Creates clinical standards and special consideration and processes for utilization review related to care for medically fragile children; makes changes to the effectiveness thereof.
Same As
Creates clinical standards and special consideration and processes for utilization review related to care for medically fragile children; makes changes to the effectiveness thereof.
Creates clinical standards and special consideration and processes for utilization review related to care for medically fragile children; makes changes to the effectiveness thereof.
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.
Health insurance; Ensuring Transparency in Prior Authorization Act; definitions; disclosure and review of prior authorization; adverse determinations; consultation; reviewing physicians; utilization review entity; exception; retrospective denial; length of prior authorization; continuity of care; standard for transmission of authorization; failure to comply; severability; effective date.