June 10, 2019

The purpose of this regulation is to reflect changes to bring the Benefit Determination and Utilization Review Act to current national protective standards to assure that benefit determination agencies maintain timely approval and payment for covered health care services to health care entity beneficiaries. In addition, it provides clarity for in these regulations assure quality, […]

March 12, 2019

The United States District Court for the Northern District of California recently held that United Behavioral Health illegally denied mental health and substance use coverage based on flawed medical necessity criteria. To view the full decision, please click here.

November 19, 2018

Part 4520 has been amended to recognize the Accreditation Association for Ambulatory Health Care among the list of accreditors from which utilization organizations may receive accreditation and qualify for reduced registration and renewal fees. To view these amendments, click here.

October 29, 2018

Rhode Island Department of Health is proposing to repeal 216-RICR-40-10-20 because the statutory authority under which it was created has been repealed and transferred to the Rhode Island Office of the Health Insurance Commissioner. To view the status of this regulation, click here.  

September 28, 2018

The Colorado Department of Regulatory Agencies, Division of Insurance, adopted new Rule 4-7-03: Standards for Health Maintenance Organizations, effective June 1, 2018. The purpose of the regulation is to establish standards to ensure that each HMO licensed in Colorado delivers quality health care services and to ensure that each HMO seeking licensure in Colorado has […]

March 15, 2018

Pursuant to Alaska Register 225, changes to 3 AAC 28.900 – 3 AAC 28.918 (Utilization Review and Benefit Determinations), 3 AAC 28.930 – 3 AAC 28.938 (Health Care Insurer Grievance Procedure), 3 AAC 28.950 – 3 AAC 28.982 (External Review of Health Care Coverage Decisions), and 3 AAC 28.989 (General Provisions: Utilization and Benefit Determination, […]