Louisiana Revised Statutes 22:2440 – A. The commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under this Part.
Terms Used In Louisiana Revised Statutes 22:2440
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:2392
- entity: means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing. See Louisiana Revised Statutes 22:2392
- Independent review organization: means an entity that conducts independent external reviews of adverse determinations and final adverse determinations. See Louisiana Revised Statutes 22:2392
A. The commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under this Part.
B. In order to be eligible for approval by the commissioner under this Section to conduct external reviews under this Part, an independent review organization shall:
(1) Except as otherwise provided in this Section, be accredited by a nationally recognized private accrediting entity that the commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations provided for pursuant to La. Rev. Stat. 22:2441.
(2) Submit an application for approval in accordance with Subsection D of this Section along with the application fee specified in La. Rev. Stat. 22:821(B)(37). Such application shall also include a specified e-mail address to which external review information may be submitted.
C. The commissioner shall develop an application form for approving independent review organizations to conduct external reviews.
D.(1) Any independent review organization wishing to be approved to conduct external reviews under this Part shall submit the application form and include with the form all documentation and information necessary for the commissioner to determine if the independent review organization satisfies the minimum qualifications provided for by La. Rev. Stat. 22:2441.
(2)(a) Subject to Subparagraph (b) of this Paragraph, an independent review organization shall be eligible for approval under this Section only if it is accredited by a nationally recognized private accrediting entity that the commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations provided for by La. Rev. Stat. 22:2441.
(b) 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.
(3) The commissioner shall charge an application fee as specified in La. Rev. Stat. 22:821(B)(37) that independent review organizations shall submit to the commissioner with an application for approval.
E.(1) An approval shall remain effective unless the commissioner determines that the independent review organization is not satisfying the minimum qualifications provided for by La. Rev. Stat. 22:2441, or if the independent review organization gives notice of intent to cease operations.
(2) Whenever the commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under La. Rev. Stat. 22:2441, the commissioner shall terminate the approval of the independent review organization.
F. Repealed by Acts 2017, No. 14, §2.
Acts 2013, No. 326, §1, eff. Jan. 1, 2015; Acts 2017, No. 14, §§1,2.