§ 15-10C-04
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/md/insurance/15-10c-04A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–10C–04.
(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.