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.
Short title; Findings, declarations; Definitions; Payer, information, utilization management, processing, payment of claims; Payer, respond, hospital, health care provider request, prior authorization; Carrier, respond, prior authorization requests, medication coverage submitted, NCPDP SCRIPT Standard for ePA transactions; Prior authorization, chronic, long-term care condition, validity, exception, timeline; Prior authorization, denial, limitation imposed by payer, physician, scope of actions; Prior authorization, defined number, discrete services, set time frame, validity, exception; Payer to honor prior authorization granted to covered person by previous payer, initial coverage, upon receipt of documentation; Denial of prior authorization, communicated via written communication agreed to by payer, hospital, health care provider; Adverse determinations, appeal, reviewed by physician; Payer shall not deny reimbursement, hospital, health care provider in compliance, circumstances; Payer, reimbursement according to provider contract, medically necessary emergency, urgent care covered under plan; Failure by payer to comply with deadline, health care services subject to review, automatic authorization; Statistics available regarding prior authorization approvals, denials, website; Liberal construction; Rules, regulations
Requirements relating to basic benefits
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
See the text for the various section titles.
Application; Legislative Purposes and Intent; Definitions
Definitions
Act, how cited; Definitions, where found;Covered person, defined;Emergency medical condition, defined;Emergency services, defined;Health benefits plan, defined; Health care facility, defined; Health care professional, defined; Health care provider, defined; Insurer, defined; Medical assistance program, defined; Medically necessary, defined; TRICARE, defined