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§ 15-10C-04. Suspension, revocation, or refusal to renew certificate of a medical director

West's Annotated Code of MarylandInsurance

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 10c. Medical Directors (Refs & Annos)
MD Code, Insurance, § 15-10C-04
§ 15-10C-04. Suspension, revocation, or refusal to renew certificate of a medical director
Currentness
In general
(a) Subject to the hearing procedures in §§ 2-210 through 2-214 of this article, the Commissioner may suspend, revoke, or refuse to renew a certificate of a medical director if the Commissioner finds a pattern that the utilization management procedures and policies used by the medical director in making utilization review decisions or used by a private review agent employed by or under contract with the health maintenance organization over whose utilization review decisions the medical director has responsibility are not:
(1) objective;
(2) clinically valid;
(3) compatible with established principles of health care; or
(4) flexible enough to allow deviations from the norms when justified on a case by case basis.
Consultation with independent review organization or medical expert
(b) The Commissioner may consult with an independent review organization or medical expert that meets the requirements of § 15-10A-05 of this title, the Department, the Board, or any other appropriate entity for purposes of taking an action described under subsection (a) of this section.

Credits

Added by Acts 1998, c. 111, § 2, eff. Jan. 1, 1999; Acts 1998, c. 112, § 2, eff. Jan. 1, 1999.
MD Code, Insurance, § 15-10C-04, MD INSURANCE § 15-10C-04
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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