40 Pa. Stat. § 991.2151

Current through Pa Acts 2024-53, 2024-56 through 2024-92
Section 991.2151 - Certification
(a) A utilization review entity may not review health care services delivered or proposed to be delivered in this Commonwealth unless the entity is certified by the department to perform utilization review. A utilization review entity operating in this Commonwealth on or before the effective date of this article shall have one year from the effective date of this article to apply for certification.
(b) The department shall grant certification to a utilization review entity that meets the requirements of this section. Certification shall be renewed every three years unless otherwise subject to additional review, suspension or revocation by the department.
(c) The department may adopt a nationally recognized accrediting body's standards to certify utilization review entities to the extent the standards meet or exceed the standards set forth in this article.
(d) The department may prescribe application and renewal fees for certification. The fees shall reflect the administrative costs of certification and shall be deposited in the General Fund.
(e) A licensed insurer or a managed care plan with a certificate of authority shall comply with the standards and procedures of this subarticle but shall not be required to obtain separate certification as a utilization review entity.

40 P.S. § 991.2151

1921, May 17, P.L. 682, No. 284, § 2151, added 1998, June 17, P.L. 464, No. 68, § 1, effective 1/1/1999.