<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 31.10.18.05" title_num="31" subtitle_num="10" chapter_num="18" heading="Procedures for Emergency Cases.">
  <paragraph num="A.">
    <text>An expedited review of an adverse decision in accordance with this regulation is required if the:</text>
    <paragraph num="(1)">
      <text>Adverse decision is rendered for health care services that are proposed but have not been delivered; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Services are necessary to treat a condition or illness that, without immediate medical attention, would:</text>
      <paragraph num="(a)">
        <text>Seriously jeopardize the life or health of the member of the member’s ability to regain maximum functions;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Cause the member to be in danger to self or others; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Cause the member to continue using intoxicating substances in an imminently dangerous manner.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>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.</text>
  </paragraph>
</regulation>