CO| The NEW Regulation 4-2-101, effective March 30, 2025, outlines new reporting requirements for health insurance carriers in Colorado regarding prior authorization processes. It mandates carriers to disclose information about prior authorization requests, exemptions, and prescription drug formulary requirements on their public-facing websites. The regulation aims to enhance transparency and standardize reporting across the industry.
Key points include:
- Carriers must report detailed data on prior authorization requests, including approval rates, denial reasons, and appeal outcomes, using standardized templates by April 1, 2027, and annually thereafter.
- The regulation requires carriers to provide information on exemptions from prior authorization requirements based on provider performance or specialty.
- Prescription drug formulary prior authorization requirements must be disclosed for each health benefit plan offered by the carrier.
- Non-compliance with the regulation may result in sanctions, including civil penalties, cease and desist orders, or license suspensions/revocations.