SB 17-151

Senate Bill 17-151, known as "Consumer Access To Health Care," aims to improve health insurance coverage in Colorado by setting clear standards for how insurance companies make decisions about covering medical treatments. The bill requires these companies to base their decisions on evidence-based criteria and to be transparent about the processes they use. It also ensures that healthcare providers can evaluate patients without needing prior authorization from insurers during initial visits, preventing delays in care. This bill has been signed into law, meaning its provisions are now enforceable and will affect health insurance carriers and policyholders in Colorado.

Official Summary

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.)

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