58-17I-14 Expedited review decision not initial determination for benefits--Notification--Time perio...
Expedited review decision not initial determination for benefits--Notification--Time periods--Continuation of service involving concurrent review urgent care requests.
expedited review decision, that is not an initial determination for benefits, shall be made and the
covered person or, if applicable, the covered person's authorized representative, shall be notified of
the decision in accordance with § 58-17I-15 as expeditiously as the covered person's medical
condition requires, but in no event more than seventy-two hours after the date of receipt of the
request for the expedited review. If the expedited review is of a grievance involving an adverse
determination with respect to a concurrent review urgent care request, the service shall be continued
without liability to the covered person until the covered person has been notified of the
For purposes of calculating the time periods within which a decision is required to be made under
this section, the time period within which the decision is required to be made shall begin on the date
the request is filed with the health carrier in accordance with the health carrier's procedures
established pursuant to § 58-17I-6 for filing a request, without regard to whether all of the
information necessary to make the determination accompanies the filing. (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provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the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.")
Source: SL 2011, ch 219, § 86.