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007.05.5-7. PRIVATE REVIEW AGENTS - DENIAL OR REVOCATION OF CERTIFICATION

AR ADC 007.05.5-7Arkansas Administrative Code

West's Arkansas Administrative Code
Title 007. Department of Health
Division 05. Health Facility Services
Rule 5. Rules and Regulations for Utilization Review in Arkansas
Ark. Admin. Code 007.05.5-7
007.05.5-7. PRIVATE REVIEW AGENTS - DENIAL OR REVOCATION OF CERTIFICATION
Currentness
A. The Director shall deny a certificate to an applicant if the Board finds that the applicant does not:
1. Have available the services of sufficient number of registered nurses, medical records technicians, or similarly qualified persons that are supervised by appropriate physicians to carry out its utilization review activities;
2. Meet any applicable provisions of these Rules and Regulations relating to the qualifications of private review agents or the performance of utilization review the Board adopts relating to the qualifications of private review agents or the performance of utilization review;
3. Have policies and procedures which protect the confidentiality of medical records in accordance with applicable State and Federal laws;
4. Make itself accessible to patients and providers five working days a week during normal business hours in this State.
B. The Director may revoke the certification of a private review agent if the Board finds that the agent:
1. Does not comply with performance assurances;
2. Violates any provision of these Rules and Regulations;
3. Violates any regulation adopted under any provision of this subtitle;
4. Fraudulently or deceptively obtains, attempts to obtain, or uses a certification;
5. Fails to substantially meet the standards and qualifications adopted by the Director;
6. Fails to comply with the regulations adopted by the Board.
C. Before denying or revoking a certificate, the Director shall provide the applicant or certificate holder:
1. Written notice of the reasons for the denial or revocation;
2. Thirty days in which to supply additional information demonstrating compliance with the requirements.
3. The opportunity to request a hearing in accordance with the Arkansas Administrative Procedures Act.
D. If the applicant request a hearing, the Director shall send a hearing notice by certified mail, return receipt requested, at least 30 days before the hearing.
E. An aggrieved party has the right to take direct judicial appeal of a final decision in accordance with the Arkansas Administrative Procedures Act.
F. A person who violates any provision of these regulations is guilty of a misdemeanor, and on conviction is subject to a penalty not exceeding $1,000. Each day a violation is continued after the first conviction is a separate offense.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 007.05.5-7, AR ADC 007.05.5-7
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