<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 31.10.21.06" title_num="31" subtitle_num="10" chapter_num="21" heading="Denial or Revocation of Certification.">
  <paragraph num="A.">
    <text>The Commissioner shall deny a certificate to an applicant if the Administration finds that the initial application does not include all requirements of Regulation .02 of this chapter.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The Commissioner may revoke the certification of a private review agent:</text>
    <paragraph num="(1)">
      <text>That violates any provision of this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>That fraudulently or deceptively obtains, attempts to obtain, or uses a certificate;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>That fails to meet the requirements for certification under Regulation .02B of this chapter;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>That obtains certification based on inaccurate information; or</text>
    </paragraph>
    <paragraph num="(5)">
      <text>If the Commissioner finds a pattern that the utilization management procedures and policies used by a private review agent are not:</text>
      <paragraph num="(a)">
        <text>Objective,</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Clinically valid,</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Compatible with established principles of health care, or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Flexible enough to allow deviations from the norms when justified on a case by case basis.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Before denying an initial application for certification or revoking an issued certificate, the Commissioner shall provide the applicant or certificate holder with:</text>
    <paragraph num="(1)">
      <text>Reasonable time to supply additional information which demonstrates compliance with the requirements of this chapter and the opportunity to request a hearing;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Written notice of the reasons for the denial or revocation; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>30 days in which to request a hearing in accordance with State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.</text>
    </paragraph>
  </paragraph>
</regulation>