Illinois Compiled Statutes 215 ILCS 180 Health Carrier External Review Act. Section 50

    (215 ILCS 180/50)

    Sec. 50. Approval of independent review organizations.

    (a) The Director shall approve independent review organizations eligible to be assigned to conduct external reviews under this Act.

    (b) In order to be eligible for approval by the Director under this Section to conduct external reviews under this Act an independent review organization:

        (1) except as otherwise provided in this Section,

    shall be accredited by a nationally recognized private accrediting entity that the Director has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review; and

        (2) shall submit an application for approval in

    accordance with subsection (d) of this Section.

    (c) The Director shall develop an application form for initially approving and for reapproving independent review organizations to conduct external reviews.

    (d) Any independent review organization wishing to be approved to conduct external reviews under this Act shall submit the application form and include with the form all documentation and information necessary for the Director to determine if the independent review organization satisfies the minimum qualifications established under this Act. The Director may:

        (1) approve independent review organizations that are

    not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation; and

        (2) by rule establish an application fee that

    independent review organizations shall submit to the Director with an application for approval and renewing.

    (e) An approval is effective for 2 years, unless the Director determines before its expiration that the independent review organization is not satisfying the minimum qualifications established under this Act.

    (f) Whenever the Director determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under this Act, the Director shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations approved to conduct external reviews under this Act that is maintained by the Director.

    (g) The Director shall maintain and periodically update a list of approved independent review organizations.

    (h) The Director may promulgate regulations to carry out the provisions of this Section.

(Source: P.A. 96-857, eff. 7-1-10.)

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Last modified: February 18, 2015