Do UR Policies and Procedures and a description of the process have to be filed with the administrative director?

• A. Yes
• B. No
• C. Only if requested
• D. Only in the event of a dispute

Answer: (A)

Utilization review policies and procedures for a California self‑insured plan are required to be filed with the Administrative Director. This filing creates regulatory oversight of how medical necessity decisions are made, ensuring the process is defined, standardized, and auditable. The description of the process typically covers who conducts reviews, the criteria used, timelines, documentation standards, and appeal or external review options. Having these documents on file allows the Administrative Director to monitor compliance with laws and regulations and to ensure workers’ rights are protected through consistent and timely decision-making. Changes to the UR procedures generally must be filed as well to stay in line with regulatory requirements.