{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3566.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3566.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3566.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3566.html"}],"law_id":59040,"edition_id":1,"section_id":59040,"structure_id":14588,"section_number":"38.2-3566","catch_line":"Approval of independent review organizations","history":"2011, c. 788.","full_text":"A\n\nEach independent review organization that wishes to be eligible to conduct external reviews shall submit an application to the Commission for approval or reapproval. The Commission may charge a reasonable fee for initial approval and each reapproval.B\n\nThe Commission shall approve independent review organizations that meet the minimum qualifications to conduct external reviews. Such approval is not subject to the Virginia Public Procurement Act (§ 2.2-4300 et seq.).C\n\nAn independent review organization is eligible for approval if it is accredited by a nationally recognized private accrediting entity that the Commission has determined has standards that are equivalent to or at least meet the minimum qualifications for independent review organizations.D\n\nAn approval or reapproval is effective for two years, unless the Commission determines before its expiration that the independent review organization is not satisfying the minimum qualifications or its decisions have been consistently unclear or incomplete. Whenever the Commission determines that an independent review organization has lost its accreditation or does not meet the requirements of this subsection, the Commission shall terminate the approval of the independent review organization and remove it from the list of independent review organizations approved to conduct external reviews.E\n\nThe Commission shall maintain and periodically update a list of approved independent review organizations.F\n\nThe assignment by the Commission of an approved independent review organization shall be done on a random basis, taking into consideration the nature of the health care service or treatment.","order_by":null,"text":{"0":{"id":216474,"text":"Each independent review organization that wishes to be eligible to conduct external reviews shall submit an application to the Commission for approval or reapproval. The Commission may charge a reasonable fee for initial approval and each reapproval.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":216475,"text":"The Commission shall approve independent review organizations that meet the minimum qualifications to conduct external reviews. Such approval is not subject to the Virginia Public Procurement Act (§ 2.2-4300 et seq.).","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":216476,"text":"An independent review organization is eligible for approval if it is accredited by a nationally recognized private accrediting entity that the Commission has determined has standards that are equivalent to or at least meet the minimum qualifications for independent review organizations.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":216477,"text":"An approval or reapproval is effective for two years, unless the Commission determines before its expiration that the independent review organization is not satisfying the minimum qualifications or its decisions have been consistently unclear or incomplete. Whenever the Commission determines that an independent review organization has lost its accreditation or does not meet the requirements of this subsection, the Commission shall terminate the approval of the independent review organization and remove it from the list of independent review organizations approved to conduct external reviews.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":216478,"text":"The Commission shall maintain and periodically update a list of approved independent review organizations.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"5":{"id":216479,"text":"The assignment by the Commission of an approved independent review organization shall be done on a random basis, taking into consideration the nature of the health care service or treatment.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E"}},"ancestry":[{"id":14588,"edition_id":1,"name":"Health Carrier Internal Appeal Process and External Review","identifier":"35.1","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:48:47","date_modified":"2026-06-26 03:48:47","permalink":{"id":215937,"object_type":"structure","relational_id":14588,"identifier":"35.1","token":"38.2\/35.1","url":"\/38.2\/35.1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":58140,"structure_id":14588,"section_number":"38.2-3556","catch_line":"Definitions","url":"\/38.2-3556\/","token":"38.2\/35.1\/38.2-3556","metadata":false},{"id":56086,"structure_id":14588,"section_number":"38.2-3557","catch_line":"Scope of chapter","url":"\/38.2-3557\/","token":"38.2\/35.1\/38.2-3557","metadata":false},{"id":56843,"structure_id":14588,"section_number":"38.2-3558","catch_line":"Health carrier's internal appeal process","url":"\/38.2-3558\/","token":"38.2\/35.1\/38.2-3558","metadata":false},{"id":77920,"structure_id":14588,"section_number":"38.2-3559","catch_line":"Notice of right to external review","url":"\/38.2-3559\/","token":"38.2\/35.1\/38.2-3559","metadata":false},{"id":65207,"structure_id":14588,"section_number":"38.2-3560","catch_line":"Exhaustion of internal appeal process","url":"\/38.2-3560\/","token":"38.2\/35.1\/38.2-3560","metadata":false},{"id":66856,"structure_id":14588,"section_number":"38.2-3561","catch_line":"Standard external review","url":"\/38.2-3561\/","token":"38.2\/35.1\/38.2-3561","metadata":false},{"id":83961,"structure_id":14588,"section_number":"38.2-3562","catch_line":"Expedited external review","url":"\/38.2-3562\/","token":"38.2\/35.1\/38.2-3562","metadata":false},{"id":63745,"structure_id":14588,"section_number":"38.2-3563","catch_line":"External review of experimental or investigational treatment adverse determinations","url":"\/38.2-3563\/","token":"38.2\/35.1\/38.2-3563","metadata":false},{"id":78633,"structure_id":14588,"section_number":"38.2-3564","catch_line":"Binding nature of external review decision","url":"\/38.2-3564\/","token":"38.2\/35.1\/38.2-3564","metadata":false},{"id":63044,"structure_id":14588,"section_number":"38.2-3565","catch_line":"Minimum