31.10.21.03

.03 Specific Criteria and Standards.

A. Required Copies. Upon the written request of a person or health care facility, a private reviewagent shall provide one copy of the specific criteria and standards to be used in conducting utilization review of proposed or delivered services and any subsequent revisions or modifications to the specific criteria and standards.

B. Fee for Copy. A private review agent shall:

(1) Make available a copy of specific criteria and standards used in conducting utilization review of proposed or delivered services for inspection on the premises during normal business hours;

(2) Provide a copy of the specific criteria and standards to a person or health care facility upon request at a reasonable fee determined by the private review agent; and

(3) Provide a copy of the specific criteria and standards upon request to a State agency at no charge to the agency.