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<section article="gin" article_name="Insurance" number="15-10C-04" title_number="15" title_name="Health Insurance" subtitle_number="10C" subtitle_name="Medical Directors">
  <level label="a">
    <text>Subject to the hearing procedures in §§ 2-210 through 2-214 of this article, the Commissioner may suspend, revoke, or refuse to renew a certificate of a medical director 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:</text>
    <level label="1">
      <text>objective;</text>
    </level>
    <level label="2">
      <text>clinically valid;</text>
    </level>
    <level label="3">
      <text>compatible with established principles of health care; or</text>
    </level>
    <level label="4">
      <text>flexible enough to allow deviations from the norms when justified on a case by case basis.</text>
    </level>
  </level>
  <level label="b">
    <text>The Commissioner may consult with an independent review organization or medical expert that meets the requirements of § 15-10A-05 of this title, the Department, the Board, or any other appropriate entity for purposes of taking an action described under subsection (a) of this section.</text>
  </level>
</section>
