SB 17-151

  • Colorado Senate Bill
  • 2017 Regular Session
  • Introduced in Senate Jan 31, 2017
  • Senate
  • House
  • Governor

Consumer Access To Health Care

Abstract

The bill requires a health insurance carrier or an intermediary that conducts credentialing, utilization management, or utilization review to: Base health care coverage authorizations and medical necessity determinations on generally accepted and evidence-based standards and criteria of clinical practice; Disclose to a carrier's policyholders and providers the evidence-based standards and criteria of clinical practice and processes that the carrier uses for coverage authorizations and medical necessity determinations of health care services; Ensure that coverage authorizations and medical necessity determinations are performed by a health care provider; Categorize a condition as a new episode of care if the same provider has not treated the policyholder for the condition within the previous 30 days; and Ensure that tiered prior authorization criteria are based on generally accepted and evidence-based standards and criteria of clinical practice. The bill prohibits: An intermediary from requiring coverage authorization or a medical necessity determination prior to the evaluation and management services provided by a health care provider to a policyholder during an initial health care visit; and A carrier from creating incentives to reduce or deny coverage authorizations or medical necessity determinations.(Note: This summary applies to this bill as introduced.)

Bill Sponsors (2)

Votes


Actions


Feb 15, 2017

Colorado General Assembly

Senate Committee on Business, Labor, & Technology Postpone Indefinitely

Business, Labor, & Technology

Jan 31, 2017

Colorado General Assembly

Introduced In Senate - Assigned to Business, Labor, & Technology

  • Introduction
Business, Labor, & Technology

Bill Text

Bill Text Versions Format
Amendment L.001 PDF
Committee Amendment PDF
Introduced (01/31/2017) PDF

Related Documents

Document Format
Fiscal Note FN1 (02/13/2017) PDF
Fiscal Note FN2 (05/25/2017) PDF

Sources

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