CODE OF VIRGINIA

EXAMINATION, REVIEW OR INVESTIGATION (§ 32.1-137.4)

A. The Commissioner shall cause each managed care health insurance plan licensee
subject to certification under this article to be examined or reviewed for each
new application and to be periodically examined or reviewed at reasonable times
thereafter, including both for complaint investigation and for renewal
compliance. Such examinations or reviews shall consider the compliance of the
managed care health insurance plan licensee with the regulations promulgated
under § 32.1-137.3.In lieu of or in addition to making his own examination of
the managed care health insurance plan licensee, the Commissioner may accept the
report of an examination of the licensee under similar laws of another state,
similar regulatory agency, state health commissioner, or accreditation entity.

B. Any examiner authorized by the Commissioner shall, so far as necessary for
the purposes of the examination or review, have access during regular business
hours to the premises and to any books, records, files, or property of the
licensee as far as they directly relate to the quality of care provided by the
licensee. All material copied or recorded or received shall be privileged and
confidential and shall not be subject to subpoena.

C. Every person from whom information is sought, in an investigation of a
complaint pursuant to this article against a managed care health insurance plan
licensee, shall cooperate in producing or allowing reasonable access during
regular business hours to the books, records, files, accounts, papers,
documents, and any or all computer or other recordings of the licensee being
examined or those of any person delivering health care services under contract,
affiliation, delegation or other arrangement directly relevant to the
investigation. Such information shall be limited to that which is relevant to
the investigation in question, as specified in regulations promulgated pursuant
to this article. All material copied or recorded or received shall be privileged
and confidential, and shall not be subject to subpoena.

D. The refusal of any licensee, by its officers, directors, employees or agents,
to submit to examination or review or to comply with any reasonable written
request of the examiners shall be grounds for suspension, revocation, denial, or
nonrenewal of any certificate of quality assurance held by the licensee. Any
such proceedings for suspension, revocation, denial or nonrenewal of any
certificate shall be conducted pursuant to § 32.1-137.5.

HISTORY: 1998, c. 891.