SB 22-156

Senate Bill 22-156, which has been signed into law in Colorado, stops prepaid inpatient health plans from requiring prior approval for outpatient psychotherapy services and prevents them from taking back payments they've already made to healthcare providers under certain conditions. Specifically, these plans can't reclaim money paid out if a patient was initially eligible or if the plan itself made an error processing the claim. Additionally, they are not allowed to take back any payments more than 12 months after payment unless there's a specific exception. If a provider owes over $1,000 and requests it, the health plan must work out a payment plan with them. This bill affects healthcare providers and patients receiving Medicaid services in Colorado.

Official Summary

The act prohibits a prepaid inpatient health plan from: Requiring prior authorization for outpatient psychotherapy services; Retroactively recovering provider payments if a recipient was initially determined to be eligible for medical benefits or the prepaid inpatient health plan makes an error processing the claim but the claim is otherwise accurately submitted by the provider; and Retroactively recovering provider payments after 12 months from the date a claim was paid, except in certain circumstances. If a prepaid inpatient health plan retroactively recovers a provider payment that is equal to or greater than $1,000, the act requires the prepaid inpatient health plan to work with the provider to develop a payment plan if the provider requests a payment plan. (Note: This summary applies to this bill as enacted.)

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