1. A. The Commissioner shall deny a certificate to an applicant if the Commissioner finds that the initial application does not meet the requirements of this chapter.

2. B. The Commissioner may revoke the certification of a medical director:

   1. (1) Who violates any provision of this chapter;
   2. (2) Who fails to meet the requirements for certification under Regulation .04B of this chapter;
   3. (3) Who obtains certification based on inaccurate information;
   4. (4) Who fraudulently or deceptively obtains, attempts to obtain, or uses a certificate; or

   5. (5) 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. (a) Objective;
      2. (b) Clinically valid;
      3. (c) Compatible with established principles of health care; or
      4. (d) Flexible enough to allow deviations from the norms when justified on a case by case basis.

3. C. Before denying an initial application for certification or revoking an issued certificate, the Commissioner shall provide the applicant or certificate holder with:

   1. (1) Reasonable time to supply additional information which demonstrates compliance with the requirements of this chapter and the opportunity to request a hearing;
   2. (2) Written notice of the reasons for the denial or revocation; and
   3. (3) 30 days in which to request a hearing in accordance with State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.

Authority: Insurance Article, §§2-109 and 15-10C-02, Annotated Code of Maryland

Effective date:

Regulations .01—.07 adopted as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); adopted permanently effective March 22, 1999 (26:6 Md. R. 490)

Chapter revised effective May 9, 2016 (43:9 Md. R. 532)

Regulation .01B amended effective August 27, 2018 (45:17 Md. R. 804)

Regulation .03 amended effective August 27, 2018 (45:17 Md. R. 804)