Colorado has passed a new prior authorization reform law that will take effect on January 1, 2026. The law is the result of advocacy by the Colorado Medical Society (CMS), partner specialty societies, and a coalition of patient stakeholders led by CMS. The aim is to reduce burdens associated with prior authorization requirements imposed by health plans.
The American Medical Association (AMA) supported CMS during this three-year campaign. The new legislation extends prior authorization approvals from 180 days to one year or for the length of treatment, which is expected to improve continuity of care for patients and reduce repeated paperwork for physicians. It also introduces enhanced transparency in prior authorization requirements and requires better data reporting from health plans to increase accountability.
Additionally, Colorado lawmakers have coordinated automation efforts in line with federal initiatives, aiming to streamline the process within electronic health record (EHR) systems rather than through multiple online portals. Physicians are also assured that once an approval is granted, they will not face retroactive denials for payment.
“Achieving meaningful prior authorization reform in the Rocky Mountain State – and ensuring that more health care decision-making takes place between patients and physicians – was due in large part to the Health Can’t Wait Colorado campaign coordinated by CMS. This effort to collect firsthand prior authorization experiences from patients and physicians helped convince state lawmakers that real reform was needed now,” according to the AMA president.
The AMA identifies right-sizing prior authorization as a key priority and has worked with CMS and other organizations to address what it sees as an overused management strategy by payers. The AMA president shared personal experiences with administrative hurdles caused by current processes, highlighting inefficiencies faced by medical staff when dealing with insurers.
Electronic prior authorization (ePA) technology is being advanced at both federal and state levels. New policies from the Centers for Medicare and Medicaid Services require electronic processing of these requests, aiming to decrease wait times and paperwork for providers. In Colorado, state laws are being updated alongside these federal rules so that EHR systems can support automated authorizations more effectively.
“The AMA is ensuring the physician voice is front and center in ePA development. The goal is for EHR systems to fire off requests and receive instant responses, turning today’s fax-and-phone marathon into a seamless ‘electronic handshake.’”
Medical practices are encouraged to check with their EHR vendors about readiness timelines for ePA upgrades so they can prepare staff workflows ahead of broader implementation targeted for 2027.
