Sec. 38a-226a. Annual licensure. Fees. Complaints re utilization review companies. Certification and release of information. Compliance. - Connecticut Statutes

      Sec. 38a-226a. Annual licensure. Fees. Complaints re utilization review companies. Certification and release of information. Compliance. (a) No utilization review company may conduct utilization review in this state unless it is licensed by the commissioner. All licenses shall be renewed on an annual basis.

      (b) The annual license fee shall be two thousand five hundred dollars and shall be dedicated to the regulation of utilization review, except that the commissioner shall be authorized to use such funds as is necessary to implement the provisions of sections 38a-91aa to 38a-91qq, inclusive.

      (c) The request for licensure or renewal shall include the name, address, telephone number and normal business hours of the utilization review company, the name and telephone number of a person for the commissioner to contact, and evidence of compliance noted in the provisions of section 38a-226c. Any material changes in the information filed in accordance with this subsection shall be filed with the commissioner within thirty days of the change.

      (d) The commissioner shall receive and investigate all grievances filed against utilization review companies by an enrollee. The commissioner shall code, track and review all grievances. The commissioner may impose such penalties as authorized, in accordance with section 38a-226b.

      (e) In the absence of any contractual agreement to the contrary, the enrollee is responsible for requesting certification and for authorizing the provider to release, in a timely manner, all information necessary to conduct the review. A utilization review company shall permit either the enrollee, the enrollee's representative or the provider of record to assist in fulfilling that responsibility.

      (f) If the commissioner determines that additional data from a utilization review company is necessary to determine compliance with the provisions of sections 38a-226 to 38a-226d, inclusive, he may require the utilization review company to provide data relating to reviews, appeals and denials.

      (P.A. 91-305, S. 2; P.A. 92-60, S. 24; P.A. 97-99, S. 16; P.A. 08-127, S. 20.)

      History: P.A. 92-60 amended section by replacing the biennial licensing requirement with an annual licensing requirement and made technical corrections for statutory consistency; P.A. 97-99 made technical changes in Subsec. (a), amended Subsec. (d) to require commissioner to code, track and review grievances and to authorize penalties and amended Subsec. (f) by deleting provision re providing data on an annual basis; P.A. 08-127 amended Subsec. (b) by authorizing commissioner's use of utilization review license fees to implement Secs. 38a-91aa to 38a-91qq.