Cal. Code Regs. tit. 10 § 2562.2

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 2562.2 - Medical Necessity; Case Management and Utilization Review

(a) Nothing in this article shall be construed to mandate coverage of services that are not medically necessary.

(b) Nothing in this article shall be construed to preclude an insurer from utilizing the following in accordance with the provisions of this article and Insurance Code sections 10144.5 and 10144.51:

(1) Case management;

(2) Managed care;

(3) Network providers;

(4) Utilization review techniques;

(5) Prior authorization;

(6) Copayments; or

(7) Other cost sharing.

Cal. Code Regs. Tit. 10, § 2562.2

1. New section filed 3-11-2013 as an emergency; operative 3-11-2013 (Register 2013, No. 11). A Certificate of Compliance must be transmitted to OAL by 9-9-2013 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 9-9-2013 as an emergency; operative 9-9-2013 (Register 2013, No. 37). A Certificate of Compliance must be transmitted to OAL by 12-9-2013 or emergency language will be repealed by operation of law on the following day.
3. New section filed 11-20-2013 as an emergency; operative 12-9-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 47). A Certificate of Compliance must be transmitted to OAL by 3-10-2014 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 11-20-2013 order transmitted to OAL 3-7-2014 and filed 4-10-2014 (Register 2014, No. 15).

Note: Authority cited: Sections 10144.5, 10144.51, 12921 and 12926, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Sections 10144.5 and 10144.51, Insurance Code; Harlick v. Blue Shield of California, 686 F.3d 699 (2012).