Ch. 415                                    2004 LAWS OF MARYLAND

(I) (1) A CARRIER SHALL PROVIDE NOTICE OF AN ADVERSE DECISION AS
PROVIDED IN THIS SUBSECTION.

(2) EXCEPT AS PROVIDED IN PARAGRAPH (3) OF THIS SUBSECTION, FOR
AN EMERGENCY CASE:

(I) THE CARRIER SHALL PROVIDE WRITTEN NOTICE TO THE
MEMBER AND THE AUTHORIZED REPRESENTATIVE WITHIN 72 HOURS AFTER
RECEIPT OF THE REQUEST FOR HEALTH CARE SERVICES, UNLESS THE MEMBER OR
THE AUTHORIZED REPRESENTATIVE FAILS TO PROVIDE SUFFICIENT INFORMATION
TO MAKE THE DECISION; OR

(II) IF THE MEMBER OR THE AUTHORIZED REPRESENTATIVE FAILS
TO PROVIDE SUFFICIENT INFORMATION TO MAKE THE DECISION, THE CARRIER
SHALL:

1. NOTIFY THE MEMBER AND THE AUTHORIZED

REPRESENTATIVE IN WRITING WITHIN 24 HOURS AFTER RECEIPT OF THE REQUEST
FOR HEALTH CARE SERVICES OF THE SPECIFIC INFORMATION NECESSARY TO MAKE
THE DECISION;

2. ALLOW THE MEMBER OR THE AUTHORIZED

REPRESENTATIVE AT LEAST 48 HOURS TO PROVIDE THE SPECIFIC INFORMATION;
AND

3. NOTIFY THE MEMBER AND THE AUTHORIZED

REPRESENTATIVE IN WRITING OF THE CARRIER'S DECISION WITHIN THE EARLIER
OF:

A. 48 HOURS AFTER RECEIPT OF THE SPECIFIC
INFORMATION REQUIRED IN ITEM 1 OF THIS SUBPARAGRAPH; OR

B. 48 HOURS FROM THE TIME THE SPECIFIC INFORMATION
WAS REQUIRED TO BE PROVIDED TO THE CARRIER.

(3) FOR AN EXTENSION OF A COURSE OF TREATMENT BEYOND THE
PERIOD OF TIME OR NUMBER OF TREATMENTS PREVIOUSLY APPROVED BY THE
CARRIER, THE CARRIER SHALL PROVIDE NOTICE TO THE MEMBER AND THE
AUTHORIZED REPRESENTATIVE WITHIN 24 HOURS AFTER RECEIPT OF THE REQUEST,

IF:

(I) THE DECISION ADDRESSES AN EMERGENCY CASE; AND

(II) THE REQUEST FOR THE EXTENSION WAS PROVIDED TO THE
CARRIER BY THE MEMBER OR THE AUTHORIZED REPRESENTATIVE AT LEAST 24
HOURS BEFORE THE EXPIRATION OF THE PREVIOUSLY APPROVED PERIOD OF TIME
OR NUMBER OF TREATMENTS.

(4) (I) FOR A NONEMERGENCY CASE INVOLVING CARE THAT HAS NOT
BEEN PROVIDED, THE CARRIER SHALL PROVIDE WRITTEN NOTICE TO THE MEMBER

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