{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-137.4.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-137.4.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-137.4.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-137.4.html"}],"law_id":80091,"edition_id":1,"section_id":80091,"structure_id":15832,"section_number":"32.1-137.4","catch_line":"Examination, review or investigation","history":"1998, c. 891.","full_text":"A\n\nThe 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.\n\t\t\tIn 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\n\nAny 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\n\nEvery 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\n\nThe 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.","order_by":null,"text":{"0":{"id":286800,"text":"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.\n\t\t\tIn 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.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":286801,"text":"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.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":286802,"text":"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.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":286803,"text":"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.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":15832,"edition_id":1,"name":"Certificate of Quality Assurance of Managed Care Health Insurance Plan Licensees","identifier":"1.1","label":"article","depth":3,"order_by":1,"parent_id":12728,"metadata":{},"date_created":"2026-06-26 04:00:17","date_modified":"2026-06-26 04:00:17","permalink":{"id":203095,"object_type":"structure","relational_id":15832,"identifier":"1.1","token":"32.1\/5\/1.1","url":"\/32.1\/5\/1.1\/","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":61229,"structure_id":15832,"section_number":"32.1-137.1","catch_line":"Definitions","url":"\/32.1-137.1\/","token":"32.1\/5\/1.1\/32.1-137.1","metadata":false},{"id":80679,"structure_id":15832,"section_number":"32.1-137.2","catch_line":"Certification of quality assurance; application; issuance; denial; renewal","url":"\/32.1-137.2\/","token":"32.1\/5\/1.1\/32.1-137.2","metadata":false},{"id":84080,"structure_id":15832,"section_number":"32.1-137.3","catch_line":"Regulations","url":"\/32.1-137.3\/","token":"32.1\/5\/1.1\/32.1-137.3","metadata":false},{"id":80091,"structure_id":15832,"section_number":"32.1-137.4","catch_line":"Examination, review or investigation","url":"\/32.1-137.4\/","token":"32.1\/5\/1.1\/32.1-137.4","metadata":false},{"id":61098,"structure_id":15832,"section_number":"32.1-137.5","catch_line":"Civil penalties; probation; suspension; restriction or prohibition of new enrollments to managed care health insurance plan licensee; revocation or nonrenewal of certificate of quality assurance; appeal process; correction","url":"\/32.1-137.5\/","token":"32.1\/5\/1.1\/32.1-137.5","metadata":false},{"id":74118,"structure_id":15832,"section_number":"32.1-137.6","catch_line":"Complaint system","url":"\/32.1-137.6\/","token":"32.1\/5\/1.1\/32.1-137.6","metadata":false}],"previous_section":{"id":84080,"structure_id":15832,"section_number":"32.1-137.3","catch_line":"Regulations","url":"\/32.1-137.3\/","token":"32.1\/5\/1.1\/32.1-137.3","metadata":false},"next_section":{"id":61098,"structure_id":15832,"section_number":"32.1-137.5","catch_line":"Civil penalties; probation; suspension; restriction or prohibition of new enrollments to managed care health insurance plan licensee; revocation or nonrenewal of certificate of quality assurance; appeal process; correction","url":"\/32.1-137.5\/","token":"32.1\/5\/1.1\/32.1-137.5","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-137.4\/","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.<\/p>","references":[{"id":60253,"section_number":"2.2-3705.5","catch_line":"Exclusions to application of chapter; health and social services records","order_by":null,"url":"\/2.2-3705.5\/"}],"refers_to":[{"id":84080,"section_number":"32.1-137.3","catch_line":"Regulations","order_by":null,"url":"\/32.1-137.3\/"},{"id":61098,"section_number":"32.1-137.5","catch_line":"Civil penalties; probation; suspension; restriction or prohibition of new enrollments to managed care health insurance plan licensee; revocation or nonrenewal of certificate of quality assurance; appeal process; correction","order_by":null,"url":"\/32.1-137.5\/"}],"permalink":{"id":203109,"object_type":"law","relational_id":80091,"identifier":"32.1-137.4","token":"32.1\/5\/1.1\/32.1-137.4","url":"\/32.1-137.4\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-137.4\/","token":"32.1\/5\/1.1\/32.1-137.4","dublin_core":{"Title":"Examination, review or investigation","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-137.4","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The Commissioner<\/span> 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<\/a>.\n\t\t\tIn lieu of or in addition to making his own examination of the managed care health insurance plan licensee, the Commissioner<\/span> may accept the report of an examination of the licensee under similar laws<\/span> of another state, similar regulatory agency, state health commissioner<\/span>, or accreditation entity. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Any examiner authorized by the Commissioner<\/span> 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<\/span> copied or recorded or received shall be privileged and confidential and shall not be subject to subpoena<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Every person<\/span> 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<\/span> delivering health care services under contract<\/span>, 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<\/span> copied or recorded or received shall be privileged and confidential, and shall not be subject to subpoena<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> 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<\/span>, denial, or nonrenewal of any certificate of quality assurance held by the licensee. Any such proceedings for suspension, revocation<\/span>, denial or nonrenewal of any certificate shall be conducted pursuant to § 32.1-137.5<\/a>. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nEXAMINATION, REVIEW OR INVESTIGATION (\u00a7 32.1-137.4)\n\nA. The Commissioner shall cause each managed care health insurance plan licensee\nsubject to certification under this article to be examined or reviewed for each\nnew application and to be periodically examined or reviewed at reasonable times\nthereafter, including both for complaint investigation and for renewal\ncompliance. Such examinations or reviews shall consider the compliance of the\nmanaged care health insurance plan licensee with the regulations promulgated\nunder § 32.1-137.3.\n\t\t\tIn lieu of or in addition to making his own examination of the managed care\nhealth insurance plan licensee, the Commissioner may accept the report of an\nexamination of the licensee under similar laws of another state, similar\nregulatory agency, state health commissioner, or accreditation entity.\n\nB. Any examiner authorized by the Commissioner shall, so far as necessary for\nthe purposes of the examination or review, have access during regular business\nhours to the premises and to any books, records, files, or property of the\nlicensee as far as they directly relate to the quality of care provided by the\nlicensee. All material copied or recorded or received shall be privileged and\nconfidential and shall not be subject to subpoena.\n\nC. Every person from whom information is sought, in an investigation of a\ncomplaint pursuant to this article against a managed care health insurance plan\nlicensee, shall cooperate in producing or allowing reasonable access during\nregular business hours to the books, records, files, accounts, papers,\ndocuments, and any or all computer or other recordings of the licensee being\nexamined or those of any person delivering health care services under contract,\naffiliation, delegation or other arrangement directly relevant to the\ninvestigation. Such information shall be limited to that which is relevant to\nthe investigation in question, as specified in regulations promulgated pursuant\nto this article. All material copied or recorded or received shall be privileged\nand confidential, and shall not be subject to subpoena.\n\nD. The refusal of any licensee, by its officers, directors, employees or agents,\nto submit to examination or review or to comply with any reasonable written\nrequest of the examiners shall be grounds for suspension, revocation, denial, or\nnonrenewal of any certificate of quality assurance held by the licensee. Any\nsuch proceedings for suspension, revocation, denial or nonrenewal of any\ncertificate shall be conducted pursuant to § 32.1-137.5.\n\nHISTORY: 1998, c. 891.","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}}