Directs the establishment of a pool of utilization review agents from health services specialties; requires impartiality; provides for the appointment of agents from the pool; requires random review of utilization review records; prohibits conflicts of interest.
Relates to the availability of agency records prior to or at an open meeting; removes the "to the extent practicable at least twenty-four hours" limitation from the requirement that agencies and departments shall make records available.
Requires medical records to be made available to patients in an electronic format through a web portal and in a format that allows patients to save records to their own device.
Requires medical records to be made available to patients in an electronic format through a web portal and in a format that allows patients to save records to their own device.
Prohibits agencies from charging a fee for records where an electronic copy is already available from a previous request made within the past six months except for the actual cost of a storage device or media if provided to the requester.
Prohibits agencies from charging a fee for records where an electronic copy is already available from a previous request made within the past six months except for the actual cost of a storage device or media if provided to the requester.
Requires written notice of an adverse determination made by a utilization review agent in relation to a step therapy protocol override determination which includes the clinical review criteria relied upon to make such determination and any applicable alternative prescription drugs subject to the step therapy protocol of the utilization review agent.