{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-137.16.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-137.16.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-137.16.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-137.16.html"}],"law_id":74476,"edition_id":1,"section_id":74476,"structure_id":14765,"section_number":"32.1-137.16","catch_line":"Records","history":"1998, c. 891; 2011, c. 788.","full_text":"Every entity subject to Article 1.1 (\u00a7 32.1-137.1 et seq.) of Chapter 5 and this article shall maintain or cause to be maintained, in writing and at a location accessible to employees of the Department, records of review procedures; the health care qualifications of the entity’s staff; the criteria used by the entity to make its determinations; records of complaints received, including the manner in which the complaints were resolved; the number and type of adverse determinations and reconsiderations; the number and outcome of final adverse determinations and appeals thereof, including a separate record for expedited appeals; and procedures to ensure confidentiality of medical records and personal information. Records of complaints under Article 1.1 (\u00a7 32.1-137.1 et seq.) shall be maintained from the date of the entity’s last examination and for no less than six years.\n\t\tEvery entity subject to utilization review under this article shall provide, upon request of the Commissioner, data and records pertaining to utilization review from which patient and provider identifiers have been removed. Records shall be maintained or caused to be maintained by the utilization review entity for a period of six years, and all such records shall be subject to examination by the Commissioner or his designee.","order_by":null,"text":{"0":{"id":267653,"text":"Every entity subject to Article 1.1 (\u00a7 32.1-137.1 et seq.) of Chapter 5 and this article shall maintain or cause to be maintained, in writing and at a location accessible to employees of the Department, records of review procedures; the health care qualifications of the entity’s staff; the criteria used by the entity to make its determinations; records of complaints received, including the manner in which the complaints were resolved; the number and type of adverse determinations and reconsiderations; the number and outcome of final adverse determinations and appeals thereof, including a separate record for expedited appeals; and procedures to ensure confidentiality of medical records and personal information. Records of complaints under Article 1.1 (\u00a7 32.1-137.1 et seq.) shall be maintained from the date of the entity’s last examination and for no less than six years.\n\t\tEvery entity subject to utilization review under this article shall provide, upon request of the Commissioner, data and records pertaining to utilization review from which patient and provider identifiers have been removed. Records shall be maintained or caused to be maintained by the utilization review entity for a period of six years, and all such records shall be subject to examination by the Commissioner or his designee.","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1}},"ancestry":[{"id":14765,"edition_id":1,"name":"Utilization Review Standards and Appeals","identifier":"1.2","label":"article","depth":3,"order_by":1,"parent_id":12728,"metadata":{},"date_created":"2026-06-26 03:49:48","date_modified":"2026-06-26 03:49:48","permalink":{"id":203121,"object_type":"structure","relational_id":14765,"identifier":"1.2","token":"32.1\/5\/1.2","url":"\/32.1\/5\/1.2\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12728,"edition_id":1,"name":"Regulation of Medical Care Facilities and Services","identifier":"5","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":202855,"object_type":"structure","relational_id":12728,"identifier":"5","token":"32.1\/5","url":"\/32.1\/5\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":56529,"structure_id":14765,"section_number":"32.1-137.10","catch_line":"Utilization review plan required","url":"\/32.1-137.10\/","token":"32.1\/5\/1.2\/32.1-137.10","metadata":false},{"id":83750,"structure_id":14765,"section_number":"32.1-137.11","catch_line":"Accessibility of utilization review entity","url":"\/32.1-137.11\/","token":"32.1\/5\/1.2\/32.1-137.11","metadata":false},{"id":86108,"structure_id":14765,"section_number":"32.1-137.12","catch_line":"Emergencies; extensions; access to and confidentiality of patient-specific medical records and information","url":"\/32.1-137.12\/","token":"32.1\/5\/1.2\/32.1-137.12","metadata":false},{"id":64658,"structure_id":14765,"section_number":"32.1-137.13","catch_line":"Adverse determination","url":"\/32.1-137.13\/","token":"32.1\/5\/1.2\/32.1-137.13","metadata":false},{"id":68683,"structure_id":14765,"section_number":"32.1-137.14","catch_line":"Reconsideration of adverse determination","url":"\/32.1-137.14\/","token":"32.1\/5\/1.2\/32.1-137.14","metadata":false},{"id":57196,"structure_id":14765,"section_number":"32.1-137.15","catch_line":"Adverse