<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-10C-03" title_number="15" title_name="Health Insurance" subtitle_number="10C" subtitle_name="Medical Directors">
  <level label="a">
    <text>To be certified as a medical director under this subtitle, an applicant shall:</text>
    <level label="1">
      <text>submit an application to the Commissioner on the form required by the Commissioner; and</text>
    </level>
    <level label="2">
      <text>pay to the Commissioner an application fee of no more than $100 established by the Commissioner by regulation.</text>
    </level>
  </level>
  <level label="b">
    <text>The application shall include:</text>
    <level label="1">
      <text>a description of the applicant’s professional qualifications, including medical education information and, if appropriate, board certifications and licensure status;</text>
    </level>
    <level label="2">
      <text>the utilization management procedures and policies to be used by the health maintenance organization; and</text>
    </level>
    <level label="3">
      <text>certification by the medical director that the utilization management procedures and policies are:</text>
      <level label="i">
        <text>objective;</text>
      </level>
      <level label="ii">
        <text>clinically valid;</text>
      </level>
      <level label="iii">
        <text>compatible with established principles of health care; and</text>
      </level>
      <level label="iv">
        <text>flexible enough to allow deviations from the norms when justified on a case by case basis.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>The delegation by a medical director of any of the medical director’s responsibilities under this subtitle to an associate medical director or an assistant medical director does not prevent the medical director, regardless of the delegation, from being held responsible for any violation of this subtitle.</text>
  </level>
</section>
