Section 230-RICR-20-30-14.2 - Purpose and ScopeA. It is in the best interest of the public that those individuals and health care entities involved with the determination of health plan benefit determinations, administrative and non-administrative, in our state meet the standards set forth in R.I. Gen. Laws Chapter 27-18.9 (the Act) and this Part;B. To establish reasonable standards for review agencies to ensure the timely approval of and payment for covered health care services to health care entity beneficiaries;C. To protect health care entity beneficiaries from benefit determination processes that may unreasonably impede access to covered health care services;D. To require health care entities and review agencies to improve and maintain coordination of benefit determination activities among all stakeholders and to the benefit of beneficiaries; andE. Nothing in the Act and this Part is intended to prohibit a health care entity or its review agencies from performing medical necessity determinations or maintaining processes to assess the accuracy of benefit coverage for its beneficiaries.230 R.I. Code R. 230-RICR-20-30-14.2
Adopted effective 6/9/2019