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Medical Necessity in Private Health Plans

Table 5. State Independent Review Statutes and Regulations

Jurisdiction IRO Statute (X if yes) IRO Regulations (X if yes) Citations
Alabama      
Alaska X   Alaska Stat. § 21.07.050 (2001)
Arizona X   Arizona Rev. Stat. § 20-2537 (2001)
Arkansas      
California X X Cal. Ins. Code § 10169 (2001) Proposed Regulation at Cal. Reg. Law Bulletin 2001-39 CRLB 500 (Sept. 28, 2001)
Colorado X X Colo. Rev. Stat. § 10-16-113.5 Colo. Ins. Reg. 4-2-21 (2000)
Connecticut X X Conn. Gen. Stat. § 38a-478n (2001)
Conn. Agencies Regs. §§ 38a-478n-1 to 5 (2001)
Delaware X   Del Code tit. 16 § 9119 (2001)
District of Columbia X   D.C. Code § 44-301.07 (2001)
Florida X   Fl. Stat. §§ 408.7056 (2001)
Georgia X   Ga. Code § 33-20A-32 (2001)
Hawaii X   Hi. Rev. Stat. § 432E-6 (2001)
Idaho      
Illinois X   215 Ill. Comp. Stat. 125, § 4-10 (2001)
Indiana X   Ind. Code § 27-13-10.1-1 (2001)
Iowa X   Iowa Code §§ 514J.1 to .14 (2001)
Kansas X   Kan. Stat. §§ 40-22a13-16 (2000)
Kentucky X   Ky. Stat. § 304.17A-623 (2001)
Louisiana X   La. Rev. Stat. § 22:3081 (2001)
Maine X   Me. Rev. Stat. tit. 24-A § 4323 (2001)
Maryland X X Md. Ins. Code § 15-10A-03 (2001)
Massachusetts X X Mass. Gen. Laws ch. 1760, § 14 (2001) 105 C.M.R. 128.00 (2001)
Michigan X   Mich. Comp. Laws §§ 550.1901-1929 (2001)
Minnesota X   Minn. Stat. § 62Q.73 (2000)
Mississippi      
Missouri X X Mo. Rev. Stat. § 376.1385 (2000) 20 C.S.R. 100-5.020 (2001)
Montana X X Mont. Code § 33-37-102 (2001)Mont. Admin. R. § 37.108.315 (2001)
Nebraska      
Nevada      
New Hampshire X   N.H. Rev. Stat. 420-J:5 (2000)
New Jersey X X N.J. Stat. §§ 26:2S-11 to 26:2S-12 (2001)N.J. Adm. Code § 8:38A-3.6
New Mexico X X N.M. Stat. Ann. § 59-A-57-1 (2001)
N.M. Adm. Code tit. 13, § 10.17.24 (2001)
New York X X N.Y. Ins. Law § 4910 (2001) 11 N.Y.C.R.R. § 410.1 (2001)
North Carolina X   2001 N.C. Sess. Laws 446 (S.B. 199) (2001)
North Dakota      
Ohio X   Ohio Rev. Code § 1751.84 (2001)
Oklahoma X   Okla. Stat. tit. 63, § 2528.3 (2001)
Oregon X   Or. Legis. ch. 266 (effective date July 1, 2002)
Pennsylvania X X 40 Pa. Stat. § 991.2162 (2001) 28 Pa. Code § 9.501 (2001)
Rhode Island X X R.I. Gen. Laws § 23-17.12-10 (2001) R23-17.12-I-UR (2001)
South Carolina X   S.C. Code §§ 38-71-1910-2060
South Dakota      
Tennessee X   Tenn. Code § 56-32-227 (2001)
Texas X X Tex. Ins. Code art. 21.58A 28 Tex. Adm. Code 12.5 (2001)
Utah X X Utah Code § 31A-22-629 (2001) Proposed Regulation at 2001-23 Utah Bull. 126 (Dec. 1, 2001)
Vermont X X

For Physical Health Services:
VT. Stat. tit. 8, § 4089f (2001)
Regulation H-99-1 (2001)

For Mental Health Services:
VT. Stat. Tit. 8, § 4089a (2001) Regulation 95-2 (2001)

Virginia X X Va. Code §§ 38.2-5900 - 5905 (2001) 14 VAC 5-215-10 (2001)
Washington X X Wash. Rev. Code § 48.43.535 (2001) WAC § 246-305-050 (2001)
West Virginia X   W.Va. Code § 33-25C-6 (effective July 1, 2002)
Wisconsin      
Wyoming      

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