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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 22. HEALTH |
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SubTilte 22-B. PUBLIC HEALTH AND MEDICINE |
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Chapter 22-B60. HEALTH BENEFITS PLAN MEMBERS BILL OF RIGHTS |
Section 22-B6010. CONDUCT OF EXTERNAL REVIEWS
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6010.1The IRO, in conducting external reviews assigned by the Director, shall use at least two (2) physicians licensed to practice medicine in the District of Columbia, Maryland or Virginia, except that:
(a)Medical reviewers licensed elsewhere in the United States may be used when necessary based on the medical, surgical, or mental condition under review; and
(b)The licensed medical reviewers selected shall not have any history of disciplinary action or sanctions pending or taken against them by a governmental or professional regulating body.
6010.2The IRO in reaching a determination shall follow the criteria set forth in § 107(j) of the Act, D.C. Code, 2001 Ed. §44-301.07(j).
6010.3The IRO, its employees, or agents may not disclose or publish individual medical records or any other confidential medical information obtained in the performance of independent review activities.