Table 3: Key Program Requirements

Clinical Review Criteria

Prohibition Against Financial Incentives

Telephonic

Coverage

Specified

Quality Assurance Program

Delegated Oversight

UM Reviewer Requirements

Medical Director Requirements

Same State Licensure Requirement

Offshore Reviews Permitted

Alabama

x

x

x

x

x

Alaska

x

x

American Samoa

Arizona

x

x

x

x

x

x

Arkansas

x

x

x

x

x

x

California

x

x

x

x

x

x

x

x

Colorado

x

x

x

Connecticut

x

x

x

x

x

x

x

Delaware

x

x

x

x

x

x

x

District of Columbia

Florida

Georgia

x

x

x

x

x

x

Guam

Hawaii

x

x

x

Idaho

x

x

x

x

x

Illinois

x

x

x

x

x

x

Indiana

x

x

x

x

x

x

Iowa

x

x

Kansas

x

x

x

Kentucky

x

x

x

x

x

x

x

Louisiana

x

x

x

x

x

x

x

x

Maine

x

x

x

x

x

x

x

x

Maryland

x

x

x

x

x

Massachusetts

x

x

x

x

x

x

Michigan

Minnesota

x

x

x

x

x

x

x

Mississippi

x

x

x

x

x

Missouri

x

x

x

x

x

x

x

Montana

x

x

x

x

x

x

Nebraska

x

x

x

x

x

x

Nevada

x

x

x

x

New Hampshire

x

x

x

x

x

New Jersey

x

x

x

x

x

x

New Mexico

x

x

x

x

x

x

x

New York

x

x

x

x (for HMOs)

x

x

x

North Carolina

x

x

x

x

x

x

x

x

North Dakota

x

x

x

x

x

x

x

Ohio

x

x

x

x

x

x

Oklahoma

x

x

Oregon

x

x

x

x

x

x

Pennsylvania

x

x

x

x

Puerto Rico

x

x

x

x

x

Rhode Island

x

x

x

x

x

South Carolina

x

x

x

x

South Dakota

x

x

x

x

x

x

Tennessee

x

x

x

Texas

x

x

x

x

x

x

x

Utah

Vermont

x

x

x

x

x

x

x

x

Virgin Islands

Virginia

x

x

x (for MCHIPs)

x

x

x

Washington

x

x

x

x  (dental director only)

West Virginia

x

x

x

x

x

x

x

Wisconsin

Wyoming

x