Current through Register Vol. 51, No. 22, November 1, 2024
Section 31.10.20.04 - Denial or Revocation of CertificationA. 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.B. The Commissioner may revoke the certification of a medical director: (1) Who violates any provision of this chapter;(2) Who fails to meet the requirements for certification under Regulation .04B of this chapter;(3) Who obtains certification based on inaccurate information;(4) Who fraudulently or deceptively obtains, attempts to obtain, or uses a certificate; or(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:(c) Compatible with established principles of health care, or(d) Flexible enough to allow deviations from the norms when justified on a case by case basis.C. Before denying an initial application for certification or revoking an issued certificate, the Commissioner shall provide the applicant or certificate holder with: (1) Reasonable time to supply additional information which demonstrates compliance with the requirements of this chapter and the opportunity to request a hearing;(2) Written notice of the reasons for the denial or revocation; and(3) 30 days in which to request a hearing in accordance with State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.Md. Code Regs. 31.10.20.04
Regulations .04 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); Regulation .04 recodified from .05 effective 43:9 Md. R. 532, eff. 5/9/2016