§ 23-17.12-3 - General certificate requirements. - Rhode Island Statutes

SECTION 23-17.12-3

   § 23-17.12-3  General certificaterequirements. – (a) A review agent shall not conduct utilization review in the state unless thedepartment has granted the review agent a certificate.

   (b) Individuals shall not be required to hold separatecertification under this chapter when acting as either an employee of, anaffiliate of, a contractor for, or otherwise acting on behalf of a certifiedreview agent.

   (c) The department shall issue a certificate to an applicantthat has met the minimum standards established by this chapter, and regulationspromulgated in accordance with it, including the payment of any fees asrequired, and other applicable regulations of the department.

   (d) A certificate issued under this chapter is nottransferable, and the transfer of fifty percent (50%) or more of the ownershipof a review agent shall be deemed a transfer.

   (e) After consultation with the payors and providers ofhealth care, the department shall adopt regulations necessary to implement theprovisions of this chapter.

   (f) The director of health is authorized to establish anyfees for initial application, renewal applications, and any otheradministrative actions deemed necessary by the director to implement thischapter.

   (g) The total cost of certification under this title shall beborne by the certified entities and shall be one hundred and fifty percent(150%) of the total salaries paid to the certifying personnel of the departmentengaged in those certifications less any salary reimbursements and shall bepaid to the director to and for the use of the department. That assessmentshall be in addition to any taxes and fees otherwise payable to the state.

   (h) The application and other fees required under thischapter shall be sufficient to pay for the administrative costs of thecertificate program and any other reasonable costs associated with carrying outthe provisions of this chapter.

   (i) A certificate expires on the second anniversary of itseffective date unless the certificate is renewed for a two (2) year term asprovided in this chapter.

   (j) Any systemic changes in the review agents operationsrelative to certification information on file shall be submitted to thedepartment for approval within thirty (30) days prior to implementation.