Table 3.5 Utilization Review and Prior Authorization

CA

CO

CT

FL

IA

KS

MI

MS

MT

NH

NY

PA

TX

UT

VA

Utilization review process

X

X

X

X

X

X

X

X

X

X

Prior authorization prohibited for certain procedures

X

X

X

X

X

X

Reviewers clinically competent

X

X

Time limits for prior authorization

X

X

24-hour telephone access for prior authorization

X

X

Assessment of under-utilization required

X

X

X

X

X

X

Required to use review or authorization for mental health and substance abuse

Required to use review or authorization for dual diagnosis

Provision for expedited prior authorization

X