2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 32. Health Utilization Review › Part 4. External Review › 33-32-416. Approval of independent review organizations -- renewal

33-32-416. Approval of independent review organizations -- renewal.
(1) The commissioner shall approve independent review organizations that are eligible to conduct external reviews under this part.
(2) To be eligible for approval by the commissioner to conduct external reviews under this part, an independent review organization:
(a) must be accredited by a nationally recognized private accrediting entity as provided in subsection (5) and meet the minimum qualifications provided in 33-32-417; and
(b) shall submit an application fee as provided in 33-32-419 and an application for approval in accordance with subsection (4) or, for those currently approved and seeking renewal, a renewal fee and renewal application.
(3) The commissioner shall develop an application form for initially approving and for reapproving independent review organizations to conduct external reviews.
(4) (a) Any independent review organization seeking to be approved to conduct external reviews under this part shall submit the application form and include with the form all documentation, fees, and information necessary for the commissioner to determine whether the independent review organization satisfies the minimum qualifications established under 33-32-417 and subsection (5) of this section.
(b) An independent review organization that is currently approved and seeking renewal shall submit a renewal application, fees, and other information necessary for the commissioner to determine whether the independent review organization continues to satisfy the minimum qualifications established under 33-32-417 and subsection (5) of this section.
(5) An independent review organization is eligible for approval under this section only if it is accredited by a nationally recognized private accrediting entity approved by the commissioner as having independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established under 33-32-417.
(6) The commissioner's approval of an independent review organization is effective for 2 years unless the commissioner determines before the expiration date that the independent review organization:
(a) is not satisfying the minimum qualifications established under 33-32-417; or
(b) has not fulfilled the reporting requirements under 33-32-421.
(7) If the commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under 33-32-417, the commissioner shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations maintained by the commissioner pursuant to subsection (9).
(8) If the commissioner determines that an independent review organization has not fulfilled the reporting requirements contained in 33-32-421, the commissioner may terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations maintained by the commissioner pursuant to subsection (9).
(9) The commissioner shall maintain and periodically update a list of approved independent review organizations.
(10) A person may not operate as an independent review organization in Montana unless approved by the commissioner.
History: En. Sec. 26, Ch. 428, L. 2015; amd. Sec. 2, Ch. 31, L. 2019.