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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>56657</law_id><section_number>32.1-138.9</section_number><catch_line>Standards for approval</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><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>Each <span class="dictionary">private review agent</span> shall file an application with the <span class="dictionary">Department</span> which shall meet the following minimum standards and any additional standards established by regulation pursuant to &#xA7;&#xA0;<a class="law" title="Regulations" href="/32.1-138.15/">32.1-138.15</a>, and pay a filing fee established by the <span class="dictionary">Department</span>, in <span class="dictionary">order</span> to be approved by the <span class="dictionary">Department</span>:</p></section>
						<section id="1"><p><span class="prefix-number">1.</span> A description of the procedures to be used in evaluating proposed or delivered hospital, medical, or other health care services; <a id="paragraph-207302" class="section-permalink" href="https://vacode.org/32.1-138.9/#1"><i class="fa fa-link"/></a></p></section>
						<section id="2"><p><span class="prefix-number">2.</span> The procedures by which patients or providers may seek reconsideration of determinations by <span class="dictionary">private review agents</span>; <a id="paragraph-207303" class="section-permalink" href="https://vacode.org/32.1-138.9/#2"><i class="fa fa-link"/></a></p></section>
						<section id="3"><p><span class="prefix-number">3.</span> The type and qualifications of the personnel either employed or under <span class="dictionary">contract</span> to perform the <span class="dictionary">utilization review</span>; <a id="paragraph-207304" class="section-permalink" href="https://vacode.org/32.1-138.9/#3"><i class="fa fa-link"/></a></p></section>
						<section id="4"><p><span class="prefix-number">4.</span> Procedures and policies which ensure that patient-specific medical records and information shall be kept strictly confidential except as authorized by the patient or by regulations adopted pursuant to this article; and <a id="paragraph-207305" class="section-permalink" href="https://vacode.org/32.1-138.9/#4"><i class="fa fa-link"/></a></p></section>
						<section id="5"><p><span class="prefix-number">5.</span> Assurances that reviewers be readily accessible by telephone to patients and providers at least forty hours per week during normal business hours. <a id="paragraph-207306" class="section-permalink" href="https://vacode.org/32.1-138.9/#5"><i class="fa fa-link"/></a></p></section></text><history>1990, c. 826, &#xA7; 38.2-5302; 1998, c. 129.</history><metadata></metadata></law>
