SECTION 1. Section 12 of Chapter 176O of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out subsections (b) and (c) and inserting in place thereof the following subsections:—
(b) A carrier or utilization review organization shall make a determination regarding the medical necessity of a proposed admission, procedure or service that requires a determination within two working days of obtaining all necessary information. For purposes of this section, “necessary information” shall include the results of any face-to-face clinical evaluation or second opinion that may be required. In the case of a determination to approve an admission, procedure or service, the carrier or utilization review organization shall notify 14 the provider rendering or requesting the service within 24 hours. In the case of an adverse determination, the carrier or utilization review 16 organization shall notify the provider rendering or requesting the service within 24 hours, and shall provide written or electronic confirmation of the notification to the insured and the provider within one working day thereafter.
(c) A carrier or utilization review organization shall make a concurrent review determination within one working day of obtaining all necessary information. In the case of a determination to approve an extended stay or additional services, the carrier or utilization review organization
shall notify the provider rendering or requesting the service within one working day.
In the case of an adverse determination, the carrier or utilization review organization shall notify the provider rendering or requesting the service within 24 hours and shall provide written or electronic notification to the insured and the provider within one working day thereafter. The service shall be continued without liability to the insured until the insured has been notified of the determination.
SECTION 2. Subsection (a) of Section 6 of Chapter 176O of the General Laws, as so appearing in the 2006 Official Edition, is hereby amended by striking out clause (2) thereof.
The information contained in this website is for general information purposes only. The General Court provides this information as a public service and while we endeavor to keep the data accurate and current to the best of our ability, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the website or the information contained on the website for any purpose. Any reliance you place on such information is therefore strictly at your own risk.