(a) Utilization review agents shall adhere to the minimum standards set forth in Section 27-3A-5.
Terms Used In Alabama Code 27-3A-4. Duties of utilization review agents
- appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- department: The Alabama Department of Public Health. See Alabama Code 27-3A-3
- following: means next after. See Alabama Code 1-1-1
- person: includes a corporation as well as a natural person. See Alabama Code 1-1-1
- state: The word "state," when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Alabama Code 1-1-1
- utilization review: A system for prospective and concurrent review of the necessity and appropriateness in the allocation of health care resources and services given or proposed to be given to an individual within this state. See Alabama Code 27-3A-3
- utilization review agent: Any person or entity, including the State of Alabama, performing a utilization review, except the following:
a. See Alabama Code 27-3A-3
- writing: includes typewriting and printing on paper. See Alabama Code 1-1-1
- year: means a calendar year; but, whenever the word "year" is used in reference to any appropriations for the payment of money out of the treasury, it shall mean fiscal year. See Alabama Code 1-1-1
(b) On or after July 1, 1994, a utilization review agent shall not conduct a utilization review in this state unless the agent has certified to the department in writing that the agent is in compliance with Section 27-3A-5. Certification shall be made annually on or before July 1 of each calendar year. In addition, a utilization review agent shall file the following information:
(1) The name, address, telephone number, and normal business hours of the utilization review agent.
(2) The name and telephone number of a person for the department to contact.
(3) A description of the appeal procedures for utilization review determinations.
(c) Any material changes in the information filed in accordance with this section shall be filed with the State Health Officer within 30 days of the change.
(d) Unless exempted pursuant to paragraph f. of subdivision (5) of Section 27-3A-3, each utilization review agent, upon filing the certification, shall pay an annual fee in the amount of one thousand dollars ($1,000) to the department. All fees paid pursuant to this subdivision shall be held by the department as expendable receipts for the purpose of administering this chapter.
(e) The department may adopt rules pursuant to the Administrative Procedure Act necessary to implement this chapter.