No. 40545 (5-year Review): Rule R590-261. Health Benefit Plan Adverse Benefit Determinations

DAR File No.: 40545
Filed: 06/23/2016 03:43:20 PM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Subsection 31A-2-201(3)(4) empowers the commissioner to make rules to implement the provisions of Title 31A. Subsection 31A-2-212(5)(b) requires the commissioner to require compliance with the Patient Protection and Affordable Care Act and administrative rules adopted by the commissioner related to regulation of health benefit plans. Subsection 31A-22-629(4) requires the commissioner to adopt rules that establish standards for independent reviews.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

The department has received no written comments during the last five years.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule must be continued because it implements standards that are required by the Patient Protection and Affordable Care Act. It provides a uniform standard for the establishment and maintenance of an independent review procedure to assure that a claimant has the opportunity for an independent review of a final adverse benefit determination.

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Insurance
Administration
Room 3110 STATE OFFICE BLDG
450 N MAIN ST
SALT LAKE CITY, UT 84114-1201

Direct questions regarding this rule to:

• Steve Gooch at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at [e-mail]

Effective:

06/23/2016

Authorized by:

Steve Gooch, Information Specialist

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