32.1-137.8 - Application to and compliance by utilization review entities. - Virginia Statutes

§ 32.1-137.8. Application to and compliance by utilization review entities.

A. No utilization review entity shall perform utilization review with regardto hospital, medical or other health care resources rendered or proposed tobe rendered to a covered person except in accordance with the requirementsand standards set forth in this article.

B. This article shall not apply to utilization review performed undercontract with the federal government for utilization review of patientseligible for hospital services under Title XVIII of the Social Security Actor under contract with a plan otherwise exempt from operation of this chapterpursuant to the Employee Retirement Income Security Act of 1974.

C. This article shall not apply to private review agents subject to Article2.1 (§ 32.1-138.6 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia.

D. This article shall not apply to programs administered by the Department ofMedical Assistance Services or under contract with the Department of MedicalAssistance Services.

(1998, cc. 129, 891.)