(a) Procedure to assure plan's delivery of required documents within 24 hours of
notice of IMR, if there is an imminent health threat, and waiver of plan's grievance
(b) Procedure to expeditiously review requests and immediately notify the enrollee
in writing as to whether the request for an independent medical review has been approved.
To the extent a request is not approved, it shall be treated as an immediate request for
departmental review under Section 1368(b).
(c) Procedures to assign an IMR to an independent medical review organization.
(a) Set criteria for qualifying independent medical review organizations (IMROs).
Contract with one or more IMROs in the state.
(c) Criteria to rule out the faintest conflict-of-interest of IMRO personnel.
(d) Procedures to evaluate prospective IMROs.
Develop disclosure forms re conflicts-of-interest.
Evaluation forms for proposed review procedures, personnel policies, etc.
Evaluation forms for Quality Assurance methods.
Evaluation forms for professional competence.
(e) Procedures to make the above information public.