qualifications for independent review organizations","url":"\/38.2-3565\/","token":"38.2\/35.1\/38.2-3565","metadata":false},{"id":59040,"structure_id":14588,"section_number":"38.2-3566","catch_line":"Approval of independent review organizations","url":"\/38.2-3566\/","token":"38.2\/35.1\/38.2-3566","metadata":false},{"id":79665,"structure_id":14588,"section_number":"38.2-3567","catch_line":"Independent review organizations to be held harmless","url":"\/38.2-3567\/","token":"38.2\/35.1\/38.2-3567","metadata":false},{"id":81396,"structure_id":14588,"section_number":"38.2-3568","catch_line":"External review reporting requirements","url":"\/38.2-3568\/","token":"38.2\/35.1\/38.2-3568","metadata":false},{"id":75481,"structure_id":14588,"section_number":"38.2-3569","catch_line":"Funding of external review","url":"\/38.2-3569\/","token":"38.2\/35.1\/38.2-3569","metadata":false},{"id":83489,"structure_id":14588,"section_number":"38.2-3570","catch_line":"Disclosure requirements","url":"\/38.2-3570\/","token":"38.2\/35.1\/38.2-3570","metadata":false},{"id":56157,"structure_id":14588,"section_number":"38.2-3571","catch_line":"Regulations","url":"\/38.2-3571\/","token":"38.2\/35.1\/38.2-3571","metadata":false}],"previous_section":{"id":63044,"structure_id":14588,"section_number":"38.2-3565","catch_line":"Minimum qualifications for independent review organizations","url":"\/38.2-3565\/","token":"38.2\/35.1\/38.2-3565","metadata":false},"next_section":{"id":79665,"structure_id":14588,"section_number":"38.2-3567","catch_line":"Independent review organizations to be held harmless","url":"\/38.2-3567\/","token":"38.2\/35.1\/38.2-3567","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3566\/","history_text":"

This law was first created in 2011. The record of its establishment is cataloged in chapter 788<\/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":70034,"section_number":"2.2-4300","catch_line":"Short title; purpose; declaration of intent","order_by":null,"url":"\/2.2-4300\/"}],"permalink":{"id":215979,"object_type":"law","relational_id":59040,"identifier":"38.2-3566","token":"38.2\/35.1\/38.2-3566","url":"\/38.2-3566\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3566\/","token":"38.2\/35.1\/38.2-3566","dublin_core":{"Title":"Approval of independent review organizations","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3566","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Each independent review organization<\/span> that wishes to be eligible to conduct external reviews shall submit an application to the Commission<\/span> for approval or reapproval. The Commission<\/span> may charge a reasonable fee for initial approval and each reapproval. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The Commission<\/span> shall approve independent review organizations<\/span> that meet the minimum qualifications to conduct external reviews. Such approval is not subject to the Virginia Public Procurement Act (§ 2.2-4300<\/a> et seq.). <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> An independent review organization<\/span> is eligible for approval if it is accredited by a nationally recognized private accrediting entity that the Commission<\/span> has determined has standards that are equivalent to or at least meet the minimum qualifications for independent review organizations<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> An approval or reapproval is effective for two years, unless the Commission<\/span> determines before its expiration that the independent review organization<\/span> is not satisfying the minimum qualifications or its decisions have been consistently unclear or incomplete. Whenever the Commission<\/span> determines that an independent review organization<\/span> has lost its accreditation or does not meet the requirements of this subsection, the Commission<\/span> shall terminate the approval of the independent review organization<\/span> and remove it from the list of independent review organizations<\/span> approved to conduct external reviews. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> The Commission<\/span> shall maintain and periodically update a list of approved independent review organizations<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> The assignment by the Commission<\/span> of an approved independent review organization<\/span> shall be done on a random basis, taking into consideration the nature of the health care service or treatment. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nAPPROVAL OF INDEPENDENT REVIEW ORGANIZATIONS (\u00a7 38.2-3566)\n\nA. Each independent review organization that wishes to be eligible to conduct\nexternal reviews shall submit an application to the Commission for approval or\nreapproval. The Commission may charge a reasonable fee for initial approval and\neach reapproval.\n\nB. The Commission shall approve independent review organizations that meet the\nminimum qualifications to conduct external reviews. Such approval is not subject\nto the Virginia Public Procurement Act (§ 2.2-4300 et seq.).\n\nC. An independent review organization is eligible for approval if it is\naccredited by a nationally recognized private accrediting entity that the\nCommission has determined has standards that are equivalent to or at least meet\nthe minimum qualifications for independent review organizations.\n\nD. An approval or reapproval is effective for two years, unless the Commission\ndetermines before its expiration that the independent review organization is not\nsatisfying the minimum qualifications or its decisions have been consistently\nunclear or incomplete. Whenever the Commission determines that an independent\nreview organization has lost its accreditation or does not meet the requirements\nof this subsection, the Commission shall terminate the approval of the\nindependent review organization and remove it from the list of independent\nreview organizations approved to conduct external reviews.\n\nE. The Commission shall maintain and periodically update a list of approved\nindependent review organizations.\n\nF. The assignment by the Commission of an approved independent review\norganization shall be done on a random basis, taking into consideration the\nnature of the health care service or treatment.\n\nHISTORY: 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}}