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246-305-070  <<  246-305-080 >>   246-305-090

WAC 246-305-080

Agency filings affecting this section

Application for certification as an IRO.

(1) To be certified as an IRO under this chapter, an organization shall submit to the department an application on the form required by the department. The application must include:
(a) For an applicant that is publicly held, the name of each stockholder or owner of more than five percent of any stock or options;
(b) The name of any holder of bonds or notes of the applicant that exceed one hundred thousand dollars;
(c) The name and type of business of each corporation or other organization that the applicant controls or is affiliated with and the nature and extent of the affiliation or control;
(d) The name and a biographical sketch of each director, officer, and executive of the applicant and any entity listed under (c) of this subsection and a description of any relationship the named individual has with:
(i) A carrier;
(ii) A utilization review agent;
(iii) A nonprofit or for-profit health corporation;
(iv) A health care provider;
(v) A drug or device manufacturer; or
(vi) A group representing any of the entities described by (d)(i) through (v) of this subsection;
(e) The percentage of the applicant's revenues that the applicant anticipates will be derived from reviews conducted under RCW 48.43.535;
(f) A description of the areas of expertise of the health care professionals and contract specialists making review determinations for the applicant, as well as the IRO's policies and standards addressing qualifications, training, and assignment of all types of reviewers;
(g) The procedures that the IRO will use in making review determinations regarding reviews conducted under RCW 48.43.535;
(h) Attestations that all requirements will be met;
(i) Evidence of current accreditation from a nationally recognized private accrediting organization acceptable to the federal Department of Health and Human Services or Department of Labor for the federal external review process.
(i) Applicants shall authorize release of information from primary sources, including full reports of site visits, inspections, and audits;
(ii) The department may require the applicant to indicate which documents demonstrate compliance with specific Washington state certification requirements under this chapter.
(j) Other documentation, including, but not limited to, legal and financial information, policies and procedures, and data that are pertinent to requirements of this chapter; and
(k) Any other reasonable application requirements demonstrating ability to meet all requirements for certification in Washington state.
(2) Department investigation and verification activities regarding the applicant may include, but are not limited to:
(a) Review of application and filings for completeness and compliance with standards;
(b) On-site survey or examination;
(c) Primary-source verification with accreditation or regulatory bodies of compliance with requirements which are used to demonstrate compliance with certain standards in this chapter;
(d) Other means of determining regulatory and accreditation histories; and
(e) Exercising any power of the department under WAC 246-305-100.
[Statutory Authority: RCW 43.70.235 and 48.43.535. WSR 11-23-124, § 246-305-080, filed 11/21/11, effective 11/26/11; WSR 01-08-023, § 246-305-080, filed 3/28/01, effective 4/28/01.]