CO| Colorado Division of Insurance Regulation 4-2-101 establishes comprehensive prior authorization reporting and attestation requirements for health benefit plan carriers operating in Colorado, effective January 1, 2026. The regulation mandates annual standardized public disclosures related to prior authorization requests, exemptions, and prescription drug formulary requirements, along with a formal annual attestation of compliance. Carriers are required to submit detailed data reports, make the information accessible on their websites, and affirm ongoing efforts to eliminate or reduce unnecessary prior authorization barriers.
Key Points:
- Carriers must publicly report detailed statistics on prior authorization requests, approvals, denials, appeals, and exemptions annually, segmented by type of service and provider specialty, using standardized formats.
- Separate annual reporting and website disclosure are required for prior authorization exemptions and the exact requirements for each prescription drug formulary, with clear categorization and transparency for providers and consumers.
- Carriers must submit an annual attestation to the Commissioner of Insurance, certifying compliance with statutory requirements for prior authorization reductions and chronic health maintenance drug provisions, with strict signature and documentation guidelines for submission.
Click here to see CO Regulation 4-2-101