TITLE XXXVII
INSURANCE

CHAPTER 420-E
LICENSURE OF MEDICAL UTILIZATION REVIEW ENTITIES

Section 420-E:3

    420-E:3 Information Required. –

[Paragraph I(intro. par.) effective until January 1, 2027; see also paragraph I(intro. par.) set out below.]


I. Each person, partnership or corporation licensed under this chapter shall, at the time of initial licensure and on or before April 1 of each succeeding year, provide the department with the following information:


[Paragraph I(intro. par.) effective January 1, 2027; see also paragraph I(intro. par.) set out above.]


I. Each person, partnership or corporation licensed under this chapter shall, at the time of initial licensure and upon the commissioner's request, provide the department with the following information:
(a) The process used by the entity to carry out its utilization review services, including the categories of health care personnel that perform utilization review activities and whether or not such individuals are licensed in this state.
(b) The process used by the entity for addressing beneficiary or provider complaints.
(c) The types of utilization review programs offered by the entity, including, but not limited to:
(1) Second opinion programs.
(2) Prehospital admission certification.
(3) Preinpatient service eligibility determination.
(4) Concurrent hospital review to determine appropriate length of stay.
(d) The process used by the entity to preserve beneficiary confidentiality of medical information.
II. Each person, partnership, or corporation licensed under this chapter shall adopt as the minimal acceptable standards for licensure either the Utilization Review Accreditation Commission (URAC) standards, the National Committee for Quality Assurance (NCQA) standards, or other similar standards acceptable to the commissioner, unless rules establishing stricter standards are adopted pursuant to the commissioner's authority under RSA 420-E:7, XII.

Source. 1992, 142:2. 1993, 249:2. 1999, 249:5, eff. Sept. 7, 1999. 2026, 218:18, eff. Jan. 1, 2027.