Part VII - GRIEVANCES AND EXTERNAL REVIEWS
- Section 38a-591 - Compliance with the Patient Protection and Affordable Care Act. Regulations
- Section 38a-591a - [Effective Until 1/1/2026] Definitions
- Section 38a-591a - [Effective 1/1/2026] Definitions
- Section 38a-591b - Health carrier responsibilities re utilization review
- Section 38a-591c - Utilization review criteria and procedures
- Section 38a-591d - [Effective Until 1/1/2025] Utilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination
- Section 38a-591d - [Effective 1/1/2025] Utilization review and benefit determinations. Urgent care requests. Information provided in notice of adverse determination
- Section 38a-591e - Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests
- Section 38a-591f - Internal grievance process of adverse determinations not based on medical necessity
- Section 38a-591g - External reviews and expedited external reviews
- Section 38a-591h - Record-keeping requirements. Report to commissioner upon request
- Section 38a-591i - Regulations
- Section 38a-591j - Utilization review companies: Licensure. Fees. Investigation of grievances. Duties
- Section 38a-591k - Violations. Notice and hearing. Penalties. Appeal
- Section 38a-591l - Independent review organizations conducting external reviews and expedited external reviews
- Section 38a-591m - Independent review organizations: Conflicts of interest. Liability. Record-keeping requirements. Report to commissioner upon request
- Section 38a-591n - Documents, communications, information and evidence provided to covered person or covered person's authorized representative upon request
- Section 38a-591o - [Effective 1/1/2025] Restrictions applicable to prospective or concurrent review of certain recurring prescription drugs. Exceptions
- Section 38a-592 to 38a-594 - Reserved for future use