North Dakota § 26.1-36.12-15 Effect of change in prior authorization clinical criteria

North Dakota Statutes

§ 26.1-36.12-15 — Effect of change in prior authorization clinical criteria

North Dakota § 26.1-36.12-15

Title 26.1Insurance

Ch. 26.1-36.12Prior Authorization for Health Insurance

This text of North Dakota § 26.1-36.12-15 (Effect of change in prior authorization clinical criteria) is published on Counsel Stack Legal Research, covering North Dakota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

N.D. Cent. Code § 26.1-36.12-15 (2026).

Text

1.If, during a plan year, a prior authorization review organization changes coverage terms for a health care service or the clinical criteria used to conduct prior authorizations for a health care service, the change in coverage terms or in clinical criteria does not apply until the next plan year for any enrollee who received prior authorization for a health care service using the coverage terms or clinical criteria in effect before the effective date of the change.

2.This section does not apply if a prior authorization review organization changes coverage terms for a drug or device that has been:

a.Deemed unsafe by the United States food and drug administration; or

b.Withdrawn by the United States food and drug administration or product manufacturer.

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1. If, during a plan year, a prior authorization review organization changes coverage
terms for a health care service or the clinical criteria used to conduct prior
authorizations for a health care service, the change in coverage terms or in clinical
criteria does not apply until the next plan year for any enrollee who received prior
authorization for a health care service using the coverage terms or clinical criteria in
effect before the effective date of the change.
2. This section does not apply if a prior authorization review organization changes
coverage terms for a drug or device that has been:
a. Deemed unsafe by the United States food and drug administration; or
b. Withdrawn by the United States food and drug administration or product
manufacturer.