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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>74476</law_id><section_number>32.1-137.16</section_number><catch_line>Records</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>32.1-137.6</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="32.1">Health</unit><unit label="chapter" level="2" order_by="1" identifier="5">Regulation of Medical Care Facilities and Services</unit><unit label="article" level="3" order_by="1" identifier="1.2">Utilization Review Standards and Appeals</unit></structure><text>
						<section><p>Every entity subject to Article 1.1 (&#xA7;&#xA0;<a class="law" title="Definitions" href="/32.1-137.1/">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 <span class="dictionary">Department</span>, records of review procedures; the health care qualifications of the entity&#x2019;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 <span class="dictionary">final adverse determinations</span> and <span class="dictionary">appeals</span> thereof, including a separate record for expedited <span class="dictionary">appeals</span>; and procedures to ensure confidentiality of medical records and personal information. Records of complaints under Article 1.1 (&#xA7;&#xA0;<a class="law" title="Definitions" href="/32.1-137.1/">32.1-137.1</a> et seq.) shall be maintained from the date of the entity&#x2019;s last examination and for no less than six years.
		Every entity subject to utilization review under this article shall provide, upon request of the <span class="dictionary">Commissioner</span>, data and records pertaining to utilization review from which patient and <span class="dictionary">provider</span> identifiers have been removed. Records shall be maintained or caused to be maintained by the <span class="dictionary">utilization review entity</span> for a period of six years, and all such records shall be subject to examination by the <span class="dictionary">Commissioner</span> or his designee.</p></section></text><history>1998, c. 891; 2011, c. 788.</history><metadata></metadata></law>
