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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>66986</law_id><section_number>32.1-138.15</section_number><catch_line>Regulations</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>32.1-138.9</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="2.1">Private Review Agents</unit></structure><text>
						<section><p>The <span class="dictionary">Department</span> shall promulgate regulations, pursuant to the Administrative Process Act (&#xA7;&#xA0;<a class="law" title="Short title; purpose" href="/2.2-4000/">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>
						<section id="1"><p><span class="prefix-number">1.</span> Minimum qualifications to perform review; <a id="paragraph-242824" class="section-permalink" href="https://vacode.org/32.1-138.15/#1"><i class="fa fa-link"/></a></p></section>
						<section id="2"><p><span class="prefix-number">2.</span> Procedures which require the <span class="dictionary">private review agent</span> to provide the attending physician an opportunity to consult with a <span class="dictionary">physician advisor</span> prior to issuance of a final denial in any case in which there is an initial recommendation to deny coverage; <a id="paragraph-242825" class="section-permalink" href="https://vacode.org/32.1-138.15/#2"><i class="fa fa-link"/></a></p></section>
						<section id="3"><p><span class="prefix-number">3.</span> Guidelines regarding access to and confidentiality of patient-specific medical records and information; and <a id="paragraph-242826" class="section-permalink" href="https://vacode.org/32.1-138.15/#3"><i class="fa fa-link"/></a></p></section>
						<section id="4"><p><span class="prefix-number">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. <a id="paragraph-242827" class="section-permalink" href="https://vacode.org/32.1-138.15/#4"><i class="fa fa-link"/></a></p></section></text><history>1990, c. 826, &#xA7; 38.2-5309; 1998, c. 129.</history><metadata></metadata></law>
