New York Public Health Law Title 1 - CERTIFICATION OF AGENTS AND UTILIZATION REVIEW PROCESS
- 4900 - Definitions.
For purposes of this article: 1. "Adverse determination" means a determination by a utilization review agent that an admission, extension of stay, or other health...
- 4901 - Registration of Utilization Review Agents.
1. Every utilization review agent who conducts the practice of utilization review shall biennially register with the commissioner and report, in a statement subscribed and...
- 4902 - Utilization Review Programs Standards.
4902. Utilization review program standards. 1. Each utilization review agent shall adhere to utilization review program standards consistent with the provisions of this title which...
- 4903 - Utilization Review Determinations.
1. Utilization review shall be conducted by: (a) Administrative personnel trained in the principles and procedures of intake screening and data collection, provided, however, that...
- 4904 - Appeal of Adverse Determinations by Utilization Review Agents.
1. An enrollee, the enrollee's designee and, in connection with retrospective adverse determinations, an enrollee's health care provider, may appeal an adverse determination rendered by...
- 4905 - Required and Prohibited Practices.
1. Each utilization review agent shall have written procedures for assuring that patient-specific information obtained during the process of utilization review will be: (a) kept...
- 4906 - Waiver.
1. Any agreement which purports to waive, limit, disclaim, or in any way diminish the rights set forth in this article, except as provided pursuant...
- 4907 - Rights and Remedies.
The rights and remedies conferred in this article upon enrollees and health care providers shall be cumulative and in addition to and not in lieu...
- 4908 - Applicability to Erisa Plans.
Notwithstanding the foregoing, the provisions of this article shall not apply to any utilization review conducted by, or on behalf of, a self-insured employee welfare...
Last modified: February 3, 2019