Iowa § 514J.111 Approval of independent review organizations

Iowa Statutes

§ 514J.111 — Approval of independent review organizations

Iowa § 514J.111

Title XIIICOMMERCE

Ch. 514JEXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS

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Bluebook

Iowa Code § 514J.111 (2026).

Text

1.The commissioner shall approve applications submitted by independent review organizations to conduct external reviews under this chapter. The commissioner may retain an outside expert to perform reviews of such applications.

2.In order to be eligible for approval by the commissioner to conduct external reviews, an independent review organization shall meet all of the following requirements:

a.Be accredited by a nationally recognized private accrediting entity that the commissioner determines has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established in this chapter.

b.Submit an application in a form and format as directed by the commissioner.

c.Meet the minimum qualification

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1. The commissioner shall approve applications submitted by independent review
organizations to conduct external reviews under this chapter. The commissioner may retain
an outside expert to perform reviews of such applications.
2. In order to be eligible for approval by the commissioner to conduct external reviews,
an independent review organization shall meet all of the following requirements:
a. Be accredited by a nationally recognized private accrediting entity that the
commissioner determines has independent review organization accreditation standards that
are equivalent to or exceed the minimum qualifications for independent review organizations
established in this chapter.
b. Submit an application in a form and format as directed by the commissioner.
c. Meet the minimum qualifications contained in section 514J.112.
3. The commissioner 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.
4. The commissioner shall develop an application form for initially approving and for
reapproving independent review organizations to conduct external reviews.
5. The commissioner may charge an initial application fee and a renewal fee as specified
by rule.
6. The approval of an independent review organization to conduct external reviews by
the commissioner pursuant to this chapter is effective for two years, unless the commissioner
determines that the independent review organization is not satisfying the minimum
qualifications of this chapter. If the commissioner determines that an independent review
organization has lost its accreditation or no longer satisfies the minimum requirements
establishedunderthischapter, thecommissionershallterminateapprovaloftheindependent
review organization to conduct external reviews and remove the independent review
organization from the list of independent review organizations approved to conduct external
reviews that is maintained by the commissioner.
7. The commissioner shall maintain a list of currently approved independent review
organizations.