"Utilization review determination" defined

Sec. 8. (a) As used in this chapter, "utilization review determination" means the rendering of a decision based on utilization review that denies or affirms either of the following: (1) The necessity or appropriateness of the allocation of resources. (2) The provision or proposed provision of health care services to a covered individual. (b) The term does not include the identification of alternative, optional medical care that: (1) requires the approval of the covered individual; and (2) does not affect coverage or benefits if rejected by the covered individual. As added by P.L.128-1992, SEC.1.