This chapter is intended to implement Iowa Code chapter 514J
and the federal Patient Protection and Affordable Care Act,
Pub. L.
No. 111-148 as amended by the federal Health Care
and Education Reconciliation Act of 2010,
Pub. L.
No. 111-152, which amends the Public Health
Service Act and adopts, in part,
42 U.S.C. Section
300gg-19. These rules address issues which
are unique to the external review process in this state and provide a uniform
process for covered persons of health carriers providing health insurance
coverage or the covered persons' authorized representatives to request and
receive an external review of adverse determinations and final adverse
determinations as defined in Iowa Code sections
514J.102(1)
and 514J.102(18)
and as referenced in Iowa Code section
514J.109(1).
Health carriers defined in Iowa Code section
514J.102(23),
and included in paragraph 76.2(2)"c" are subject to these
rules.
Notes
Iowa Code r. 191-76.1
ARC 9637B, IAB
7/27/11, effective 7/8/11; ARC
9979B, IAB 1/25/12, effective 2/29/12; ARC 2601C, IAB 6/22/16, effective
7/27/16; ARC 6121C, IAB
12/29/21, effective 2/2/22
Adopted by
IAB
June 22, 2016/Volume XXXVIII, Number 26, effective
7/27/2016
Amended by
IAB
December 29, 2021/Volume XLIV, Number 13, effective
2/2/2022
