Regulation .04 Denial or Revocation of Certification.
Regulation .04 Denial or Revocation of Certification.LinkCopy Citation
A.
The Commissioner shall deny a certificate to an applicant if the Commissioner finds that the initial application does not meet the requirements of this chapter.
B.
The Commissioner may revoke the certification of a medical director:
(1)
Who violates any provision of this chapter;
(2)
Who fails to meet the requirements for certification under Regulation .04B of this chapter;
(3)
Who obtains certification based on inaccurate information;
(4)
Who fraudulently or deceptively obtains, attempts to obtain, or uses a certificate; or
(5)
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:
(a)
Objective;
(b)
Clinically valid;
(c)
Compatible with established principles of health care; or
(d)
Flexible enough to allow deviations from the norms when justified on a case by case basis.
C.
Before denying an initial application for certification or revoking an issued certificate, the Commissioner shall provide the applicant or certificate holder with:
(1)
Reasonable time to supply additional information which demonstrates compliance with the requirements of this chapter and the opportunity to request a hearing;
(2)
Written notice of the reasons for the denial or revocation; and
(3)
30 days in which to request a hearing in accordance with State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.