CO HB1326

Requires health insurance carriers and intermediaries to base coverage authorizations and medical necessity determinations for physical rehabilitation services on generally accepted, evidence-based clinical standards and criteria, which must be disclosed to providers and policyholders.

Mandates that coverage authorizations and medical necessity determinations be made by a licensed provider in the same health field as the requesting provider and in good standing.

Prohibits different or tiered authorization standards for providers of the same licensed profession in the same network and eliminates prior authorization requirements for initial evaluation and management visits.

Requires categorization of care for recurring conditions as a new episode if the same provider has not treated the patient within the previous 30 days and mandates communication between the treating provider and prescribing provider about services actually provided.

Prohibits carriers from compensating intermediaries based on their coverage determinations and establishes violations as unfair or deceptive trade practices; effective January 1, 2018, subject to referendum petition.