- A. Scope. This regulation does not apply to a person that uses a treatment plan form solely for internal purposes, unless the private review agent requires the information to authorize treatment.
- B. Form Required. If a private review agent requires a health care provider to submit a treatment plan or telephonically provide the information requested on the uniform treatment plan, to enable the private review agent to conduct utilization review of services for the treatment of a mental illness, emotional disorder, or a substance abuse disorder, the private review agent shall use the uniform treatment plan form set forth in §H of this regulation.
C. Acceptance of Form by Private Review Agent. A private review agent shall accept the uniform treatment plan form as a properly submitted treatment plan form and may not require a health care provider to:
- (1) Modify the uniform treatment plan form or its content except as provided in this regulation; or
- (2) Submit additional treatment plan forms.
- D. Instructions. A private review agent may provide a set of instructions for use by the health care provider regarding the private review agent's specific managed care requirements.
- E. Modification of Form Prohibited. A private review agent may not modify the uniform treatment plan form in any manner.
- F. Use of Form by Health Care Provider. A health care provider shall use and properly complete the uniform treatment plan form as provided in this regulation.
- G. Submission of Form by Electronic Transfer. The uniform treatment plan form may be submitted by electronic transfer.
- H. The uniform treatment plan form required by this regulation shall read as follows: FORM AT END OF CHAPTER
- I. Telephonic Review. If a private review agent conducts utilization review of services for the treatment of a mental illness, emotional disorder, or a substance abuse disorder telephonically, the private review agent may not require the health care provider to provide any information that is not requested on the uniform treatment plan form.
Authority: Insurance Article, §§2-109(a)(1), 15-10B-03(h), and 15-802(d)(5), Annotated Code of Maryland
Effective date: June 6, 1994 (21:11 Md. R. 951)
Chapter revised and recodified from COMAR 10.07.19 to COMAR 31.10.21 as an emergency provision effective January 1, 1999 (26:2 Md. R. 104); amended and recodified permanently effective March 22, 1999 (26:6 Md. R. 491)
Regulation .02-1 adopted effective August 21, 2000 (27:16 Md. R. 1526)
Chapter revised effective April 12, 2004 (31:7 Md. R. 587)
Regulation .01B amended effective August 27, 2018 (45:17 Md. R. 804)
Regulation .02 amended effective August 27, 2018 (45:17 Md. R. 804)
Regulation .02-1 repealed and new Regulation .02-1 adopted effective January 30, 2006 (33:2 Md. R. 83)
Regulation .02-1 amended effective May 17, 2010 (37:10 Md. R. 724)
Regulation .02-1H amended as an emergency provision effective January 1, 2013 (40:6 Md. R. 470); amended permanently effective April 15, 2013 (40:7 Md. R. 613)
Regulation .02-1H amended effective May 11, 2015 (42:9 Md. R. 648); February 24, 2020 (47:4 Md. R. 264)
Regulation .03 amended effective August 15, 2016 (43:16 Md. R. 902)