New Hampshire Revised Statutes 420-E:3 – Information Required
Current as of: 2023 | Check for updates
|
Other versions
I. Each person, partnership or corporation licensed under this chapter shall, at the time of initial licensure and on or before April 1 of each succeeding year, provide the department with the following information:
(a) The process used by the entity to carry out its utilization review services, including the categories of health care personnel that perform utilization review activities and whether or not such individuals are licensed in this state.
(b) The process used by the entity for addressing beneficiary or provider complaints.
(c) The types of utilization review programs offered by the entity, including, but not limited to:
(1) Second opinion programs.
(2) Prehospital admission certification.
(3) Preinpatient service eligibility determination.
(4) Concurrent hospital review to determine appropriate length of stay.
(d) The process used by the entity to preserve beneficiary confidentiality of medical information.
II. Each person, partnership, or corporation licensed under this chapter shall adopt as the minimal acceptable standards for licensure either the Utilization Review Accreditation Commission (URAC) standards, the National Committee for Quality Assurance (NCQA) standards, or other similar standards acceptable to the commissioner, unless rules establishing stricter standards are adopted pursuant to the commissioner’s authority under N.H. Rev. Stat. § 420-E:7, XII.
(a) The process used by the entity to carry out its utilization review services, including the categories of health care personnel that perform utilization review activities and whether or not such individuals are licensed in this state.
Terms Used In New Hampshire Revised Statutes 420-E:3
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- following: when used by way of reference to any section of these laws, shall mean the section next preceding or following that in which such reference is made, unless some other is expressly designated. See New Hampshire Revised Statutes 21:13
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
- person: may extend and be applied to bodies corporate and politic as well as to individuals. See New Hampshire Revised Statutes 21:9
- state: when applied to different parts of the United States, may extend to and include the District of Columbia and the several territories, so called; and the words "United States" shall include said district and territories. See New Hampshire Revised Statutes 21:4
(b) The process used by the entity for addressing beneficiary or provider complaints.
(c) The types of utilization review programs offered by the entity, including, but not limited to:
(1) Second opinion programs.
(2) Prehospital admission certification.
(3) Preinpatient service eligibility determination.
(4) Concurrent hospital review to determine appropriate length of stay.
(d) The process used by the entity to preserve beneficiary confidentiality of medical information.
II. Each person, partnership, or corporation licensed under this chapter shall adopt as the minimal acceptable standards for licensure either the Utilization Review Accreditation Commission (URAC) standards, the National Committee for Quality Assurance (NCQA) standards, or other similar standards acceptable to the commissioner, unless rules establishing stricter standards are adopted pursuant to the commissioner’s authority under N.H. Rev. Stat. § 420-E:7, XII.