Section 1374.35 Of Article 5.55. Appeals Seeking Independent Medical Reviews From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.55.
1374.35
. (a) After considering the results of a competitive bidding
process and any other relevant information on program costs, the
director shall establish a reasonable, per-case reimbursement
schedule to pay the costs of independent medical review organization
reviews, which may vary depending on the type of medical condition
under review and on other relevant factors.
(b) The costs of the independent medical review system for
enrollees shall be borne by health care service plans pursuant to an
assessment fee system established by the director. In determining the
amount to be assessed, the director shall consider all
appropriations available for the support of this chapter, and
existing fees paid to the department. The director may adjust fees
upward or downward, on a schedule set by the department, to address
shortages or overpayments, and to reflect utilization of the
independent review process.