Licensing & Renewal Requirements For Utilization Review Companies

STATE OF CONNECTICUT INSURANCE DEPARTMENT BULLETIN HC-86-14 JULY 21, 2014 TO: UTILIZATION REVIEW COMPANIES RE: LICENSING & RENEWAL REQUIREMEN COMPANIES TS FOR UTILIZATION REVIEW This bulletin supersedes Bulletin HC-86-13 (REVISED) dated July 16, 2013. Connecticut Public Act No. 14-40 (the "Act") modifies existing requirements for licensure of utilization review companies effective May 28, 2014. There are two key changes. The first change is in Section 1 of the Act that amends subdivision (7) of section §38a-591a of the 2014 supplement to the Connecticut General Statutes regarding the definition of clinical peer. The definition of a clinical peer no longer includes an individual who is nationally board certified in psychology, but replaces this requirement with an individual with a doctoral level psychology degree with appropriate training and clinical experience. The second change is in Section 2 of the Act that amends Section §38a-591c of the 2014 supplement to the Connecticut General Statutes. The amendment removes the requirement that clinical peers conduct all utilization reviews, although maintains the requirement that clinical peers evaluate the clinical appropriateness of an adverse determination. The license application is available on the Insurance Department's website (www.ct.gov/cid) 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 of the $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 1,2014 should review the Act, Connecticut Insurance Department Bulletins and the license application. The company need only provide changes and updated information to the previously submitted application. Utilization review companies should also note that any material change in information supplied in an application for licensure or renewal must be filed with the Insurance Department within 30 calendar days after such change. QUESTIONS Please contact the Insurance Department Life and Health Division at cid.lh@ ct.gov with any questions. LAt::e ThomasB.Leon~ Insurance Commissioner www.ct.govlcid P.O. Box 816 • Hartford, CT 06l42-0816 An Equal Opportunity Employer