48.43.520 Requirement to maintain a documented utilization review program description and written utilization review criteria

48.43.520 Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.

WA Rev Code § 48.43.520 (2019) (N/A)

Copy with citation

Copy as parenthetical citation

RCW 48.43.520 Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.

(1) Carriers that offer a health plan shall maintain a documented utilization review program description and written utilization review criteria based on reasonable medical evidence. The program must include a method for reviewing and updating criteria. Carriers shall make clinical protocols, medical management standards, and other review criteria available upon request to participating providers.

(2) The commissioner shall adopt, in rule, standards for this section after considering relevant standards adopted by national managed care accreditation organizations and state agencies that purchase managed health care services.

(3) A carrier shall not be required to use medical evidence or standards in its utilization review of religious nonmedical treatment or religious nonmedical nursing care.

[ 2000 c 5 § 8.]

NOTES:

Application—Short title—Captions not law—Construction—Severability—Application to contracts—Effective dates—2000 c 5: See notes following RCW 48.43.500.

Previous Section

48.43.517 Enrollment of child participating in medical assistance program—Employer-sponsored health plan.

Next Section

48.43.525 Prohibition against retrospective denial of health plan coverage—Rules.