1. (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. (1) The necessity or appropriateness of the allocation of resources.
   2. (2) The provision or proposed provision of health care services to a covered individual.

2. (b) The term does not include the identification of alternative, optional medical care that:

   1. (1) requires the approval of the covered individual; and
   2. (2) does not affect coverage or benefits if rejected by the covered individual.

As added by P.L.128-1992, SEC.1.