<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-10C-01" title_number="15" title_name="Health Insurance" subtitle_number="10C" subtitle_name="Medical Directors">
  <level label="a">
    <text>In this subtitle the following words have the meanings indicated.</text>
  </level>
  <level label="b">
    <text>“Board” means the State Board of Physicians established under Title 14 of the Health Occupations Article.</text>
  </level>
  <level label="c">
    <text>“Certificate” means a certificate issued by the Commissioner under this subtitle to act as a medical director.</text>
  </level>
  <level label="d">
    <text>“Department” means the Maryland Department of Health.</text>
  </level>
  <level label="e">
    <text>“Health maintenance organization” has the meaning stated in § 19–701 of the Health – General Article.</text>
  </level>
  <level label="f">
    <level label="1">
      <text>“Medical director” means a physician employed by or under contract with a health maintenance organization who is responsible for:</text>
      <level label="i">
        <text>the establishment or maintenance of the policies and procedures at the health maintenance organization for:</text>
        <level label="1">
          <text>quality assurance; and</text>
        </level>
        <level label="2">
          <text>utilization management;</text>
        </level>
      </level>
      <level label="ii">
        <text>compliance with the quality assurance and utilization management policies and procedures of the health maintenance organization; and</text>
      </level>
      <level label="iii">
        <text>oversight of utilization review decisions of private review agents employed by or under contract with the health maintenance organization.</text>
      </level>
    </level>
    <level label="2">
      <text>“Medical director” includes an associate medical director or an assistant medical director, as defined by the Commissioner by regulation.</text>
    </level>
  </level>
</section>
