TITLE 41

INSURANCE

CHAPTER 59

IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT

41-5911.  approval of independent review organizations.  (1) The director shall approve independent review organizations eligible to be assigned on a random basis to conduct external reviews under this chapter.

(2)  In order to be eligible for approval by the director under this section to conduct external reviews under this chapter an independent review organization shall:

(a)  Except as otherwise provided in this section, be accredited by a nationally recognized private accrediting entity that the director has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established under section 41-5912, Idaho Code; and

(b)  Submit an application for approval in accordance with subsection (4) of this section.

(3)  The director shall develop an application form for initially approving and for reapproving independent review organizations to conduct external reviews.

(4)  Any independent review organization wishing to be approved to conduct external reviews under this chapter shall submit the application form and include with the form all documentation and information necessary for the director to determine whether the independent review organization satisfies the minimum qualifications established under section 41-5912, Idaho Code.

(5)  The director shall publish prominently on the department of insurance website notice of a submitted application or reapplication by an independent review organization to provide external reviews under this chapter.

(a)  Any person wishing to comment on an application shall have forty-two (42) days, from the publication of notice by the director, to provide written comments to the director on the application or reapplication submitted by an independent review organization.

(b)  The director shall review and consider the written comments received in determining whether to approve the application or reapplication of an independent review organization.

(c)  The director may approve independent review organizations that are not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.

(6)  The director may charge an application fee that independent review organizations shall submit to the director with an application for approval and reapproval.

(7)  An approval is effective for two (2) years, unless the director determines before its expiration that the independent review organization no longer satisfies the minimum qualifications established under section 41-5912, Idaho Code.

(8)  The director shall maintain and periodically update a list of approved independent review organizations. Whenever the director determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under section 41-5912, Idaho Code, the director shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations approved to conduct external reviews under this chapter. The director may also establish a standard flat fee schedule for each external review performed by the independent review organization.

(9)  The director may promulgate administrative rules to carry out the provisions of this section.

History:

[41-5911, added 2009, ch. 87, sec. 1, p. 252.]