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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>59040</law_id><section_number>38.2-3566</section_number><catch_line>Approval of independent review organizations</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="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="35.1">Health Carrier Internal Appeal Process and External Review</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> Each <span class="dictionary">independent review organization</span> that wishes to be eligible to conduct external reviews shall submit an application to the <span class="dictionary">Commission</span> for approval or reapproval. The <span class="dictionary">Commission</span> may charge a reasonable fee for initial approval and each reapproval. <a id="paragraph-216474" class="section-permalink" href="https://vacode.org/38.2-3566/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> The <span class="dictionary">Commission</span> shall approve <span class="dictionary">independent review organizations</span> that meet the minimum qualifications to conduct external reviews. Such approval is not subject to the Virginia Public Procurement Act (&#xA7; <a class="law" title="Short title; purpose; declaration of intent" href="/2.2-4300/">2.2-4300</a> et seq.). <a id="paragraph-216475" class="section-permalink" href="https://vacode.org/38.2-3566/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> An <span class="dictionary">independent review organization</span> is eligible for approval if it is accredited by a nationally recognized private accrediting entity that the <span class="dictionary">Commission</span> has determined has standards that are equivalent to or at least meet the minimum qualifications for <span class="dictionary">independent review organizations</span>. <a id="paragraph-216476" class="section-permalink" href="https://vacode.org/38.2-3566/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> An approval or reapproval is effective for two years, unless the <span class="dictionary">Commission</span> determines before its expiration that the <span class="dictionary">independent review organization</span> is not satisfying the minimum qualifications or its decisions have been consistently unclear or incomplete. Whenever the <span class="dictionary">Commission</span> determines that an <span class="dictionary">independent review organization</span> has lost its accreditation or does not meet the requirements of this subsection, the <span class="dictionary">Commission</span> shall terminate the approval of the <span class="dictionary">independent review organization</span> and remove it from the list of <span class="dictionary">independent review organizations</span> approved to conduct external reviews. <a id="paragraph-216477" class="section-permalink" href="https://vacode.org/38.2-3566/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> The <span class="dictionary">Commission</span> shall maintain and periodically update a list of approved <span class="dictionary">independent review organizations</span>. <a id="paragraph-216478" class="section-permalink" href="https://vacode.org/38.2-3566/#E"><i class="fa fa-link"/></a></p></section>
						<section id="F"><p><span class="prefix-number">F.</span> The assignment by the <span class="dictionary">Commission</span> of an approved <span class="dictionary">independent review organization</span> shall be done on a random basis, taking into consideration the nature of the health care service or treatment. <a id="paragraph-216479" class="section-permalink" href="https://vacode.org/38.2-3566/#F"><i class="fa fa-link"/></a></p></section></text><history>2011, c. 788.</history><metadata></metadata></law>
