# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 10 — Health Insurance — General

### Chapter 20 — Certification of HMO Medical Directors

#### Regulation .04 Denial or Revocation of Certification.

*COMAR 31.10.20.04*

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.