Md. Code Regs. 31.10.18.05

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.10.18.05 - Procedures for Emergency Cases

A. An expedited review of an adverse decision in accordance with this regulation is required if the:

(1) Adverse decision is rendered for health care services that are proposed but have not been delivered; and

(2) Services are necessary to treat a condition or illness that, without immediate medical attention, would:

(a) Seriously jeopardize the life or health of the member of the member's ability to regain maximum functions;

(b) Cause the member to be in danger to self or others; or

(c) Cause the member to continue using intoxicating substances in an imminently dangerous manner.

B. The content of any written notice by a carrier of an adverse decision or grievance decision under this regulation shall comply with Regulation .04 of this chapter and Insurance Article, § 15-10 A-02(f) and (i), Annotated Code of Maryland.

Md. Code Regs. 31.10.18.05

Regulations .05 adopted as an emergency provision effective January 1, 1999 (26:2 Md. R. 104); adopted permanently effective March 22, 1999 (26:6 Md. R. 490); amended effective 45:15 Md. R. 728, eff. 7/30/2018