                                 CODE OF VIRGINIA

APPLICATION TO AND COMPLIANCE BY UTILIZATION REVIEW ENTITIES (§ 32.1-137.8)

A. No utilization review entity shall perform utilization review with regard to
hospital, medical or other health care resources rendered or proposed to be
rendered to a covered person except in accordance with the requirements and
standards set forth in this article.

B. This article shall not apply to utilization review performed under contract
with the federal government for utilization review of patients eligible for
hospital services under Title XVIII of the Social Security Act or under contract
with a plan otherwise exempt from operation of this chapter pursuant to the
Employee Retirement Income Security Act of 1974.

C. This article shall not apply to private review agents subject to Article 2.1
(&#xA7; 32.1-138.6 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia.

D. This article shall not apply to programs administered by the Department of
Medical Assistance Services or under contract with the Department of Medical
Assistance Services.

HISTORY: 1998, cc. 129, 891.