Licensing & Renewal Requirements For Utilization Review Companies - Revised

BULLETIN HC-86-13 (REVISED) JULY 16,2013 TO: UTILIZATION REVIEW COMPANIES RE: LICENSING & RENEWAL REQUIREMENTS FOR UTILIZATION REVIEW COMPANIES Connecticut Public Act No. 13-3 modifies existing requirements for licensure of utilization review companies effective October 1,2013. Key changes include new utilization review requirements specific to mental and substance abuse disorders regarding standards for clinical review criteria and revised timeframes, a requirement that clinical peers now conduct all utilization reviews, and an optional peer to peer review that is not considered a grievance of the initial adverse determination. The license application is available on the Insurance Department's website under the tab "Forms and Applications." Applications may also be requested from the Life & Health Division at the address listed below. Companies should be sure that each application is complete with all necessary supporting materials. The application and all supporting materials including letters to enrollees should be specific to Connecticut for plans that are fully insured. Any application that contains provisions regarding jurisdictions outside of Connecticut or for self-funded plans will be rejected. Applications will not be considered until all required information is submitted. The license fee should not be sent with the application. Upon satisfactory review of the application, the company will be invoiced and the license will be issued upon receipt ofthe $3,000 license fee. All checks must be made payable to the Treasurer - State of Connecticut. Note that utilization review company licenses must be renewed annually every October 1 regardless of the date of initial licensure. License fees are not prorated. Companies renewing October 1, 2013 should review the Public Act, Connecticut Insurance Department Bulletin HC-92 and revised license application, and provide updated information to verify compliance with the new requirements. QUESTIONS Please contact the Insurance Department Life and Health Division at cid.1h@ ct.gov with any questions.