Cal. Code Regs. Tit. 10, § 2562.2 Medical Necessity; Case Management and Utilization Review

• Library: California Code of Regulations
• Edition: 2023
• Currency: Current through Register 2023 Notice Reg. No. 52, December 29, 2023
• Citation: Cal. Code Regs. Tit. 10, § 2562.2
• Year: 2023

(a) Nothing in this article shall be construed to mandate coverage of services that are not medically necessary.

(b) Nothing in this article shall be construed to preclude an insurer from utilizing the following in accordance with the provisions of this article and Insurance Code sections California Insurance Codeundefined10144.5 and California Insurance Codeundefined10144.51:

(1) Case management;

(2) Managed care;

(3) Network providers;

(4) Utilization review techniques;

(5) Prior authorization;

(6) Copayments; or

(7) Other cost sharing.

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Notes:

History: 1. New section filed 3-11-2013 as an emergency; operative 3-11-2013 (Register 2013, No. 11). A Certificate of Compliance must be transmitted to OAL by 9-9-2013 or emergency language will be repealed by operation of law on the following day.2. New section refiled 9-9-2013 as an emergency; operative 9-9-2013 (Register 2013, No. 37). A Certificate of Compliance must be transmitted to OAL by 12-9-2013 or emergency language will be repealed by operation of law on the following day.3. New section filed 11-20-2013 as an emergency; operative 12-9-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 47). A Certificate of Compliance must be transmitted to OAL by 3-10-2014 or emergency language will be repealed by operation of law on the following day.4. Certificate of Compliance as to 11-20-2013 order transmitted to OAL 3-7-2014 and filed 4-10-2014 (Register 2014, No. 15).

Source: 1. New section filed 3-11-2013 as an emergency; operative 3-11-2013 (Register 2013, No. 11). A Certificate of Compliance must be transmitted to OAL by 9-9-2013 or emergency language will be repealed by operation of law on the following day.2. New section refiled 9-9-2013 as an emergency; operative 9-9-2013 (Register 2013, No. 37). A Certificate of Compliance must be transmitted to OAL by 12-9-2013 or emergency language will be repealed by operation of law on the following day.3. New section filed 11-20-2013 as an emergency; operative 12-9-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 47). A Certificate of Compliance must be transmitted to OAL by 3-10-2014 or emergency language will be repealed by operation of law on the following day.4. Certificate of Compliance as to 11-20-2013 order transmitted to OAL 3-7-2014 and...