California Health and Safety Code ARTICLE 5.55 - Appeals Seeking Independent Medical Reviews

• Section 1374.30.
  (a) Commencing January 1, 2001, there is hereby established in the department the Independent Medical Review System.(b) For the purposes of this chapter, “disputed health care service”...
• Section 1374.31.
  (a)  If there is an imminent and serious threat to the health of the enrollee, as specified in subdivision (c) of Section 1374.33, all necessary...
• Section 1374.32.
  (a)   The department shall contract with one or more independent medical review organizations in the state to conduct reviews for purposes of this article....
• Section 1374.33.
  (a) Upon receipt of information and documents related to a case, the medical professional reviewer or reviewers selected to conduct the review by the independent medical...
• Section 1374.34.
  (a) Upon receiving the decision adopted by the director pursuant to Section 1374.33 that a disputed health care service is medically necessary, the plan shall promptly...
• Section 1374.35.
  (a)  After considering the results of a competitive bidding process and any other relevant information on program costs, the director shall establish a reasonable, per-case...
• Section 1374.36.
  (a)  The director shall submit to the Legislature by March 1, 2002, a report on the initial implementation of this article. The report shall include...

Last modified: October 22, 2018