Section 22-B6011. EXTERNAL REVIEW HEARINGS

 

6011.1The IRO shall schedule and hold a hearing within the District of Columbia as soon as possible after receiving a request for a hearing from a member or a member representative, but in no event later than fifteen (15) business days after receipt of the request.

 

6011.2The IRO shall utilize a hearing process which complies with § 107(k) of the Act, D.C. Code, 2001 Ed. §44-301.07(k).

 

6011.3All recommendations of the IRO shall be in writing and approved by the medical director of the IRO. The final determinations shall:

 

(a)Reference the specific terms and standards, including interpretive guidelines, upon which the final decision is based; and

 

(b)State in detailed, clear, and understandable language the specific factual basis for the decision.

 

6011.4Within five (5) business days of the receipt of the IRO's recommendation from the Director, the insurer shall submit a written report to the Director and the member or member representative indicating whether it will accept and implement the recommendations, or whether it will reject the IRO's recommendations. In the case of rejection, the insurer shall specifically indicate in writing to the Director each and every basis for its rejection.

 

source

Final Rulemaking published at 47 DCR 229 (January 14, 2000).