later than 3 business days after the date that
an independent review organization receives a
request for a review of an adverse determina-
tion of a utilization review agent, such utiliza-
tion review agent shall provide to the appro-
priate independent review organization—
‘‘(i) any medical records of the partic-
ipant or beneficiary that are relevant to
the review;
‘‘(ii) any documents used by the utili-
zation review agent in making the deter-
mination that is to be reviewed by the or-
ganization;
‘‘(iii) written notification to the par-
ticipant or beneficiary indicating the clin-
ical basis for the denial of the appeal;
‘‘(iv) any documentation and written
information submitted to the utilization re-
view agent in support of the appeal; and
‘‘(v) a list of each physician or health
care provider who has provided care to the
participant or beneficiary and who may
have medical records relevant to the ap-
peal.
‘‘(C) TIMELINES FOR DETERMINATIONS BY
INDEPENDENT REVIEW ORGANIZATION.—
‘‘(i) IN
GENERAL.—An independent
review organization shall make its deter-
mination not later than the earlier of—
‘‘(I) the 15th day after the date
the independent review organization
receives the information necessary to
make the determination; or
‘‘(II) the 20th day after the date
the independent review organization
receives the request that the deter-
mination be made.
‘‘(ii) 
LIFE-THREATENING
CONDI-
TION.—In the case of a life-threatening
condition, an independent review organiza-
tion shall make its determination not later
than the earlier of—
‘‘(I) the 5th day after the date
the independent review organization
receives the information necessary to
make the determination; or
‘‘(II) the 8th day after the date
the independent review organization
receives the request that the deter-
mination be made.
‘‘(3) CERTIFICATION OF INDEPENDENT REVIEW
ORGANIZATIONS.—
‘‘(A) IN GENERAL.—To be treated as an
independent review organization, an organiza-
tion must be certified by the Secretary.
‘‘(B) APPLICATION FOR CERTIFICATION.—
To be certified by the Secretary as an inde-
pendent review organization, an organization
shall submit on an annual basis to the Sec-
retary an application which shall include the
following information:
‘‘(i) Any applicant that is a publicly
held organization shall include the name of
each stockholder or owner of more than 5
percent of any stock or options.
‘‘(ii) The name and type of business
of each corporation or other organization
that the applicant controls or is affiliated
with and the nature and extent of the af-
filiation or control.
‘‘(iii) The name of any holder of
bonds or notes of the applicant that exceed
$100,000.
‘‘(iv) The name and a biographical
sketch of each director, officer, and execu-
tive of the applicant.
‘‘(v) A description of any relationship
the individuals in clauses (iii) and (iv) have
with—
‘‘(I) a provider of health insur-
ance coverage;
‘‘(II) a health maintenance orga-
nization;
‘‘(III) a utilization review agent;
‘‘(IV) a nonprofit health corpora-
tion;
‘‘(V) a payor;
‘‘(VI) a health care provider; or
‘‘(VII) a group representing any
of the entities described in subclauses
(I) through (VII).
‘‘(vi) The percentage of the appli-
cant’s revenues that are anticipated to be
derived from reviews conducted under this
subsection.
‘‘(vii) A description of the areas of ex-
pertise of the health care professionals