| 26.1-36.12-01 |
Definitions (Effective after December 31, 2025)
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| 26.1-36.12-02 |
Disclosure and review of prior authorization requirements (Effective after December 31, 2025)
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| 26.1-36.12-03 |
Personnel qualified to make adverse determinations (Effective after December 31, 2025)
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| 26.1-36.12-04 |
Personnel qualified to review appeals (Effective after December 31, 2025)
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| 26.1-36.12-05 |
Prior authorization ‑ Nonurgent circumstances (Effective after December 31, 2025)
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| 26.1-36.12-06 |
Prior authorization - Urgent health care services (Effective after December 31, 2025)
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| 26.1-36.12-07 |
Prior authorization - Emergency medical condition (Effective after December 31, 2025)
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| 26.1-36.12-08 |
No prior authorization for medication-assisted treatment (Effective after December 31, 2025)
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| 26.1-36.12-09 |
Retrospective denial (Effective after December 31, 2025)
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| 26.1-36.12-10 |
Length of prior authorization (Effective after December 31, 2025)
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| 26.1-36.12-11 |
Chronic or long-term care conditions (Effective after December 31, 2025)
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| 26.1-36.12-12 |
Continuity of care for enrollees (Effective after December 31, 2025)
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| 26.1-36.12-13 |
Failure to comply - Services deemed authorized (Effective after December 31, 2025)
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| 26.1-36.12-14 |
Procedures for appeals of adverse determinations (Effective after December 31, 2025)
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| 26.1-36.12-15 |
Effect of change in prior authorization clinical criteria (Effective after December 31, 2025)
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| 26.1-36.12-16 |
Notification to claims administrator (Effective after December 31, 2025)
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| 26.1-36.12-17 |
Annual report to insurance commissioner (Effective after December 31, 2025)
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