NOTE: §1260.43 enacted by Acts 2023, No. 312, eff. Jan. 1, 2024.
§1260.43. Single utilization review per episode of care
A health insurance issuer shall not impose any additional utilization review
requirement with respect to any surgical procedure or otherwise invasive procedure, nor any
item furnished as part of the surgical or invasive procedure, if the procedure or item is
furnished during the perioperative period of a procedure and either of the following
conditions is met:
(1) Prior authorization was received by the healthcare provider from the health
insurance issuer before the surgical procedure or item, as part of the surgical or otherwise
invasive procedure, was furnished.
(2) Prior authorization was not required by the health insurance issuer.
Acts 2023, No. 312, §1, eff. Jan. 1, 2024.