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PA Bulletin, Doc. No. 14-1292



Certification as an Independent Review Organization; Long-Term Care Benefit Trigger Determinations; Notice 2014-09

[44 Pa.B. 3660]
[Saturday, June 14, 2014]

 The act of July 9, 2010 (P. L. 362, No. 51) (Act 51) added to the Commonwealth's long-term care insurance laws a provision granting a right to appeal an insurer's determination that a benefit trigger is not met. See section 1111.1 of The Insurance Company Law of 1921 (act) (40 P. S. § 991.1111a). Act 51 also added definitions of ''benefit trigger'' and ''independent review organization'' to section 1103 of the act (40 P. S. § 991.1103).

 Under the act, an entity must be certified by the Insurance Department (Department) to perform an independent review of benefit trigger determinations. To be certified, an independent review organization (IRO) must: (a) be certified as an IRO in another state, if the other state requires the IRO to meet substantially similar qualifications as those established by the National Association of Insurance Commissioners; or (b) be certified or approved by the Department. To maintain certification, the IRO shall comply with the the Act 51 amendments to the long-term care insurance laws and its representations in its application to the Commonwealth or any other state by which it is certified.

 The following organizations have been approved by the Department to perform independent reviews of long-term care benefit trigger determinations:

LTCI Independent Eligibility Review Specialists, LLC
1636 North Cedar Crest Boulevard, Suite 107
Allentown, PA 18104
Telephone: (800) 878-9579
Fax: (484) 661-4757
Contact: Stephen R. La Pierre

National Medical Reviews, Inc.
260 Knowles Avenue, Suite 330
Southampton, PA 18966
Telephone: (215) 352-7800
Fax: (215) 352-7801
Contact: Danielle E. Bontcue, Esq.

MAXIMUS Federal Services, Inc.
11419 Sunset Hills Road
Reston, VA 20190-5207
Telephone: (703) 251-8500
Fax: (703) 251-8240
Contact: David Sherman

 (Reviews will be conducted at the following location)

MAXIMUS Federal Services, Inc.
50 Square Drive, Suite 210
Victor, NY 14564
Telephone: (585) 425-5200
Fax: (585) 425-5290

 This notice is updated as of June 3, 2014.

 Questions regarding this notice may be directed to Carolyn M. Morris, Director, Bureau of Consumer Services at (717) 783-9862 or

Insurance Commissioner

[Pa.B. Doc. No. 14-1292. Filed for public inspection June 13, 2014, 9:00 a.m.]

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