For purposes of calculating the time periods within which a determination is required to be made for prospective and retrospective reviews, the time period within which the determination is required to be made begins on the date the request is received by the health carrier in accordance with the health carrier’s procedures established pursuant to § 58-17H-16. If the time period for making the determination for a prospective or retrospective review is extended due to the covered person or, if applicable, the covered person’s authorized representative’s failure to submit the information necessary to make the determination, the time period for making the determination shall be tolled from the date on which the health carrier sends the notification of the extension to the covered person or, if applicable, the covered person’s authorized representative, until the earlier of: the date on which the covered person or, if applicable, the covered person’s authorized representative, responds to the request for additional information or the date on which the specified information was to have been submitted. If the covered person or the covered person’s authorized representative fails to submit the information before the end of the period of the extension, as specified in §§ 58-17H-28 and 58-17H-30, the health carrier may deny the certification of the requested benefit.

Source: SL 2011, ch 219, § 56.

Commission Note: SL 2012, ch 239, § 1 provides: “The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.”