The Colorado Medical Society provided comments to the Division of Insurance on draft regulation related to implementation of HB 19-1211, which CMS strongly supported and was passed by the 2019 Colorado General Assembly to streamline and standardize prior authorization.
CMS carefully examined different sections in the regulation to be sure the goals of the bill are fully effectuated: that carriers shall make a determination of a non-urgent prior authorization request and notify the provider and the covered person within five business days, and shall make a determination for an urgent prior authorization request within 72 hours. Regarding drug benefit prior authorization, if the carrier denies a prior authorization request, the carrier must include whether the carrier requires an alternative treatment, test, procedure or medication.
When the specified timeframes are not met and prior authorization requests are deemed granted automatically, the DOI must define how a provider should show proof of this approval to ensure a patient’s timely access to care and the physician’s timely payment for the service. CMS recommends assigning a unique prior authorization number to the request to serve as this proof. Finally, CMS asks that the requirement that a carrier update its website includes a requirement to provide a date for amendments to help providers comply.