32.1-137.16 - Records. - Virginia Statutes

§ 32.1-137.16. Records.

Every entity subject to Article 1.1 (§ 32.1-137.1 et seq.) of Chapter 5 ofthis title and this article shall maintain or cause to be maintained, inwriting and at a location accessible to employees of the Department, recordsof review procedures; the health care qualifications of the entity's staff;the criteria used by the entity to make its decisions; records of complaintsreceived, including the manner in which the complaints were resolved; thenumber and type of adverse decisions, and reconsiderations; the number andoutcome of final adverse decisions and appeals thereof, including a separaterecord for expedited appeals; and procedures to ensure confidentiality ofmedical records and personal information. Records of complaints under Article1.1 (§ 32.1-137.1 et seq.) of this chapter shall be maintained from the dateof the entity's last examination and for no less than five years.

Every entity subject to utilization review under this article shall provide,upon request of the Commissioner, data and records pertaining to utilizationreview from which patient and provider identifiers have been removed. Recordsshall be maintained or caused to be maintained by the utilization reviewentity for a period of five years, and all such records shall be subject toexamination by the Commissioner or his designee.

(1998, c. 891.)