58-17H-29 Concurrent review determinations--Timing--Notification requirements.
Concurrent review determinations--Timing--Notification requirements.
concurrent review determinations, if a health carrier has certified an ongoing course of treatment to
be provided over a period of time or number of treatments:
Any reduction or termination by the health carrier during the course of treatment before
the end of the period or number treatments, other than by health benefit plan amendment
or termination of the health benefit plan, shall constitute an adverse determination; and
The health carrier shall notify the covered person of the adverse determination in
accordance with § 58-17H-32 at a time sufficiently in advance of the reduction or
termination to allow the covered person or, if applicable, the covered person's authorized
representative, to file a grievance to request a review of the adverse determination
pursuant to chapter 58-17I, and obtain a determination with respect to that review of the
adverse determination before the benefit is reduced or terminated.
The health care service or treatment that is the subject of the adverse determination shall be
continued without liability to the covered person until the covered person has been notified of the
determination by the health carrier with respect to the internal review request made pursuant to
chapter 58-17I. (SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session
Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010,
Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final
decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals
Source: SL 2011, ch 219, § 54.