Administrative Code

Virginia Administrative Code
5/29/2022

Part III. Informal Hearing Procedures

16VAC30-60-120. Informal fact finding.

Peer review committee consideration of each request for review shall be conducted as follows:

1. Meetings of the peer review committee shall be scheduled by the chairman. The informal hearing on a request for review shall be scheduled during a meeting of the peer review committee. The hearing shall be scheduled on the next open agenda and shall be held no later than 180 days after the date the request is received by the commission.

2. The Secretary of the Statewide Coordinating Committee shall notify the defending party by certified mail, return receipt requested, of the date of the informal hearing no less than 15 days before the hearing. A copy of the notice shall be sent to the party requesting review. In the event there is a request for a continuance of an informal hearing, the decision whether to grant the continuance shall be left to the discretion of the chairman.

3. Informal hearings on requests for review shall be conducted as follows:

a. A quorum shall consist of three members;

b. The chairman or his designated substitute shall preside;

c. The committee member who evaluated the request for review shall present orally his evaluation and recommendation;

d. The defending party shall be advised of any contrary factual basis or information in the committee's possession upon which the committee may rely in making an adverse decision;

e. The chairman shall allow the defending party, or counsel, an opportunity to present factual data, argument, or proofs for a period of time not exceeding 20 minutes;

f. Upon the conclusion of the presentation of all relevant information, the hearing will be closed;

g. The committee will, at a convenient time, conduct its deliberations outside the presence of the parties.

4. The peer review committee shall determine whether the physician has provided treatment or charged fees as prevail in the same community for injuries requiring similar treatment when the treatment is paid for by the injured person (§ 65.2-605 of the Code of Virginia).

5. Peer review committee proceedings, deliberations, and records constitute privileged communications as provided by § 65.2-1308 of the Code of Virginia. Committee communications, both oral and written, shall not be disclosed except as provided.

Statutory Authority

§ 65.2-1305 of the Code of Virginia.

Historical Notes

Derived from VR405-02-01 § 3.1, eff. Jan. 9, 1981; July 16, 1993.

16VAC30-60-130. Decision.

A. After deliberation, the peer review committee will vote on the recommended disposition, in the following manner:

1. The vote of the majority of the members present shall be adopted;

2. In the case of a tie vote, the review will be terminated and the decision deemed to be favorable to the defending party; and

3. Dissenting members may record their objections in writing.

B. If the decision is favorable to the physician, the peer review committee shall approve the payment of fees.

C. If the decision is unfavorable to the physician, the peer review committee shall set the physician's fee at a reasonable amount as described by the standard set out in § 65.2-605 of the Code of Virginia and, if the fee has already been paid by the party requesting review, require repayment by the physician of the excess amount.

D. Within 30 days of the informal hearing, the peer review committee shall prepare a statement, in writing, of the factual basis for its decision. Notice of the defending party's right of appeal shall be included in this statement. A copy of this statement shall be forwarded by the Secretary of the Statewide Coordinating Committee by certified mail, return receipt requested, to the defending party, the party requesting review, and the commission. The peer review committee file compiled under 16VAC30-60-110 of this chapter shall be forwarded to the commission

Statutory Authority

§ 65.2-1305 of the Code of Virginia.

Historical Notes

Derived from VR405-02-01 § 3.2, eff. Jan. 9, 1981; July 16, 1993.

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