determination; appeal","url":"\/32.1-137.15\/","token":"32.1\/5\/1.2\/32.1-137.15","metadata":false},{"id":74476,"structure_id":14765,"section_number":"32.1-137.16","catch_line":"Records","url":"\/32.1-137.16\/","token":"32.1\/5\/1.2\/32.1-137.16","metadata":false},{"id":57237,"structure_id":14765,"section_number":"32.1-137.17","catch_line":"Limitation on Commissioner's jurisdiction","url":"\/32.1-137.17\/","token":"32.1\/5\/1.2\/32.1-137.17","metadata":false},{"id":72177,"structure_id":14765,"section_number":"32.1-137.7","catch_line":"Definitions","url":"\/32.1-137.7\/","token":"32.1\/5\/1.2\/32.1-137.7","metadata":false},{"id":78307,"structure_id":14765,"section_number":"32.1-137.8","catch_line":"Application to and compliance by utilization review entities","url":"\/32.1-137.8\/","token":"32.1\/5\/1.2\/32.1-137.8","metadata":false},{"id":59792,"structure_id":14765,"section_number":"32.1-137.9","catch_line":"Requirements and standards for utilization review entities","url":"\/32.1-137.9\/","token":"32.1\/5\/1.2\/32.1-137.9","metadata":false}],"previous_section":{"id":57196,"structure_id":14765,"section_number":"32.1-137.15","catch_line":"Adverse determination; appeal","url":"\/32.1-137.15\/","token":"32.1\/5\/1.2\/32.1-137.15","metadata":false},"next_section":{"id":57237,"structure_id":14765,"section_number":"32.1-137.17","catch_line":"Limitation on Commissioner's jurisdiction","url":"\/32.1-137.17\/","token":"32.1\/5\/1.2\/32.1-137.17","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-137.16\/","history_text":"

This law was first created in 1998. The record of its establishment is cataloged in chapter 891<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 1 time. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. That modification is as follows: in 2011, chapter 788<\/a>.<\/p>","references":[{"id":74118,"section_number":"32.1-137.6","catch_line":"Complaint system","order_by":null,"url":"\/32.1-137.6\/"}],"refers_to":[{"id":61229,"section_number":"32.1-137.1","catch_line":"Definitions","order_by":null,"url":"\/32.1-137.1\/"}],"permalink":{"id":203147,"object_type":"law","relational_id":74476,"identifier":"32.1-137.16","token":"32.1\/5\/1.2\/32.1-137.16","url":"\/32.1-137.16\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-137.16\/","token":"32.1\/5\/1.2\/32.1-137.16","dublin_core":{"Title":"Records","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-137.16","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

Every entity subject to Article 1.1 (\u00a7 32.1-137.1<\/a> et seq.) of Chapter 5 and this article shall maintain or cause to be maintained, in writing and at a location accessible to employees of the Department<\/span>, records of review procedures; the health care qualifications of the entity’s staff; the criteria used by the entity to make its determinations; records of complaints received, including the manner in which the complaints were resolved; the number and type of adverse determinations and reconsiderations; the number and outcome of final adverse determinations<\/span> and appeals<\/span> thereof, including a separate record for expedited appeals<\/span>; and procedures to ensure confidentiality of medical records and personal information. Records of complaints under Article 1.1 (\u00a7 32.1-137.1<\/a> et seq.) shall be maintained from the date of the entity’s last examination and for no less than six years.\n\t\tEvery entity subject to utilization review under this article shall provide, upon request of the Commissioner<\/span>, data and records pertaining to utilization review from which patient and provider<\/span> identifiers have been removed. Records shall be maintained or caused to be maintained by the utilization review entity<\/span> for a period of six years, and all such records shall be subject to examination by the Commissioner<\/span> or his designee.<\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nRECORDS (\u00a7 32.1-137.16)\n\nEvery entity subject to Article 1.1 (\u00a7 32.1-137.1 et seq.) of Chapter 5 and\nthis article shall maintain or cause to be maintained, in writing and at a\nlocation accessible to employees of the Department, records of review\nprocedures; the health care qualifications of the entity’s staff; the\ncriteria used by the entity to make its determinations; records of complaints\nreceived, including the manner in which the complaints were resolved; the number\nand type of adverse determinations and reconsiderations; the number and outcome\nof final adverse determinations and appeals thereof, including a separate record\nfor expedited appeals; and procedures to ensure confidentiality of medical\nrecords and personal information. Records of complaints under Article 1.1 (\u00a7\n32.1-137.1 et seq.) shall be maintained from the date of the entity’s last\nexamination and for no less than six years.\n\t\tEvery entity subject to utilization review under this article shall provide,\nupon request of the Commissioner, data and records pertaining to utilization\nreview from which patient and provider identifiers have been removed. Records\nshall be maintained or caused to be maintained by the utilization review entity\nfor a period of six years, and all such records shall be subject to examination\nby the Commissioner or his designee.\n\nHISTORY: 1998, c. 891; 2011, c. 788.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}