58-17H-46 Concurrent review urgent care requests--Extended care requests--Time for determination and...
Concurrent review urgent care requests--Extended care requests--Time for
determination and notice.
For concurrent review urgent care requests involving a request by the
covered person or the covered person's authorized representative to extend the course of treatment
beyond the initial period of time or the number of treatments, if the request is made at least twenty-four hours prior to the expiration of the prescribed period of time or number of treatments, the health
carrier shall make a determination with respect to the request and notify the covered person or, if
applicable, the covered person's authorized representative, of the determination, whether it is an
adverse determination or not, as soon as possible, taking into account the covered person's medical
condition but in no event more than twenty-four hours after the date of the health carrier's receipt of
the request. If the health carrier's determination is an adverse determination, the health carrier shall
provide notice of the adverse determination in accordance with § 58-17H-48. (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provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the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 elapsed.")
Source: SL 2011, ch 219, § 71.