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1 New Paragraph; Managed Care Law; Utilization Review. Amend RSA 420-J:6 by inserting after paragraph VI the following new paragraph:
VII. The commissioner shall establish uniform guidelines for inpatient psychiatric services authorization and utilization review. The uniform guidelines shall establish a single set of criteria for admission, continued stay, discharge determinations, and retrospective review. The guidelines shall prohibit utilization review during the first 30 days of inpatient or residential behavioral health admission, provided that the treating facility notifies the health plan of the admission and the treatment plan within 2 days of the admission and performs daily clinical review of the covered person.
2 Effective Date. This act shall take effect 60 days after its passage.
Text to be added highlighted in green.
1 New Paragraph; Managed Care Law; Utilization Review. Amend RSA 420-J:6 by inserting after paragraph VI the following new paragraph:
VII. The commissioner shall establish uniform guidelines for inpatient psychiatric services authorization and utilization review. The uniform guidelines shall establish a single set of criteria for admission, continued stay, discharge determinations, and retrospective review. The guidelines shall prohibit utilization review during the first 30 days of inpatient or residential behavioral health admission, provided that the treating facility notifies the health plan of the admission and the treatment plan within 2 days of the admission and performs daily clinical review of the covered person.
2 Effective Date. This act shall take effect 60 days after its passage.