual mental health wellness examination content.
Mental health wellness examination components
These services define the content of the mental health wellness examination.
Visit Limits — Frequency and Duration
Background
The bill frames the annual mental health wellness examination as a preventive service intended to support early identification and intervention for mental health issues, noting population‑level benefits (including youth and aging adults) and the role of integrating mental health into primary care. As preventive care, the exam is positioned to reduce progression to crisis (for example, suicide and overdose risk) and to expand access to early supports and treatment.
Revision History / Policy Changes
Statutory requirement: policies delivered, issued, renewed, or reinstated on or after Jan 1, 2010 must cover the total cost of specified preventive services, including the annual mental health wellness examination.
Added mandatory coverage for an annual mental health wellness examination of up to sixty minutes performed by a qualified mental health care provider.
Operationalized the benefit to require the examination be up to 60 minutes in duration and performed by a 'qualified mental health care provider'.
Established parity and parity compliance: coverage for the annual mental health wellness examination must be no less extensive than coverage for a physical examination and must comply with the Mental Health Parity and Addiction Equity Act (MHPAEA).
Defined the 'mental health wellness examination' to include behavioral health screening; education and consultation on healthy lifestyle changes; referrals to ongoing treatment and supports; and discussion of potential medication options.
Document summary notes an effective applicability for policies on or after January 1, 2010; the policy's metadata lists an effective date of 2022-01-01 for this document review context.
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