Amendments for HB19-1211
House Journal, March 28
49 HB19-1211 be amended as follows, and as so amended, be referred to
50 the Committee of the Whole with favorable
51 recommendation:
52
53 Amend printed bill, page 3, line 14, strike "INCLUDING" and substitute
54 "EXCLUDING".
55
1 Page 3, line 15, strike "BENEFITS." and substitute "BENEFITS PURSUANT TO
2 SECTION 10-16-124.5.".
3
4 Page 3, line 16, strike "TO A" and substitute "TO:
5 (I) A".
6
7 Page 3, line 19, strike "GROUP." and substitute "GROUP;
8 (II) A NONPROFIT HEALTH MAINTENANCE ORGANIZATION
9 OPERATED BY OR UNDER THE CONTROL OF THE DENVER HEALTH AND
10 HOSPITAL AUTHORITY CREATED BY ARTICLE 29 OF TITLE 25 OR ANY
11 SUBSIDIARY OF THE AUTHORITY; OR
12 (III) CARRIERS, ORGANIZATIONS, AND MEDICAL BENEFITS SUBJECT
13 TO THE "WORKERS' COMPENSATION ACT OF COLORADO", ARTICLES 40 TO
14 47 OF TITLE 8.".
15
16 Page 4, after line 5 insert:
17 "(III) WHEN POSTING PRIOR AUTHORIZATION REQUIREMENTS AND
18 RESTRICTIONS PURSUANT TO THIS SUBSECTION (2)(a) OR SUBSECTION
19 (2)(b) OF THIS SECTION, A CARRIER IS NEITHER REQUIRED TO POST NOR
20 PROHIBITED FROM POSTING THE PRIOR AUTHORIZATION REQUIREMENTS
21 AND RESTRICTIONS ON A PUBLIC-FACING PORTION OF ITS WEBSITE.".
22
23 Page 4, line 12, strike "25-37-104 (1);" and substitute "25-37-102 (9)(c)
24 OR 25-37-104 (1), AS APPLICABLE;".
25
26 Page 4, line 18, strike "POST ON ITS WEBSITE" and substitute "POST, ON A
27 PUBLIC-FACING PORTION OF ITS WEBSITE,".
28
29 Page 4, line 19, strike "REQUESTS" and substitute "REQUESTS, INCLUDING
30 REQUESTS FOR DRUG BENEFITS PURSUANT TO SECTION 10-16-124.5,".
31
32 Page 4, strike line 21 and substitute "CATEGORIES, IN THE AGGREGATE:".
33
34 Page 4, line 25, after "DENIALS" insert "SPECIFIED UNDER SUBSECTION
35 (2)(c)(I)(C) OF THIS SECTION THAT ARE".
36
37 Page 5, line 7, strike "Nonurgent, urgent, and emergency" and
38 substitute "Nonurgent and urgent".
39
40 Page 5, line 12, strike "TWO" and substitute "FIVE".
41
42 Page 5, line 18, strike "TWO" and substitute "FIVE".
43
44 Page 5, line 21, after "DENIED;" add "AND".
45
46 Page 5, lines 24 and 25, strike "ONE CALENDAR DAY" and substitute "TWO
47 BUSINESS DAYS BUT NOT LONGER THAN SEVENTY-TWO HOURS".
48
49 Page 6, lines 3 and 4, strike "ONE CALENDAR DAY" and substitute "TWO
50 BUSINESS DAYS BUT NOT LONGER THAN SEVENTY-TWO HOURS".
51
52 Page 6, strike lines 7 through 14 and substitute "DENIED.".
53
54 Page 7, strike lines 2 through 5.
55
1 Reletter succeeding paragraphs accordingly.
2
3 Page 7, strike lines 12 and 13 and substitute "AUTHORIZATION REQUEST
4 BASED ON A GROUND SPECIFIED IN SECTION 10-16-113 (3)(a), THE
113 5 NOTIFICATION IS SUBJECT TO THE REQUIREMENTS OF SECTION 10-16-
6 (3)(a) AND COMMISSIONER".
