{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-138.15.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-138.15.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-138.15.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-138.15.html"}],"law_id":66986,"edition_id":1,"section_id":66986,"structure_id":13616,"section_number":"32.1-138.15","catch_line":"Regulations","history":"1990, c. 826, \u00a7 38.2-5309; 1998, c. 129.","full_text":"The Department shall promulgate regulations, pursuant to the Administrative Process Act (\u00a7 2.2-4000 et seq.), to implement the provisions of this article, which shall include, but not be limited to, the following items:\n\n1\n\nMinimum qualifications to perform review;2\n\nProcedures 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\n\nGuidelines regarding access to and confidentiality of patient-specific medical records and information; and4\n\nSetting the amount of any fees required by this article, which shall be sufficient to pay for the administrative costs of regulation under this article.","order_by":null,"text":{"0":{"id":242823,"text":"The Department shall promulgate regulations, pursuant to the Administrative Process Act (\u00a7 2.2-4000 et seq.), to implement the provisions of this article, which shall include, but not be limited to, the following items:","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1,"next_prefix":"1"},"1":{"id":242824,"text":"Minimum qualifications to perform review;","type":"section","prefixes":["1"],"prefix":"1","entire_prefix":"1","prefix_anchor":"1","level":1,"prior_prefix":"","next_prefix":"2"},"2":{"id":242825,"text":"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;","type":"section","prefixes":["2"],"prefix":"2","entire_prefix":"2","prefix_anchor":"2","level":1,"prior_prefix":"1","next_prefix":"3"},"3":{"id":242826,"text":"Guidelines regarding access to and confidentiality of patient-specific medical records and information; and","type":"section","prefixes":["3"],"prefix":"3","entire_prefix":"3","prefix_anchor":"3","level":1,"prior_prefix":"2","next_prefix":"4"},"4":{"id":242827,"text":"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.","type":"section","prefixes":["4"],"prefix":"4","entire_prefix":"4","prefix_anchor":"4","level":1,"prior_prefix":"3"}},"ancestry":[{"id":13616,"edition_id":1,"name":"Private Review Agents","identifier":"2.1","label":"article","depth":3,"order_by":1,"parent_id":12728,"metadata":{},"date_created":"2026-06-26 03:45:23","date_modified":"2026-06-26 03:45:23","permalink":{"id":203197,"object_type":"structure","relational_id":13616,"identifier":"2.1","token":"32.1\/5\/2.1","url":"\/32.1\/5\/2.1\/","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":74883,"structure_id":13616,"section_number":"32.1-138.10","catch_line":"Expiration; renewal","url":"\/32.1-138.10\/","token":"32.1\/5\/2.1\/32.1-138.10","metadata":false},{"id":69661,"structure_id":13616,"section_number":"32.1-138.11","catch_line":"Denial; revocation","url":"\/32.1-138.11\/","token":"32.1\/5\/2.1\/32.1-138.11","metadata":false},{"id":54583,"structure_id":13616,"section_number":"32.1-138.12","catch_line":"Waiver of requirements of article","url":"\/32.1-138.12\/","token":"32.1\/5\/2.1\/32.1-138.12","metadata":false},{"id":73931,"structure_id":13616,"section_number":"32.1-138.13","catch_line":"Access to and confidentiality of patient-specific medical records and information","url":"\/32.1-138.13\/","token":"32.1\/5\/2.1\/32.1-138.13","metadata":false},{"id":63195,"structure_id":13616,"section_number":"32.1-138.14","catch_line":"No private right of action created","url":"\/32.1-138.14\/","token":"32.1\/5\/2.1\/32.1-138.14","metadata":false},{"id":66986,"structure_id":13616,"section_number":"32.1-138.15","catch_line":"Regulations","url":"\/32.1-138.15\/","token":"32.1\/5\/2.1\/32.1-138.15","metadata":false},{"id":63369,"structure_id":13616,"section_number":"32.1-138.6","catch_line":"Definitions","url":"\/32.1-138.6\/","token":"32.1\/5\/2.1\/32.1-138.6","metadata":false},{"id":75335,"structure_id":13616,"section_number":"32.1-138.7","catch_line":"Certificates of registration required; issuance; transferability; regulations","url":"\/32.1-138.7\/","token":"32.1\/5\/2.1\/32.1-138.7","metadata":false},{"id":67769,"structure_id":13616,"section_number":"32.1-138.8","catch_line":"Consultation with health regulatory boards","url":"\/32.1-138.8\/","token":"32.1\/5\/2.1\/32.1-138.8","metadata":false},{"id":56657,"structure_id":13616,"section_number":"32.1-138.9","catch_line":"Standards for approval","url":"\/32.1-138.9\/","token":"32.1\/5\/2.1\/32.1-138.9","metadata":false}],"previous_section":{"id":63195,"structure_id":13616,"section_number":"32.1-138.14","catch_line":"No private right of action created","url":"\/32.1-138.14\/","token":"32.1\/5\/2.1\/32.1-138.14","metadata":false},"next_section":{"id":63369,"structure_id":13616,"section_number":"32.1-138.6","catch_line":"Definitions","url":"\/32.1-138.6\/","token":"32.1\/5\/2.1\/32.1-138.6","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-138.15\/","history_text":"

This law was first created in 1990. The record of its establishment is cataloged in chapter 826 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. Unfortunately, the 1990 \u201cActs\u201d aren\u2019t available online. 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 1998, chapter 129<\/a>.<\/p>","references":[{"id":56657,"section_number":"32.1-138.9","catch_line":"Standards for approval","order_by":null,"url":"\/32.1-138.9\/"}],"refers_to":[{"id":86911,"section_number":"2.2-4000","catch_line":"Short title; purpose","order_by":null,"url":"\/2.2-4000\/"}],"permalink":{"id":203219,"object_type":"law","relational_id":66986,"identifier":"32.1-138.15","token":"32.1\/5\/2.1\/32.1-138.15","url":"\/32.1-138.15\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-138.15\/","token":"32.1\/5\/2.1\/32.1-138.15","dublin_core":{"Title":"Regulations","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-138.15","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

The Department<\/span> shall promulgate regulations, pursuant to the Administrative Process Act (\u00a7 2.2-4000<\/a> et seq.), to implement the provisions of this article, which shall include, but not be limited to, the following items:<\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Minimum qualifications to perform review; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Procedures which require the private review agent<\/span> to provide the attending physician an opportunity to consult with a physician advisor<\/span> prior to issuance of a final denial in any case in which there is an initial recommendation to deny coverage; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Guidelines regarding access to and confidentiality of patient-specific medical records and information; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> 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. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nREGULATIONS (\u00a7 32.1-138.15)\n\nThe Department shall promulgate regulations, pursuant to the Administrative\nProcess Act (\u00a7 2.2-4000 et seq.), to implement the provisions of this article,\nwhich shall include, but not be limited to, the following items:\n\n1. Minimum qualifications to perform review;\n\n2. Procedures which require the private review agent to provide the attending\nphysician an opportunity to consult with a physician advisor prior to issuance\nof a final denial in any case in which there is an initial recommendation to\ndeny coverage;\n\n3. Guidelines regarding access to and confidentiality of patient-specific\nmedical records and information; and\n\n4. Setting the amount of any fees required by this article, which shall be\nsufficient to pay for the administrative costs of regulation under this article.\n\nHISTORY: 1990, c. 826, \u00a7 38.2-5309; 1998, c. 129.","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}}