State Law
07/26/2023
Massachusetts
Sections 958 CMR 3.020, 3.100, 3.101, 3.305, 3.306, 3.309, 3.310, and 3.311
Definitions; Clinical Decisions; Carrier’s Medical Necessity Guidelines; Time Limits for Resolution of Non-expedited Internal Grievances; Review of Internal Grievances; Expedited Internal Review of Adverse Determinations; Additional Requirements for Expedited Internal Review; Failure of Carrier to Meet Time Limits
Medical Necessity-Definition, State Medical Necessity Appeals-Deadlines, U.R. Criteria
State Law
07/10/2023
West Virginia
Section 33-16-3dd
Prior authorization
State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
Ama Policy
10/15/2019
State Medical Necessity Appeals-Deadlines
State Law
08/24/2023
Tennessee
Section 56-6-705
Utilization Review Agents — Minimum Standards
Amendments, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law
08/24/2023
Texas
Section 1711
Written Procedures for Appeal of Adverse Determinations
State Medical Necessity Appeals-Deadlines
State Law
08/29/2023
Wisconsin
Section 18.05
Expedited grievance procedure
State Medical Necessity Appeals-Deadlines
State Law
08/29/2023
Wisconsin
Section 18.03
State Medical Necessity Appeals-Deadlines
State Law
08/07/2023
Maine
Sections 1-10
Purpose; Authority; Applicability and Scope; Affordable Care Act; Definitions; Quality Assurance Standards; Access to Services; Adverse Health Care Treatment Decisions; Grievance Register and Grievance Procedures; Reporting Requirements; Effective Date
Credentialing-Deadlines, Credentialing-Due Process-Denial of Contract, Network Adequacy, Retroactive Denial, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law
08/16/2023
New York
Section 4904
Appeal of adverse determinations by utilization review agents
State Medical Necessity Appeals-Deadlines
State Law
08/09/2023
Missouri
Section 376.1385
Second-level review procedures
State Medical Necessity Appeals-Deadlines
