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Current as of January 01, 2025 | Updated by Findlaw Staff
(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.
(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.
Cite this article: FindLaw.com - Maryland Code, Insurance § 15-10C-04 - last updated January 01, 2025 | https://codes.findlaw.com/md/insurance/md-code-insurance-sect-15-10c-04/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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