(a) Utilization review agents shall adhere to the minimum standards set forth in Section 27-3A-5.
(b) On or after July 1, 1994, a utilization review agent shall not conduct a utilization review in this state unless the agent has certified to the department in writing that the agent is in compliance with Section 27-3A-5. Certification shall be made annually on or before July 1 of each calendar year. In addition, a utilization review agent shall file the following information:
(1) The name, address, telephone number, and normal business hours of the utilization review agent.
(2) The name and telephone number of a person for the department to contact.
(3) A description of the appeal procedures for utilization review determinations.
(c) Any material changes in the information filed in accordance with this section shall be filed with the State Health Officer within 30 days of the change.
(d) Unless exempted pursuant to paragraph f. of subdivision (5) of Section 27-3A-3, each utilization review agent, upon filing the certification, shall pay an annual fee in the amount of one thousand dollars ($1,000) to the department. All fees paid pursuant to this subdivision shall be held by the department as expendable receipts for the purpose of administering this chapter.
(e) The department may adopt rules pursuant to the Administrative Procedure Act necessary to implement this chapter.
Last modified: May 3, 2021