Illinois Administrative Code › Title 50 - INSURANCE › Part 4520 - MANAGED CARE REFORM & PATIENT RIGHTS › Section 4520.130 - Registration of Utilization Review Organizations

Current through Register Vol. 48, No. 28, July 12, 2024
a) Registration: On or after July 1, 2000, a
			 URO may not conduct utilization review for persons subject to Section 85 of the
			 Act unless the URO has registered with the Director. An application for
			 registration shall be made using the standard form available on the Department
			 website (
https://insurance.illinois.gov
),
			 and must be signed by an officer or director of the URO. Initial registration
			 applications shall be deemed approved unless the Director finds the application
			 to be noncompliant with either the standards set forth in Section 85 of the Act
			 or this Part.
b) The application
			 for registration shall include, but not be limited to, the following
			 information: applicant's identifying and contact information; applicant's agent
			 for service of process in Illinois; applicant's accreditation status; signed
			 affirmation by an officer or director; and for each utilization review program:
			 contact information and business hours; organization and governing structure;
			 number of reviews in Illinois for the current and previous years; description
			 of the grievance process; written policies and procedures for protection of
			 confidential information; and biographical information for officers and
			 directors. The Department will accept the biographical affidavit, and any
			 supplement to that affidavit, that is obtained from the website of the National
			 Association of Insurance Commissioners (NAIC) or the Department.
c) Fees: A URO must register with the
			 Director every two years. A fee of $3,000 must be submitted with each
			 application or renewal unless the URO is accredited by URAC (formerly
			 Utilization Review Accreditation Commission), the National Committee for
			 Quality Assurance (NCQA), The Joint Commission (JCAHO), or the Accreditation
			 Association for Ambulatory Health Care (AAAHC), in which case the fee is
			 $1500.
d) Any material changes in
			 the information filed pursuant to this Part shall be filed with the Director
			 within 30 days after the change. Loss of accreditation status will require
			 re-registration and payment of a $3000 fee pursuant to subsections (a) and
			 (b).
e) Renewals and Appeals:
1) A registered URO may continue to operate,
			 if the application and fee have been filed 30 days prior to the renewal date,
			 until the renewal is denied or issued by the Director.
2) If the renewal application and fee are not
			 received prior to the renewal date, the registration will automatically expire
			 and the URO must re-register and pay a fee pursuant to subsections (a) and
			 (b).
3) If an application for
			 registration or renewal is denied under this Part, the applicant may appeal
			 that denial by requesting a hearing under Article 10 of the Illinois
			 Administrative Procedure Act [5 ILCS 100 ] and 50 Ill. Adm. Code 2402. A
			 petition for hearing must be postmarked no later than 30 days after the date of
			 initial denial. A hearing shall be scheduled within 45 days after the petition
			 is filed with the Director. A decision by the Director shall be rendered within
			 60 days after the close of the hearing.