State Law
05/02/2025
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
State Law
07/29/2023
Connecticut
Section 38a-591e
Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests.
State Medical Necessity Appeals-Deadlines
State Law
08/22/2023
Rhode Island
Part 14. Benefit Determination and Utilization Review
Benefit Determination and Utilization Review
Retroactive Denial, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
Ama Policy
10/15/2019
State Medical Necessity Appeals-Deadlines
Ama Policy
08/29/2023
ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, Step Therapy Override, U.R. Criteria
State Law
07/10/2023
West Virginia
Section 33-25A-8S
State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law
07/10/2023
West Virginia
Section 33-25-8P
State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law
07/10/2023
West Virginia
Section 33-24-7S
State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
