of the Amendments to the Medical Protocols Rule
Q. Will insurers that have currently approved Decision Point Review Plans have to file a new Plan to comply with the changes to the rule?
A. Yes. Insurers should follow standard filing procedures when making Decision Point Review Plan filings. In addition, insurers should determine if any of the their policy forms need to be refiled. Some insurers incorporated parts of their Decision Point Review Plans into their policy forms.
Q. What will happen if an insurer does not have a new plan approved by the October 27, 2004 operative date of the rule?
A. If an insurer does not have a new plan filed and approved by the October 27, 2004 operative date of the rule, those portions of its old plan that are inconsistent with the new rule will not be enforceable.
Q. How should insurers that use a vendor to administer their Decision Point Review Plans make their filings?
A. In order to make Department review of Decision Point Review Plans as efficient as possible, the Department will accept generic Decision Point Review Plan filings from vendors using the following procedure:
- Vendors should file a generic Decision Point Review Plan with the Department for approval.
- Once the vendor’s Plan is approved, the vendor’s insurer clients should make a filing with the Department of those plan documents that differ from those of the vendor as well as all Insured/Claimant and provider letters. The filing must show the changes from the vendor’s approved plan by bracketing and underlining. The filing must also include a certification from the insurer that, except as specifically indicated, there are no other changes from the vendor’s filing.
Q. Can Decision Point Review Plans be filed electronically?
A. Insurers and vendors can use the System for Electronic Rate and Form Filing (SERFF) to make plan filings electronically. Information about filing through SERFF is available here or call JaneBorcherding at 816-783-8475 . The Department will not accept filings by e-mail.
Q. Will the procedures in the new Decision Point Review Plans apply to claims that were opened under the old Decision Point Review Plans?
A. Insurers should include in their Decision Point Review Plans a transition plan that explains how the insurer will provide notice to its existing claimants about the provisions of its new Decision Point Review plan. The transition can be phased in over time for a period not to exceed 3 months.