Virginia § 32.1-138.15 Regulations

Virginia Statutes

§ 32.1-138.15 — Regulations

Virginia § 32.1-138.15

Title 32.1HEALTH

Ch. 5REGULATION OF MEDICAL CARE FACILITIES AND SERVICES

Art. 2.1PRIVATE REVIEW AGENTS

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Bluebook

Va. Code Ann. § 32.1-138.15 (2026).

Text

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.

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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.