Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.
Definitions; Utilization Review Standards; Appeals of Determinations Not to Certify; Computation of Time; Urgent Prior Authorization Requests; Access to Physicians; Notification for Adverse Determinations / Form; Qualifications of persons reviewing appeals; Change of patient status to emergency status after submission of prior authorization request; Length of Approvals; Approvals for chronic conditions; Continuity of Prior Approvals; Revocations of prior authorizations; Standardized electronic prior authorizations; Reports to the Department; Prior Authorization Statistics; Enforcement and administration; Penalties; Severability; Effective Date
Definitions; Certificate requirement for general in-house utilization review, exemptions; Certification of need of immediate hospital care, prima facie evidence; Judicial review, other remedies; Other health insurance policies, certificate requirement, contract with private review agent, reimbursement under policy where medical necessity in dispute; Adverse determination to patient or health-care provider, discussion of reasons, denial of third party reimbursement or precertification, evaluation by trained specialist
Short title; Definitions; Disclosure and review of prior authorization requirements; Persons qualified to make adverse determinations; Consultation after issuing an adverse determination; Requirements applicable to persons reviewing appeals; Health insurer or contracted utilization review entities’ obligations regarding prior authorization for nonurgent health care services; Health insurer or contracted utilization review entities’ obligations with respect to prior authorizations for urgent health care services; No prior authorization for medications for opioid use disorder; Length of authorization generally; revocation of prior authorizations prohibited; length of authorization for chronic or long-term care conditions; Continuity of care for enrollees; Provider exemptions from prior authorization requirements; Prior authorization for rehabilitative or habilitative services.
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
Written Procedures for Appeal of Adverse Determinations
Expedited grievance procedure