20-3406. Uniform prior authorization request forms; definition

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A. Notwithstanding any other law, on or before January 1, 2022, the department shall approve a uniform prior authorization request form for prescription drugs, devices or durable medical equipment and a uniform prior authorization request form for all other health care procedures, treatments and services. On or before January 1, 2023, all providers shall use only the approved uniform prior authorization request forms and all health care services plans and utilization review agents shall accept and process prior authorization requests submitted using the approved uniform prior authorization request forms.

Prior authorization requests that are submitted on or after January 1, 2023 are invalid unless the requests are submitted on the approved uniform prior authorization request forms. The uniform prior authorization request forms shall both:

1. Not exceed two printed pages. This two-page limit does not apply to or include a provider's notes or documentation that the provider submits in support of a prior authorization request.

2. Meet the electronic submission and acceptance requirements prescribed in section 20-3403.

B. In approving the uniform prior authorization request forms, the department shall both:

1. Consider the following:

(a)Any existing prior authorization request forms that the centers for medicare and medicaid services or the United States department of health and human services has developed.

(b)Any national standards relating to electronic prior authorization.

(c)Any other form adopted by the director or another state agency.

2. Seek input from interested stakeholders, including providers, health care services plans, utilization review agents, pharmacists and pharmacy benefit managers.

C. This section does not prohibit a payor or any entity acting for a payor under contract with the payor from using a prior authorization methodology that uses an internet webpage, an internet webpage portal or a similar electronic, internet and web-based system if the methodology is consistent with the uniform prior authorization request forms approved by the director pursuant to this section.

D. For the purposes of this section, "provider" includes a health professional as defined in section 32-3218 or a health care institution that is licensed under title 36.