Section 33-32-103 - Utilization review planAn entity covered under the provisions of this chapter may not conduct a utilization review of health care services provided or to be provided to a patient covered under a contract or plan for health care services issued in this state unless that entity, at all times, maintains and can provide at the commissioner's request a current utilization review plan that includes:
(1) a description of review criteria, standards, and procedures to be used in evaluating proposed or delivered health care services that, to the extent possible, must: (a) be based on nationally recognized criteria, standards, and procedures;(b) reflect community standards of care, except that a utilization review plan for health care services under the medicaid program provided for in Title 53 need not reflect community standards of care;(c) ensure quality of care; and(d) ensure access to needed health care services;(2) policies and procedures to ensure that a representative of the entity conducting the utilization review is reasonably accessible to patients and health care providers at all times;(3) policies and procedures to ensure compliance with all applicable state and federal laws to protect the confidentiality of individual medical records;(4) a copy of the materials designed to inform applicable patients and health care providers of the requirements of the utilization review plan; and(5) any other information that may be required by the commissioner that is necessary to implement this chapter.Amended by Laws 2017, Ch. 151,Sec. 39, eff. 10/1/2017.Amended by Laws 2015, Ch. 428, Sec. 36, eff. 1/1/2016.En. Sec. 3, Ch. 665, L. 1991; amd. Sec. 5, Ch. 561, L. 1993.