Ins-adverse Determination

Amends the Managed Care Reform and Patient Rights Act. Provides that if a health care plan uses an automated process to make an initial adverse determination or relies on a utilization review organization's automated process for an initial adverse determination, the health care plan shall ensure that any appeal is processed as required by the provisions, including the restriction that only a clinical peer may review an appeal. Provides that an automated process of a health care plan or registered utilization review program may make an initial adverse determination for services not included under specified provisions. Provides that utilization review programs that use automated processes to…