Regulation .05 Procedures for Emergency Cases.
Regulation .05 Procedures for Emergency Cases.LinkCopy Citation
A.
An expedited review of an adverse decision in accordance with this regulation is required if the:
(1)
Adverse decision is rendered for health care services that are proposed but have not been delivered; and
(2)
Services are necessary to treat a condition or illness that, without immediate medical attention, would:
(a)
Seriously jeopardize the life or health of the member of the member’s ability to regain maximum functions;
(b)
Cause the member to be in danger to self or others; or
(c)
Cause the member to continue using intoxicating substances in an imminently dangerous manner.
B.
The content of any written notice by a carrier of an adverse decision or grievance decision under this regulation shall comply with Regulation .04 of this chapter and Insurance Article, §15-10A-02(f) and(i), Annotated Code of Maryland.