Sec 36-2947. Program contractors; additional responsibilities

A. Program contractors shall establish and submit to the director for the director's approval utilization control systems comprised of prior authorization, concurrent review and retrospective review of services.

B. If a member is no longer eligible for the system, the program contractor and the department shall notify the administration in accordance with rules adopted pursuant to section 36-2932, subsection G. If that member may be eligible for services under article 1 of this chapter, the program contractor shall refer the person to the administration and arrange for the transfer of records to the appropriate provider as defined in section 36-2901 on notice by the administration.