<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 31.10.18.07" title_num="31" subtitle_num="10" chapter_num="18" heading="Requirements for Internal Grievance Process.">
  <text>An internal grievance process shall:</text>
  <paragraph num="A.">
    <text>Meet the requirements established under this chapter; and</text>
  </paragraph>
  <paragraph num="B.">
    <text>Include an expedited procedure for use in an emergency case for purposes of rendering a grievance decision within 24 hours after filing the grievance pursuant to the carrier's internal grievance process, that includes an explanation about:</text>
    <paragraph num="(1)">
      <text>Who will make the determination whether an emergency case exists when a grievance asserts an emergency case,</text>
    </paragraph>
    <paragraph num="(2)">
      <text>How the determination will be made about the existence of an emergency case,</text>
    </paragraph>
    <paragraph num="(3)">
      <text>How the disclosure to the member, the member’s representative, or health care provider required by Insurance Article, §15-10A-02(g), Annotated Code of Maryland, will be provided when the grievance asserts that an emergency case exists; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>How the notice to the member and, if applicable, the member’s representative and health care provider required by Insurance Article, §15-10A-02(i), Annotated Code of Maryland, will be provided when the grievance asserts that an emergency case exists.</text>
    </paragraph>
  </paragraph>
</regulation>