CODE OF VIRGINIA

REGULATIONS (§ 32.1-138.15)

The Department shall promulgate regulations, pursuant to the Administrative
Process Act (§ 2.2-4000 et seq.), to implement the provisions of this article,
which shall include, but not be limited to, the following items:

   1.  Minimum qualifications to perform review;

   2.  Procedures which require the private review agent to provide the attending
   physician an opportunity to consult with a physician advisor prior to issuance
   of a final denial in any case in which there is an initial recommendation to
   deny coverage;

   3.  Guidelines regarding access to and confidentiality of patient-specific
   medical records and information; and

   4.  Setting the amount of any fees required by this article, which shall be
   sufficient to pay for the administrative costs of regulation under this
   article.

HISTORY: 1990, c. 826, § 38.2-5309; 1998, c. 129.