{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-137.8.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-137.8.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-137.8.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-137.8.html"}],"law_id":78307,"edition_id":1,"section_id":78307,"structure_id":14765,"section_number":"32.1-137.8","catch_line":"Application to and compliance by utilization review entities","history":"1998, cc. 129, 891.","full_text":"A\n\nNo utilization review entity shall perform utilization review with regard to hospital, medical or other health care resources rendered or proposed to be rendered to a covered person except in accordance with the requirements and standards set forth in this article.B\n\nThis article shall not apply to utilization review performed under contract with the federal government for utilization review of patients eligible for hospital services under Title XVIII of the Social Security Act or under contract with a plan otherwise exempt from operation of this chapter pursuant to the Employee Retirement Income Security Act of 1974.C\n\nThis article shall not apply to private review agents subject to Article 2.1 (§ 32.1-138.6 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia.D\n\nThis article shall not apply to programs administered by the Department of Medical Assistance Services or under contract with the Department of Medical Assistance Services.","order_by":null,"text":{"0":{"id":280706,"text":"No utilization review entity shall perform utilization review with regard to hospital, medical or other health care resources rendered or proposed to be rendered to a covered person except in accordance with the requirements and standards set forth in this article.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":280707,"text":"This article shall not apply to utilization review performed under contract with the federal government for utilization review of patients eligible for hospital services under Title XVIII of the Social Security Act or under contract with a plan otherwise exempt from operation of this chapter pursuant to the Employee Retirement Income Security Act of 1974.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":280708,"text":"This article shall not apply to private review agents subject to Article 2.1 (§ 32.1-138.6 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":280709,"text":"This article shall not apply to programs administered by the Department of Medical Assistance Services or under contract with the Department of Medical Assistance Services.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"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":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},"next_section":{"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},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-137.8\/","history_text":"

This law was first created in 1998. The record of its establishment is cataloged in chapters 129<\/a> and 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":false,"refers_to":[{"id":63369,"section_number":"32.1-138.6","catch_line":"Definitions","order_by":null,"url":"\/32.1-138.6\/"}],"permalink":{"id":203159,"object_type":"law","relational_id":78307,"identifier":"32.1-137.8","token":"32.1\/5\/1.2\/32.1-137.8","url":"\/32.1-137.8\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-137.8\/","token":"32.1\/5\/1.2\/32.1-137.8","dublin_core":{"Title":"Application to and compliance by utilization review entities","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-137.8","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No utilization review entity<\/span> shall perform utilization review with regard to hospital, medical or other health care resources rendered or proposed to be rendered to a covered person<\/span> except in accordance with the requirements and standards set forth in this article. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> This article shall not apply to utilization review performed under contract<\/span> with the federal government for utilization review of patients eligible for hospital services under Title XVIII of the Social Security Act or under contract<\/span> with a plan<\/span> otherwise exempt from operation of this chapter pursuant to the Employee Retirement Income Security Act of 1974. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> This article shall not apply to private review agents<\/span> subject to Article 2.1 (§ 32.1-138.6<\/a> et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> This article shall not apply to programs administered by the Department<\/span> of Medical Assistance Services or under contract<\/span> with the Department<\/span> of Medical Assistance Services. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nAPPLICATION TO AND COMPLIANCE BY UTILIZATION REVIEW ENTITIES (\u00a7 32.1-137.8)\n\nA. No utilization review entity shall perform utilization review with regard to\nhospital, medical or other health care resources rendered or proposed to be\nrendered to a covered person except in accordance with the requirements and\nstandards set forth in this article.\n\nB. This article shall not apply to utilization review performed under contract\nwith the federal government for utilization review of patients eligible for\nhospital services under Title XVIII of the Social Security Act or under contract\nwith a plan otherwise exempt from operation of this chapter pursuant to the\nEmployee Retirement Income Security Act of 1974.\n\nC. This article shall not apply to private review agents subject to Article 2.1\n(§ 32.1-138.6 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia.\n\nD. This article shall not apply to programs administered by the Department of\nMedical Assistance Services or under contract with the Department of Medical\nAssistance Services.\n\nHISTORY: 1998, cc. 129, 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}}