02-031 C.M.R. ch. 765, § 5 - STANDARDS OF EMERGENCY PREPAREDNESS

Current through 2022-14, April 6, 2022

Carriers subject to this rule must be capable of implementing the following actions within 72 hours in the event that the Superintendent issues a direction, rule, or order to do so pursuant to 24AM.R.S.A. § 478.

1. Suspension of plan rules for prior medical authorization, pre-certification, and utilization review.
2. Suspension of plan requirements for accessing prescription drugs, including prior approval requirements, refill limitations, and co-payments. This includes, but is not limited to, suspension of formulary requirements that are more stringent than treatment guidelines established by the United States Centers for Disease Control.
3. Suspension of incentives or requirements for enrollees to obtain health services from contracted network providers.
4. Suspension of rate increases, extensions of grace periods, suspension of termination of coverage for employees losing group coverage, and easing of enrollment requirements.
5. Suspension of cost barriers for accessing needed services, including co-payments, co-insurance, and deductibles.
6. Suspension of time limits for filing claims.

Notes

02-031 C.M.R. ch. 765, § 5

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