Bill Sponsor
Colorado House Bill 1149
Session 2024A
Prior Authorization Requirements Alternatives
Active
Active
Passed Senate on Apr 25, 2024
Sponsors
Democrat
Shannon Bird
Republican
Lisa Frizell
Democrat
Dylan Roberts
Republican
Barbara Kirkmeyer
First Action
Jan 30, 2024
Latest Action
May 16, 2024
Origin Chamber
House
Type
Bill
Bill Number
1149
State
Colorado
Session
2024A
Sponsorship by Party
Republican
Primary
Democrat
Primary
Republican
Primary
Democrat
Primary
Summary
With regard to prior authorization requirements imposed by carriers, private utilization review organizations (organizations), and pharmacy benefit managers (PBMs) for certain health-care services and prescription drug benefits covered under a health benefit plan, the bill requires carriers, organizations, and PBMs, as applicable, to adopt a program, in consultation with participating providers, to eliminate or substantially modify prior authorization requirements in a manner that removes administrative burdens on qualified providers and their patients with regard to certain health-care services, prescription drugs, or related benefits based on specified criteria. Additionally, a carrier or organization is prohibited from denying a claim for a health-care procedure a provider provides, in addition or related to an approved surgical procedure, under specified circumstances or from denying an initially approved surgical procedure on the basis that the provider provided an additional or a related health-care procedure. Starting January 1, 2027, if a provider submits a prior authorization request through an electronic interface or secure electronic transmission system used by the carrier, organization, or PBM, as applicable, the carrier, organization, or PBM to which the request was submitted is required to accept and respond to the request through its interface or electronic transmission system. A carrier or PBM is prohibited from imposing prior authorization requirements more than once every 3 years for an FDA-approved chronic maintenance drug that the carrier or PBM has previously approved for a person covered under the carrier's or PBM's health benefit plan, except under specified conditions. The bill extends the duration of an approved prior authorization for a health-care service or prescription drug benefit from 180 days to a calendar year. Carriers are required to post, on their public-facing websites, specified information regarding: The number of prior authorization requests that are approved, denied, and appealed; The number of prior authorization exemptions or alternatives to prior authorization requirements provided pursuant to a program developed and offered by the carrier, an organization, or a PBM; and The prior authorization requirements as applied to prescription drug formularies for each health benefit plan the carrier or PBM offers. The bill appropriates $36,514 from the division of insurance cash fund to the department of regulatory agencies for use by the division of insurance to implement the bill. The bill applies to conduct occurring on or after January 1, 2026. (Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.) (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)
Actions (15)
05/16/2024
Office of the Governor
Sent to the Governor
05/16/2024
Senate
Signed by the President of the Senate
05/16/2024
House
Signed by the Speaker of the House
04/25/2024
Senate
Senate Third Reading Passed - No Amendments
04/24/2024
Senate
Senate Second Reading Passed - No Amendments
04/23/2024
Senate
Senate Second Reading Laid Over to 04/24/2024 - No Amendments
04/19/2024
Senate
Senate Committee on Appropriations Refer Unamended to Senate Committee of the Whole
04/03/2024
Senate
Senate Committee on Health & Human Services Refer Unamended to Appropriations
03/12/2024
Senate
Introduced In Senate - Assigned to Health & Human Services
03/11/2024
House
House Third Reading Passed - No Amendments
03/08/2024
House
House Second Reading Special Order - Passed with Amendments - Committee, Floor
03/05/2024
House
House Second Reading Laid Over Daily - No Amendments
03/01/2024
House
House Committee on Appropriations Refer Amended to House Committee of the Whole
02/21/2024
House
House Committee on Health & Human Services Refer Amended to Appropriations
01/30/2024
House
Introduced In House - Assigned to Health & Human Services
Sources
Record Created
Jan 31, 2024 12:53:03 AM
Record Updated
May 17, 2024 6:38:06 AM