(a) Each health
carrier shall file with the commissioner a copy of the written procedures,
including all forms used to process requests, for (1) the review of grievances
of adverse determinations that were based, in whole or in part, on medical
necessity, (2) the expedited review of grievances of adverse determinations of
urgent care requests, including concurrent review urgent care requests
involving an admission, availability of care, continued stay or health care
service for a covered person who has received emergency services but has not
been discharged from a facility, and (3) notifying covered persons or covered
persons' authorized representatives of such adverse determinations.
(b) Each health carrier shall file with the
commissioner an initial copy of such procedures, including all forms used to
process requests, no later than September 1, 2012 and any subsequent material
modifications to such procedures no later than one month following
implementation of the modification.
Conn. Agencies Regs.
Effective September 4,