Section 5420.130  Registration of Utilization Review Organizations

a)         Registration:  On or after July 1, 2000, a utilization review organization may not conduct utilization review for persons subject to Section 85 of the Managed Care Reform and Patient Rights Act [215 ILCS 134/85] unless the utilization review organization has registered with the Director.  An application for registration shall be in a format as set forth in Exhibit D of this Part, and must be signed by an officer or director of the utilization review organization.  Initial registration applications shall be deemed approved unless the Director finds such application to be noncompliant with either the standards set forth in Section 85 of the Managed Care Reform and Patient Rights Act or this Part.

b)         Fees:  A utilization review organization must register with the Director every two years.  A fee of $3,000 must be submitted with each application or renewal unless the utilization review organization is accredited by the Health Utilization Medical Standards of the American Accreditation Healthcare Commission (URAC), the National Committee for Quality Assurance (NCQA), or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), in which case the fee is $1500.

c)         Any material changes in the information filed pursuant to this Part shall be filed with the Director within 30 days after such change.  Loss of accreditation status will require re-registration and payment of a $3000 fee pursuant to subsections (a) and (b) of this Section.

d)         Renewals and Appeals:

1)         A registered utilization review organization may continue to operate, if the application and fee have been filed 30 days prior to the renewal date, until the renewal is denied or issued by the Director.

2)         If the renewal application and fee are not received prior to the renewal date, the registration will automatically expire and the utilization review organization must re-register and pay a fee pursuant to subsections (a) and (b) of this Section.

3)         If an application for registration or renewal is denied under this Part, the applicant may appeal such denial by requesting a hearing under the terms of Article 10 of the Illinois Administrative Procedure Act [5 ILCS 100/10-5 through 10-70] and 50 Ill. Adm. Code 2402. A petition for hearing must be postmarked no later than 30 days from the date of initial denial.  A hearing shall be scheduled within 45 days after the petition is filed with the Director.  A decision by the Director shall be rendered within 60 days after the close of the hearing.

(Source:  Added at 24 Ill. Reg. 9429, effective July 1, 2000)