Home Table of Contents

007.05.1-XVII. UTILIZATION REVIEW.

AR ADC 007.05.1-XVIIArkansas Administrative Code

West's Arkansas Administrative Code
Title 007. Department of Health
Division 05. Health Facility Services
Rule 1. Rules and Regulations for Health Maintenance Organizations in Arkansas
Ark. Admin. Code 007.05.1-XVII
007.05.1-XVII. UTILIZATION REVIEW.
A. Each HMO shall develop a Utilization Review Plan that includes:
1. A description of review standards and procedures to be used in evaluating proposed, ongoing, or delivered hospital and outpatient medical services;
2. The provisions by which patients, physicians, or hospitals may seek reconsideration or appeal of adverse decisions;
3. The type, qualifications, and oversight of the personnel performing utilization review and case management;
4. The policies and procedures to insure that a utilization review representative is reasonably accessible to patients and Providers five (5) days a week during normal business hours in Arkansas;
5. The policies and procedures to insure that all applicable state and federal laws to protect the confidentiality of individual medical records are followed;
6. Compliance with all relevant provisions of rules and regulations promulgated pursuant to Act 537 of 1989.
B. If a private review agent performs the utilization review, that entity shall meet the requirements of Act 537 of 1989 and rules and regulations promulgated pursuant to same Act.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 007.05.1-XVII, AR ADC 007.05.1-XVII
End of Document