§ 32-1-138-15

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:\n1. Minimum qualifications to perform review;\n2. 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;\n3. Guidelines regarding access to and confidentiality of patient-specific medical records and information; and\n4. 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.\n1990, c. 826, § 38.2-5309; 1998, c. 129.