PURPOSE: This rule sets forth the procedure for a utilization review agent to obtain a certificate of registration and prescribes the standards to which the utilization review agent must adhere in order to conduct utilization review in this state. This rule is adopted pursuant to section 374.515, RSMo and implements sections 374.500–374.515, RSMo.

1. (1) A utilization review agent may not conduct utilization review in this state without a certificate of registration issued by the director. The application for a certificate shall be submitted on the form set forth in Exhibit A. The application shall be signed by the applicant or, if the applicant is a corporation, by an officer or, if the applicant is a partnership, by one (1) of the partners. The application shall be accompanied by an application fee of one thousand dollars ($1,000).
2. (2) The application for a certificate of registration shall be submitted on the form set forth in Exhibit A. The application shall be signed by the applicant or, if the applicant is a corporation, by an officer or, if the applicant is partnership, by one (1) of the partners. The application shall be accompanied by an application fee of one thousand dollars ($1,000).

3. (3) Each application for renewal shall—

   1. (A) Be submitted on the form set forth in Exhibit A;
   2. (B) Contain a verified statement describing any material changes in the information filed by the utilization review agent on its original application for certificate of registration; and
   3. (C) Be accompanied by a renewal fee of five hundred dollars ($500). The certificate of registration issued to a utilization review agent shall be renewed annually on or before the anniversary date of the initial certificate as shown on the original certification.
4. (4) Failure to renew a certificate of registration in a timely manner shall result in a fine as set forth in section 374.280, RSMo.
5. (5) Pursuant to sections 374.046 and 374.512, RSMo, the director may take action against any utilization review agent doing business in this state without a certificate of registration in violation of section 374.503, 20 CSR 700-4

RSMo, even if the principal place of business of the utilization review agent is located in another state.

1. (6) Any utilization review agent doing businesses in this state under a name other than its true name shall file with the director a copy of all documents, including the authorization from the Missouri Secretary of State which shows the legal authority for the utilization review agent to use such other name. Even though multiple names may be registered with the Missouri Secretary of State, the utilization review agent must choose only one (1) authorized name for a certificate of authority to conduct business as a utilization review agent.
2. (7) No utilization review agent shall require or request a Federal Drug Enforcement Administration Number or a Missouri Controlled Substance Registration Number from any provider.

AUTHORITY: sections 374.515, RSMo 1994 and 376.1399, RSMo Supp. 1997.* Emergency rule filed Nov. 1, 1991, effective Nov. 11, 1991, expired March 10, 1992. Original rule filed Nov. 1, 1991, effective May 14, 1992. Amended: Filed Aug. 26, 1993, effective May 9, 1994. Amended: Filed Nov. 3, 1997, effective May 30, 1998. *Original authority 1991, amended 1993.