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District of Columbia Code Division V. Local Business Affairs § 31-3875.04. Length of prior authorization.

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) Except as otherwise provided in subsection (b) of this section, approval shall be valid for at least one year from the date the enrollee receives notice of the approval and shall remain valid regardless of any changes in dosage for a prescription drug prescribed by the health care provider; provided, that the utilization review entity may rescind the approval for dosages exceeding limitations set by federal or District laws or regulations.

(b)(1) Approval for a course of treatment, as that term is defined at 2 CFR 422.112(b)(8)(ii)(A), or for a health care service to treat a chronic condition, shall remain valid for as long as medically reasonable and necessary to avoid disruptions in care, in accordance with applicable coverage criteria, the enrollee's medical history, and the treating provider's recommendation.

<Text of subsec. (b)(2) applicable upon the date of inclusion of its fiscal effect in an approved budget and financial plan.>

(2) The Department of Health Care Finance may require annual reauthorization for long-term services and supports.

(c) A utilization review entity may not revoke, limit, condition, or restrict approval if care is provided within 45 business days from the date the enrollee receives notice of the approval; provided, that approval may be revoked or otherwise restricted in cases of fraud.

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Cite this article: FindLaw.com - District of Columbia Code Division V. Local Business Affairs § 31-3875.04. Length of prior authorization. - last updated January 01, 2024 | https://codes.findlaw.com/dc/division-v-local-business-affairs/dc-code-sect-31-3875-04/

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