N.Y. Comp. Codes R. & Regs. tit. 14 § 514.5

Current through Register Vol. 46, No. 45, November 2, 2024

Section 514.5 - Standards for the approval of Clinical Review Criteria for use by Utilization Review Agents

(a) A Utilization Review Agent shall submit its Clinical Review Criteria to the Office for review and approval.

(b) The Office shall approve Clinical Review Criteria that are evidencebased, peer-reviewed, age-appropriate, and meet standards published by the Office, including the Guiding Principles for the Review and Approval of Clinical Review Criteria for Mental Health Services, incorporated by reference in section 514.6 of this Part.

(c) The Office shall not approve Clinical Review Criteria that does not comply with Federal or State mental health and substance use disorder parity laws, which shall be determined in consultation with the Commissioner of Health and the Superintendent of Financial Services.

(d) If a Utilization Review Agent intends to implement new or revised Clinical Review Criteria, the Utilization Review Agent shall submit such criteria to the Office no later than 60 days prior to the date of implementation and shall not implement such criteria without the prior written approval of the Office.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 514.5

Adopted New York State Register May 15, 2024/Volume XLVI, Issue 20, eff. 5/15/2024