SB 21-137 Behavioral Health Recovery Act, Section 9, is effective as of July 1, 2023.
SB 21-137, Section 9, requires the Department of Health Care Policy & Financing (the Department) to contract with an external vendor to provide a secondary medical necessity review for previously denied or partially denied residential or inpatient Substance Use Disorder (SUD) requests. If a RAE denies or reduces SUD services, and a Colorado Administrative Law Judge has upheld the denial, a member’s providers can submit a request for a secondary medical necessity review. Providers submitting the request form must be enrolled in Health First Colorado. Visit the ColoradoPAR: Health First Colorado Prior Authorization Request Program web page for additional information.
Members may also request the second review. Members should email their name and contact information to HCPF_SUDreviewrequest@state.co.us. The member will be contacted for more information and the name of their SUD provider. The identified provider will then be contacted with instructions on how to formally request the second SUD review.
Refer to the ColoradoPAR: Health First Colorado Prior Authorization Request Program web page for more information about the ColoradoPAR Program or with questions about PAR submissions.