225.994 IPRO Reviewers:
MSSNY is taking all necessary and immediate steps to:
(1) Assure that IPRO disclose the names, qualifications and performance of its reviewers; (2) Assure that physicians in New York State be given information on the specific guidelines IPRO utilizes to assess the qualifications and performance of its reviewers;
(3) Require IPRO to utilize a board certified practicing physician of the same specialty from a like practice setting when PRO reconsideration determinations are conducted;
(4) Require IPRO to utilize the practice parameters as provided by the AMA and developed by its recognized specialty societies. (HOD 1991-62; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
