2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 126 - External Review (§§ 9501 — 9517) › § 9512 - Approval of independent review organizations

(a) The Commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under this chapter.
(b) In order to be eligible for approval by the Commissioner under this chapter to conduct external reviews, an independent review organization:
(1) Except as otherwise provided in this Section, shall be accredited by a recognized private accrediting entity that the Commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established under § 9513 of this title, and
(2) shall submit an application for approval to the Commissioner in accordance with subsection (d) of this section.
(c) The Commissioner shall develop an application form for initially approving and for reapproving independent review organizations to conduct external reviews.
(d)
(1) Any independent review organization wishing to be approved by the Commissioner to conduct external reviews under this chapter shall submit the application form and include with the form all documentation and information necessary for the Commissioner to determine if the independent review organization satisfies the minimum requirements of capacity and competence established under § 9513 of this title.
(2)
(A) Subject to paragraph (B) of this clause, an independent review organization shall be eligible for approval by the Commissioner only if it is accredited by a recognized private accrediting entity that the Commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum requirements of capacity and competence established under § 9513 of this title.
(B) The Commissioner may approve an independent review organization that is not accredited by a recognized private accrediting entity only if there are no acceptable recognized private accrediting entities providing independent review organization accreditation.
(3) The Commissioner may charge a fee or contribution as deemed convenient for independent review organization applications for approval and re-approval.
(e)
(1) An independent review organization approval shall be effective for two (2) years, unless the Commissioner determines before its expiration that the independent review organization is not satisfying the minimum requirements of capacity and competence established under § 9513 of this title.
(2) Whenever the Commissioner determines that an independent review organization no longer satisfies the minimum requirements of capacity and competence established under § 9513 of this title, the Commissioner shall terminate the approval of the independent review organization and remove it from the list of independent review organizations approved to conduct external reviews under this chapter.
(f) The Commissioner shall maintain and periodically update a list of approved independent review organizations.
(g) The Commissioner may promulgate regulations as necessary to carry out the duties imposed under this section.
History —Aug. 29, 2011, No. 194, added as § 28.130 on Aug. 23, 2012, No. 203, § 7, eff. 90 days after Aug. 23, 2012.