191—76.1 (514J) Purpose. This chapter is intended to implement Iowa Code chapter 514J and the federal Patient Protection and Affordable Care Act, Pub.	L. No.	111-148 as amended by the federal Health Care and Education Reconciliation Act of 2010, Pub.	L. No.	111-152, which amends the Public Health Service Act and adopts, in part, new 42 U.S.C. Section 300gg-19. These rules address issues which are unique to the external review process in this state and provide a uniform process for covered persons of health carriers providing health insurance coverage or the covered persons’ authorized representatives to request and receive an external review of adverse determinations and final adverse determinations as defined in Iowa Code sections 514J.102(1) and 514J.102(18) and as referenced in Iowa Code section 514J.109(1). Health carriers defined in Iowa Code section 514J.102(23), and included in paragraph 76.2(2)“c” are subject to these rules.
[ARC 9637B, IAB 7/27/11, effective 7/8/11; ARC 9979B, IAB 1/25/12, effective 2/29/12; ARC 2601C, IAB 6/22/16, effective 7/27/16]