Colorado Medicaid Pauses Prior Authorization Requirements For Long-Term Home Health Services

A two-year pause has been placed on the prior authorization requirements for a series of long-term home health therapies and services for the Medicaid pediatric population in Colorado following complaints from provider organizations about denials and delays. Although 90% of claims are processed without issue, 10% of claims have been initially denied or delayed for clinical or administrative issues for longer than is permitted by federal Medicaid requirements.

In May 2021, the Colorado Department of Health Care Policy and Financing (the Department) contracted with Keystone Peer Review Organization (Kepro) as a utilization management vendor handle prior authorization requests . . .