Pennsylvania Statutes Title 40 P.S. Insurance § 991.2154. Medical policies and clinical review criteria

(1) An insurer or MA or CHIP managed care plan shall make available its current medical policies through the insurer's or MA or CHIP managed care plan's publicly accessible Internet website and provider portal.

(2) Each medical policy developed by an insurer or MA or CHIP managed care plan shall identify the clinical review criteria used in the policy's development. The insurer or MA or CHIP managed care plan shall identify any third-party licensure restrictions preventing disclosure of all or part of clinical review criteria.

(3) An insurer or MA or CHIP managed care plan shall review each adopted medical policy on at least an annual basis.

(1) Clinical review criteria adopted by an insurer or MA or CHIP managed care plan shall, at the time of medical policy development or review:

(2) Nothing in this act shall require an insurer or MA or CHIP managed care plan to provide coverage for a health care service to a covered person or enrollee that is otherwise excluded from coverage under a health insurance policy or an agreement with the Department of Human Services.