Rule 16 and Rule 18 Rule Changes

The Colorado Department of Labor and Employment (CDLE) is rewriting workers’ compensation rules that will directly affect physical therapy practice in Colorado. This is an important opportunity to help ensure these changes support PTs, PTAs, and the patients we serve.Please use the template below to submit comments to the Department. Be sure to personalize the opening paragraph with your name, community, and practice area so the Department hears directly from providers across Colorado.

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Your Message to the legislators

Dear (name and title inserted automatically),

Dear Ms. Kingston,

My name is [NAME], and I am a [physical therapist/physical therapist assistant/practice owner] practicing in [CITY/COMMUNITY]. I am writing to share my concerns about several of the proposed changes to Rules 16 and 18.

I appreciate the Division’s efforts to make the rules clearer and improve transparency around billing, payment, and utilization review. However, several of the proposed changes could create additional administrative burdens for providers and potentially delay care for injured workers.

Prior Authorization – Rule 16.7
I am particularly concerned about the proposed prior authorization requirements. I respectfully ask the Division to consider the following changes:
Remove the requirement for prior authorization simply because a treatment is not addressed by the Medical Treatment Guidelines (MTGs). Clinical research and practice evolve faster than the guidelines can be updated. Treatments should not automatically require prior authorization simply because they are not specifically addressed in the MTGs.
Reduce the prior authorization review period from 10 days to 72 hours. A 10-day delay can interrupt continuity of care, slow patient progress, and in some cases result in greater utilization. Providers and patients should be able to receive decisions much more quickly.
Clarify the language regarding “administrative convenience” in Rule 16.7.D. The term is not clearly defined, and I am concerned that the proposed audit language could make payers less willing to approve appropriate treatment outside the MTGs even when the provider and payer agree that the care is medically appropriate.
Require utilization review to be performed by a Colorado-licensed clinician from the same profession as the provider whose services are being reviewed. Physical therapy is a specialized area of clinical practice. Decisions about the necessity and appropriateness of physical therapy care should be reviewed by clinicians who understand and are qualified to evaluate that care.

Overpayments – Rule 16.11.D
I support requiring payers to provide clearer information when seeking repayment from a provider. However, I ask the Division to provide additional protections and clarity for providers disputing an alleged overpayment.
Specifically, I encourage the Division to:
Increase the repayment or response period from 30 to 60 days.
Clearly explain what documentation a provider must submit to dispute an overpayment.
Clarify when the repayment period begins.
Allow additional time when necessary records are controlled by a payer, clearinghouse, or another third party.
Confirm that a timely written response preserves the provider’s right to dispute the overpayment.
Clarify that disputed amounts cannot be withheld from future payments before the dispute is resolved.

Rule 18 – Billing and Payment
I support the proposed changes requiring payers to provide clearer explanations when claims are denied, reduced, or changed. Providers should be able to understand why a payment decision was made and have a fair opportunity to correct or challenge that decision.
I also ask the Division to provide additional guidance regarding work hardening and work conditioning under Rule 18.4.10.F, including billing examples for services lasting less than one hour, between one and two hours, and more than two hours.
For the Rehabilitation Communication Form under Rule 18.7.2.D, I encourage the Division to retain the existing four-week reporting schedule or clarify that submitting the form every four weeks satisfies the proposed 30-day requirement.

Missed Appointments and Late Cancellations
I also encourage the Division to address reimbursement for missed appointments and late cancellations. Physical therapy frequently involves multiple appointments each week, and providers generally schedule those visits directly with patients. Requiring the payer to schedule an appointment before a provider can receive compensation for a missed visit is not practical.
Repeated no-shows and late cancellations leave clinical time unfilled, disrupt treatment plans, and create costs for practices. I encourage the Division to work with stakeholders on a reasonable policy that allows providers to seek compensation for missed appointments while protecting injured workers when an absence is caused by circumstances outside their control.
Physical Therapist Assistant Payment

Finally, I ask the Division to review reimbursement for services provided by physical therapist assistants. Level I accredited PTAs who meet the Division’s applicable training and competency requirements should be reimbursed at 100% of the applicable rate.
Recognizing qualified PTAs appropriately supports the rehabilitation workforce and helps maintain access to care, particularly in rural and underserved communities.
Thank you for considering these comments and for the opportunity to participate in this rulemaking process. I respectfully ask the Division to consider these changes as it finalizes Rules 16 and 18.

Sincerely,
[NAME], [CREDENTIALS]
[PRACTICE/ORGANIZATION, if applicable]
[CITY, COLORADO]

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