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Ch. 123
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PARRIS N. GLENDENING, Governor
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LICENSED DENTIST WHO SHALL CONSULT WITH A DENTIST WHO IS BOARD
CERTIFIED OR ELIGIBLE IN THE SAME SPECIALTY AS THE SERVICE UNDER REVIEW;
OR
(3) WHEN THE ADVERSE GRIEVANCE DECISION INVOLVES A MENTAL
HEALTH OR SUBSTANCE ABUSE SERVICE, A LICENSED PHYSICIAN, OR A PANEL OF
OTHER APPROPRIATE HEALTH CARE SERVICE REVIEWERS WITH AT LEAST ONE
PHYSICIAN, SELECTED BY THE PRIVATE REVIEW AGENT WHO:
(I) IS BOARD CERTIFIED OR ELIGIBLE IN THE SAME SPECIALTY AS
THE TREATMENT UNDER REVIEW; OR
(II) IS ACTIVELY PRACTICING OR HAS DEMONSTRATED EXPERTISE
IN THE ALCOHOL, DRUG ABUSE, OR MENTAL HEALTH SERVICE OR TREATMENT
UNDER REVIEW.
15-10B-10.
(a) A certificate expires on the second anniversary of its effective date unless
the certificate is renewed for a 2-year term as provided in this section.
(b) Before the certificate expires, a certificate may be renewed for an
additional 2-year term if the applicant:
(1) otherwise is entitled to the certificate;
(2) pays to the Commissioner the renewal fee set by the Commissioner
through regulation; and
(3) submits to the Commissioner:
(i) a renewal application on the form that the Commissioner
requires; and
(ii) satisfactory evidence of compliance with any requirement under
this subtitle for certificate renewal.
(c) If the requirements of this section are met, the Commissioner shall renew
a certificate.
[15-10B-11.
(a) (1) The Commissioner shall deny a certificate to any applicant if, upon
review of the application, the Commissioner finds that the applicant proposing to
conduct utilization review does not:
(i) have available the services of sufficient numbers of registered
nurses, medical records technicians or similarly qualified persons supported and
supervised by appropriate physicians to carry out its utilization review activities; and
(ii) meet any applicable regulations the Commissioner adopts
under this subtitle relating to the qualifications of private review agents or the
performance of utilization review.
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- 761 -
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