(1) At least forty-five days before using, changing, or declining to award a designation in an existing program of designation, a health care entity shall provide the physician or dentist with written notice of the designation decision. The written notice shall describe the procedures by which the physician or dentist may:
Obtain the information pursuant to section 25-38-105, including all of the data uponwhich the designation was based or declined; and
Request an appeal of the designation decision, including the opportunity for a faceto-face meeting pursuant to subparagraph (IV) of paragraph (a) of subsection (2) of this section.
(2) (a) Any health care entity providing designations of physicians or dentists shall establish procedures for the designated physician or dentist to appeal the designation, including a change in designation or a declination to award a designation in an existing program of designation. The procedures, in addition to the written notice provided for in subsection (1) of this section, shall provide for the following:
A reasonable method by which the designated physician or dentist shall provide notice of his or her desire to appeal;
If requested by the designated physician or dentist, disclosure of the methodologyand data upon which the health care entity's decision is based;
The name, title, qualifications, and relationship to the health care entity of the person or persons responsible for the appeal of the designated physician or dentist;
An opportunity to submit or have considered corrected data relevant to the designation decision and to have considered the applicability of the methodology used in the designation decision. If requested by the designated physician or dentist, the opportunity may be afforded by the health care entity in a face-to-face meeting with those responsible for the appeal decision at a location reasonably convenient to the physician or dentist or by teleconference. All data submitted to the entity by a designated physician or dentist is presumed valid and accurate. However, this presumption does not permit a health care entity to unreasonably withhold consideration of corrected or supplemented data pursuant to this subparagraph (IV).
The right of the physician or dentist to be assisted by a representative;
An opportunity, if so desired, to be considered as part of the appeal, an explanationof the designation decision that is the subject of the appeal by a person or persons deemed by the health care entity as responsible for the designation decision;
A written decision regarding the physician's or dentist's appeal that states the reasons for upholding, modifying, or rejecting the physician's or dentist's appeal.
The appeal shall be made to a person or persons with the authority granted by thedesignating health care entity to uphold, modify, or reject the designation decision or to require additional action to ensure that the designation is fair, reasonable, and accurate.
The appeal process shall be complete within forty-five days from the date upon which the data and methodology are disclosed unless otherwise agreed to by the parties to the appeal.
No change or modification of a designation that is the subject of an appeal shall beimplemented or used by the health care entity until the appeal is final.
With respect to any designation previously disclosed publicly, the health care entityshall update any changes to such designation within thirty days after the appeal is final.
Source: L. 2008: Entire article added, p. 2016, § 1, effective September 1. L. 2009:
(2)(a)(IV) amended, (SB 09-292), ch. 369, p. 1973, § 93, effective August 5. L. 2015: IP(1) and
(2)(a) amended, (HB 15-1191), ch. 95, p. 273, § 6, effective August 5.