191—76.7 (84GA,HF597) Certification of independent review organization.
	 76.7(1) In addition to the minimum qualifications set forth in 2011 Iowa Acts, House File 597, section 12, the following minimum standards are required for certification as an independent review organization:
	  a.   	 The applicant shall provide a description of the procedures employed to comply with 2011 Iowa Acts, House File 597, section 12(1)“a.”
	  b.   	 The applicant shall provide the number of reviewers retained by the independent review organization and a description of the areas of expertise available from such reviewers and the types of cases such reviewers are qualified to review.
	  c.   	 The applicant shall provide the names and résumés of all directors, officers, and executives of the independent review organization.
	  d.   	 The applicant shall provide a description of the fees to be charged by the independent review organization for external reviews. Fees shall be reasonable in relation to those of other independent review organizations providing external review services in Iowa. A health carrier or the commissioner may object to a fee as unreasonable, and the commissioner or the commissioner’s designee, at the discretion of the commissioner, may conduct a review.
	  e.   	 The applicant shall provide the name of the medical director or health professional director responsible for the supervision and oversight of the independent review procedure.
	 76.7(2) The independent review organization shall develop written policies and procedures to ensure adherence to the requirements of this chapter and 2011 Iowa Acts, House File 597, by any contractor, subcontractor, subvendor, agent or employee affiliated with the certified independent review organization.
	 76.7(3) In addition to the toll-free telephone service required by 2011 Iowa Acts, House File 597, section 12(1)“b,” the independent review organization shall establish a facsimile and electronic mail service to receive information relating to external reviews pursuant to this chapter and 2011 Iowa Acts, House File 597.
	 76.7(4) The independent review organization shall provide the commissioner within ten business days of request such data, information, and reports as the commissioner determines necessary to evaluate the external review process established under 2011 Iowa Acts, House File 597, or a report in the format of Appendix C to comply with 2011 Iowa Acts, House File 597, section 14(1).
	 76.7(5) Applications shall be submitted to the Commissioner of Insurance, 330 Maple Street, Des Moines, Iowa 50319; or as designated by the commissioner. Applications must be submitted in full to be considered. All applicants will be notified of the certification decision. A list of certified independent review organizations shall be maintained by the commissioner and shall be available through the Web site of the Iowa insurance division: www.iid.state.ia.us.
[ARC 9637B, IAB 7/27/11, effective 7/8/11]