4908 – Applicability to Erisa Plans.
§ 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 benefit plan, as defined in the employee retirement income security act of 1974, as amended.
4909 – Site of Service Clinical Review.
§ 4909. Site of service clinical review. (a) For purposes of this section: (1) “Free-standing ambulatory surgical center” shall mean a diagnostic and treatment center authorized pursuant to article twenty-eight of the public health law and operated independently from a hospital. (2) “Health care plan” shall mean an insurer, a corporation organized pursuant to article […]
4900 – Definitions.
§ 4900. Definitions. For purposes of this article: (a) “Adverse determination” means a determination by a utilization review agent that an admission, extension of stay, or other health care service, upon review based on the information provided, is not medically necessary. * (b) “Clinical peer reviewer” means: (1) for purposes of title one of this […]