Oklahoma § 36-6561 - Refusal to issue or renew or suspension or revocation of

§ 36-6561. Refusal to issue or renew or suspension or revocation of

certificate - Hearing - Appeal.

A. The Insurance Commissioner may refuse to issue or renew or

may suspend or revoke a certificate if the holder does not comply

with performance assurances under this section, violates any

provision of the Hospital and Medical Services Utilization Review

Act, or violates any rule adopted pursuant thereto.

B. The Commissioner shall deny or refuse to renew a certificate

to any applicant if, upon review of the application, the

Commissioner finds that the applicant proposing to conduct

utilization review does not:

Oklahoma Statutes - Title 36. Insurance

1. Have available the services of a sufficient number of

qualified medical professionals supervised by appropriate health

care providers to carry out the applicant's utilization review

activities. Said sufficiency shall be based on standards and

criteria pursuant to the provisions of subparagraph b of paragraph 1

of Section 8 of this act;

2. Meet any applicable rules the Commissioner adopted pursuant

to the Hospital and Medical Services Utilization Review Act relating

to the qualifications of private review agents or the performance of

utilization review; and

3. Provide assurances satisfactory to the Commissioner that:

a.

the procedure and policies of the private review agent

shall protect the confidentiality of medical records,

and

b.

the review agent shall be reasonably accessible in

this state to patients, hospitals and health care

providers as required by this act.

C. Before denying, not renewing, or revoking a certificate, the

Commissioner shall provide the applicant or certificate holder with

reasonable time to supply additional information demonstrating

compliance with the requirements of the Hospital and Medical

Services Utilization Review Act and the opportunity to request a

hearing. If an applicant or certificate holder requests a hearing,

the Commissioner shall send a hearing notice and conduct a hearing

in accordance with the Administrative Procedures Act.

D. Any person aggrieved by a final decision of the Commissioner

in a contested case may appeal the decision as provided for in the

Administrative Procedures Act.

Added by Laws 1991, c. 294, § 11, eff. Nov. 1, 1991.