                                 CODE OF VIRGINIA

REGULATIONS (§ 32.1-138.15)

The Department shall promulgate regulations, pursuant to the Administrative
Process Act (§ 2.2-4000 et seq.), to implement the provisions of this article,
which shall include, but not be limited to, the following items:

1. Minimum qualifications to perform review;

2. Procedures which require the private review agent to provide the attending
physician an opportunity to consult with a physician advisor prior to issuance
of a final denial in any case in which there is an initial recommendation to
deny coverage;

3. Guidelines regarding access to and confidentiality of patient-specific
medical records and information; and

4. 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.

HISTORY: 1990, c. 826, § 38.2-5309; 1998, c. 129.