W. Va. Code R. § 114-58-1

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-58-1 - General

1.1. Scope. -- The purpose of this rule is to provide standards for the external review process set forth in W. Va. Code '33-25C-6, including the procedures for selection of and assignment of external review organizations.

a. Except as otherwise provided, this rule applies to:

1. Health maintenance organizations and prepaid limited health service organizations; and

2. External review organizations seeking approval by the commissioner to conduct external reviews on behalf of managed care plans.

b. This rule does not apply to:

1. Coverage provided by managed care plans to medicaid recipients under W. Va. Code '33-25A-27;

2. Coverage provided by managed care plans to beneficiaries enrolled in medicare programs operated under Title XVIII of the Social Security Act, 42 Stat. 620 (1935), 42 U.S.C. '1851, as amended; or

3. Workers' compensation insurance under W. Va. Code ''23-2-1 et seq.

1.2. Authority. -- W. Va. Code ''33-2-10 , 33-25C-6 and 33-25C-9.

1.3. Filing Date. -- April 8, 2002.

1.4. Effective Date. -- July 1, 2002.

W. Va. Code R. § 114-58-1