California Health and Safety Code

§ 1367.215

HSC § 1367.215 Effective Jan 1, 2003Div. 2 · Ch. 2.2 · Art. 5

Statute text

(a)Every health care service plan contract that covers prescription drug benefits shall provide coverage for appropriately prescribed pain management medications for terminally ill patients when medically necessary. The plan shall approve or deny the request by the provider for authorization of coverage for an enrollee who has been determined to be terminally ill in a timely fashion, appropriate for the nature of the enrollee’s condition, not to exceed 72 hours of the plan’s receipt of the information requested by the plan to make the decision. If the request is denied or if additional information is required, the plan shall contact the provider within one working day of the determination, with an explanation of the reason for the denial or the need for additional information. The requested treatment shall be deemed authorized as of the expiration of the applicable timeframe. The provider shall contact the plan within one business day of proceeding with the deemed authorized treatment, to do all of the following:

(1)Confirm that the timeframe has expired.

(2)Provide enrollee identification.

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Legislative history

Amended by Stats. 2002, Ch. 791, Sec. 2. Effective January 1, 2003.