§334B-1 Purpose. The legislature finds and declares that the purposes of this chapter are to: (1) Promote the delivery of quality health care in a cost-effective manner; (2) Foster greater coordination between health care providers, third-party payors, and others who conduct utilization review and managed care activities; (3) Protect patients, employers, and health care providers […]
§334B-2 Definitions. As used in this chapter: “Director” means the director of health. “Health care provider” means any person, corporation, facility, or institution licensed by this State to provide health care services, including but not limited to a physician, hospital or other health care facility, nurse, psychologist, or substance abuse counselor, and officer, employee, or […]
§334B-3 Standards for review agents. (a) A review agent who approves or denies payment, or who recommends approval or denial of payment for mental health, alcohol, or drug abuse treatment services, or whose review results in approval or denial of payment for these services on a case by case basis, shall conduct utilization review or […]
§334B-4 Waiver. This chapter shall not apply to a review agent that operates under contract with the federal government for utilization review activities relating to recipients and health care providers under Title XVIII of the Social Security Act, Title XIX of the Social Security Act, and the Civilian Health and Medical Program of the Uniformed […]
§334B-5 Confidentiality. A review agent may not disclose or publish individual medical or psychological records or any other confidential medical or psychological information obtained in the performance of utilization review or managed care activities. [L 1991, c 95, pt of §1]
§334B-6 Penalty for violation. Any person or agency who violates any provision of this chapter or any rule adopted pursuant to this chapter or who submits any false information shall be guilty of a misdemeanor and upon conviction shall be subject to a penalty of not more than $1,000. [L 1991, c 95, pt of […]
§334B-7 Appeal by aggrieved party. Any person aggrieved by a final decision of the complaint resolution panel in a contested case under this chapter may appeal to the director. [L 1991, c 95, pt of §1]
§334B-8 Annual report. The director shall submit an annual report to the governor and the legislature at least twenty days prior to the convening of each regular session concerning the conduct of review agents that have been reported to the complaint resolution panel. The report shall include an analysis of complaints filed against agents by […]
