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.
Provides additional support to medically fragile children who rely on community-based or home health services.
Home Health Aides for Medically Fragile Children
Home Health Aide for Medically Fragile Children Program
Ensure Timely/Clinically Sound Utiliz. Review
Home Health Aide for Medically Fragile Children Program
Relates to the practice of natural hair care and braiding; creates an apprenticeship in such area; makes conforming technical changes.
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.