W. Va. Code R. § 114-58-12

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

Section 114-58-12 - Exemption from External Review Requirements

12.1. Upon written application to and approval by the commissioner a managed care plan may be exempted from the requirements for external review as specified in W. Va. Code '33-25C-6 upon a showing that:

a. The managed care plan has an established external review procedure in place;

b. The managed care plan has been reviewed by and maintains a current full accreditation from a nationally recognized accreditation and review organization approved by the commissioner, in accordance with W. Va. Code '33-25A-17a; and

c. As part of the accreditation process, the accreditation and review organization reviewed and approved the managed care plan's external review process.

12.2. The managed care plan shall immediately notify the commissioner upon any loss of accreditation or upon any corrective plan of action made or suggested to the plan's external review process by the accreditation and review organization.

W. Va. Code R. § 114-58-12