7
8 Page 7, line 14, strike "ALSO" and substitute "MUST".
9
10 Page 7, line 20, strike "(3)(d)(II)" and substitute "(3)(c)(II)".
11
12 Page 8, line 7, strike "LIMIT" and substitute "CONSIDER LIMITING".
13
14 Page 8, line 10, strike "FACTORS." and substitute "FACTORS AND PRESENT
15 OPPORTUNITIES FOR IMPROVEMENT IN ADHERENCE TO THE CARRIER'S OR
16 ORGANIZATION'S PRIOR AUTHORIZATION REQUIREMENTS.".
17
18 Page 8, line 11, strike "SHALL EXEMPT" and substitute "MAY OFFER
19 PROVIDERS WITH A HISTORY OF ADHERENCE TO THE CARRIER'S OR
20 ORGANIZATION'S PRIOR AUTHORIZATION REQUIREMENTS AT LEAST ONE
21 ALTERNATIVE TO PRIOR AUTHORIZATION, INCLUDING AN EXEMPTION".
22
23 Page 8, line 12, after "REQUIREMENTS" insert "FOR".
24
25 Page 8, line 17, after "FROM" insert "OR OTHER ALTERNATIVE TO".
26
27 Page 8, strike lines 24 through 26.
28
29 Page 9, line 3, strike "PRESCRIBED OR ORDERED" and substitute
30 "AUTHORIZED".
31
32 Page 9, line 8, strike "STATUS OF" and substitute "COVERAGE OF OR
33 APPROVAL CRITERIA FOR".
34
35 Page 9, strike lines 9 and 10 and substitute "HEALTH CARE SERVICE, THE
36 CHANGE IN COVERAGE OR APPROVAL CRITERIA DOES NOT AFFECT A
37 COVERED PERSON".
38
39 Page 9, after line 12 insert:
40 "(c) SUBSECTIONS (5)(a) AND (5)(b) OF THIS SECTION DO NOT
41 APPLY IF:
42 (I) THE PRIOR AUTHORIZATION APPROVAL WAS BASED ON FRAUD;
43 (II) THE PROVIDER NEVER PERFORMED THE SERVICES THAT WERE
44 REQUESTED FOR PRIOR AUTHORIZATION;
45 (III) THE SERVICE PROVIDED DID NOT ALIGN WITH THE SERVICE
46 THAT WAS AUTHORIZED;
47 (IV) THE PERSON RECEIVING THE SERVICE NO LONGER HAD
48 COVERAGE UNDER THE HEALTH COVERAGE PLAN ON OR BEFORE THE DATE
49 THE SERVICE WAS DELIVERED; OR
50 (V) THE COVERED PERSON'S BENEFIT MAXIMUMS WERE REACHED
51 ON OR BEFORE THE DATE THE SERVICE WAS DELIVERED.".
52
53 Page 10, line 2, after "DETERMINATION" insert "BY THE CARRIER".
54
55 Page 10, line 3, after "PARTICULAR" insert "COVERED".
1 Page 10, line 8, strike "PRACTICE;" and substitute "PRACTICE AND
2 APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION OR OTHER
3 REQUIRED AGENCY;".
4
5 Page 10, strike line 10 and substitute "EXTENT, SERVICE SITE, AND LEVEL
6 AND DURATION OF SERVICE;
7 (III) KNOWN TO BE EFFECTIVE IN IMPROVING HEALTH, AS PROVEN
8 BY SCIENTIFIC EVIDENCE;
9 (IV) THE MOST APPROPRIATE SUPPLY, SETTING, OR LEVEL OF
10 SERVICE THAT CAN BE SAFELY PROVIDED GIVEN THE PATIENT'S CONDITION
11 AND THAT CANNOT BE OMITTED;
12 (V) NOT EXPERIMENTAL OR INVESTIGATIONAL;
13 (VI) NOT MORE COSTLY THAN AN ALTERNATIVE DRUG, SERVICE,
14 SERVICE SITE, OR SUPPLY THAT IS NOT CONTRAINDICATED FOR THE
15 PATIENT'S CONDITION OR SAFETY AND IS AT LEAST AS LIKELY TO PRODUCE
16 EQUIVALENT THERAPEUTIC OR DIAGNOSTIC RESULTS AS TO THE DIAGNOSIS
17 OR TREATMENT OF AN ILLNESS, INJURY, DISEASE, OR SYMPTOM; AND".
18
19 Renumber succeeding subparagraph accordingly.
20
21 Page 11, strike line 6 and substitute "FUNCTION;
22 (II) FOR A PERSON WITH A PHYSICAL OR MENTAL DISABILITY,
23 CREATE AN IMMINENT AND SUBSTANTIAL LIMITATION ON THE PERSON'S
24 EXISTING ABILITY TO LIVE INDEPENDENTLY; OR".
25
26 Renumber succeeding subparagraph accordingly.
27
28
Senate Journal, April 16
HB19-1211 by Representative(s) Michaelson Jenet and Caraveo; also Senator(s) Williams A.--
Concerning prior authorization requests submitted by providers for a determination of
coverage of health care services under a health benefit plan.
Amendment No. 1(L.019), by Senator Smallwood.
Amend reengrossed bill, page 3, line 17, strike "NONPROFIT".
As amended, ordered revised and placed on the calendar for third reading and final
passage.