More States Pass Utilization Review Laws

OPEN MINDS The Behavioral Health & Social Service Industry Analyst Industry News In 1990, six states - Georgia, Kentucky, Maryland, Mississippi, South Carolina, and Virginia - have enacted legislation to regulate the practices of private utilization review (UR) agents. These bills enacted this year require companies conducting utilization review in their state to obtain certification from either the State Department of Health or the Commissioner of Insurance. In order to be certified the UR firm must submit information describing: Review criteria and procedures Types and qualifications of personnel Policies and procedures ensuring that reviewers are ‘reasonably accessible” during normal business hours Policies . . .