Section 2905.10  Definitions

 

"Act" means the Workers' Compensation Act [820 ILCS 305].

 

"Department" means the Illinois Department of Insurance.

 

"Director" means the Director of the Illinois Department of Insurance.

 

"Utilization Review" means the evaluation of proposed or provided health care services as defined in Section 8.7 of the Workers’ Compensation Act.

 

(Source:  Amended at 46 Ill. Reg. 9867, effective May 31, 2022)

 

Section 2905.20  Registration

 

a)         On or after July 1, 2005, a workers' compensation utilization review organization may not conduct utilization review for workers' compensation services as provided by Section 8.7 of the Act unless the utilization review organization has registered with the Director. An application for registration shall be made using the standard form available on the Department website (https://insurance.illinois.gov), and must be signed by an officer or director of the utilization review organization. Initial registration applications shall be deemed approved unless the Director finds the application to be noncompliant with either the standards set forth in Section 8.7 of the Act or this Part.

 

b)         The application for registration shall include, but not be limited to, the following information: applicant's identifying and contact information; applicant's agent for service of process in Illinois; applicant's accreditation status; signed affirmation by an officer or director; and for each utilization review program: contact information and business hours; organization and governing structure; number of reviews in Illinois for the current and previous years; description of the grievance process; written policies and procedures for protection of confidential information; and biographical information for officers and directors.  The Department will accept the biographical affidavit, and any supplement to that affidavit, that is obtained from the website of the National Association of Insurance Commissioners (NAIC) or the Department.

 

(Source:  Amended at 46 Ill. Reg. 9867, effective May 31, 2022)

 

Section 2905.30  Fees

 

A workers' compensation utilization review organization must register with the Director every two years. A fee of $3,000 must be submitted with each application or renewal unless the utilization review organization is accredited under the Health Utilization Management Standards or the Workers' Compensation Utilization Management Standards of URAC (formerly Utilization Review Accreditation Commission), in which case the fee is $1500.

 

(Source:  Amended at 46 Ill. Reg. 9867, effective May 31, 2022)

 

Section 2905.40  Material Changes

 

Any material changes in the information filed pursuant to this Part shall be filed with the Director within 30 days after the change.  Loss of accreditation status will require re-registration and payment of a $3000 fee pursuant to Sections 2905.20 and 2905.30.

 

(Source:  Amended at 46 Ill. Reg. 9867, effective May 31, 2022)

 

Section 2905.50  Renewals and Appeals

 

a)         If a renewal application and fee are not received prior to the renewal date, the registration will automatically expire and the utilization review organization must re-register and pay a fee pursuant to Sections 2905.20 and 2905.30 of this Part in order to conduct utilization review for workers' compensation services as provided by Section 8.7 of the Workers' Compensation Act [820 ILCS 305/8.7].

 

b)         If an application for registration or renewal is denied under this Part, the applicant may appeal that denial by requesting a hearing under the terms of Article 10 of the Illinois Administrative Procedure Act [5 ILCS 100/Art. 10] and 50 Ill. Adm. Code 2402. A petition for hearing must be postmarked no later than 30 days from the date of initial denial.  A hearing shall be scheduled within 45 days after the petition is filed with the Director.  A decision by the Director shall be rendered within 60 days after the close of the hearing.

Section 2905.EXHIBIT A   Application for Registration of a Utilization Review Organization (Repealed)

 

(Source:  Repealed at 46 Ill. Reg. 9867, effective May 31, 2022)

Section 2905.EXHIBIT B   Utilization Review Organization Officers and Directors Biographical Affidavit (Repealed)

 

(Source:  Repealed at 46 Ill. Reg. 9867, effective May 31, 2022)