CO SB156

Prepaid inpatient health plans shall not require prior authorization for outpatient psychotherapy services as defined in the Current Procedural Terminology published by the American Medical Association.

Prepaid inpatient health plans cannot retroactively recover provider payments if the recipient was initially determined eligible for medical benefits with an eligibility guarantee number or if the plan made a processing error on an otherwise accurately submitted claim.

Prepaid inpatient health plans cannot retroactively recover provider payments after twelve months from the date a claim was paid, except in cases involving primary payers (Medicare, commercial insurance, third-party liability), state or federal audits, law enforcement investigations, duplicate claims, fraudulent claims, improper billing, or inaccurate billing or diagnosis codes.

When a prepaid inpatient health plan retroactively recovers a provider payment of $1,000 or more, the plan must work with the provider to develop a payment plan if requested.

The act takes effect January 1, 2023, subject to referendum petition procedures outlined in the state constitution.