N.Y. Comp. Codes R. & Regs. Tit. 12 § 324.6 - Incorporation into policies, procedures and practices

Insurance carriers and special funds shall incorporate the medical treatment guidelines set forth in section 324.2(a) and (b) and the provisions in sections 324.3(b), 324.4(a), and 324.5 of this Part, and section 325-1.25 of this Title into their policies, procedures, and practices so that their utilization review and management criteria are consistent with the medical treatment guidelines. Insurance carriers and special funds shall have certified to the chair within 120 days of the effective date of this Part that they have done so and shall re-certify to the incorporation of the medical treatment guidelines and the regulatory provisions cited in the previous sentence within 60 days of any changes to their policies, procedures, and practices. The chair and Insurance Department will conduct audits of insurance carriers and special funds with respect to the accuracy of the certifications. Each insurance carrier shall submit the policies and procedures incorporating the medical treatment guidelines incorporated by reference in section 324.2(a) and (b) of this Part and the provisions in sections 324.3(b), 324.4(a), and 324.5 of this Part, and section 325-1.25 of this Title to the chair or Insurance Department in connection with such audit.

Notes

N.Y. Comp. Codes R. & Regs. Tit. 12 § 324.6