WILLIAM DONALD SCHAEFER, Governor

(2)  PAYS TO THE DEPARTMENT THE RENEWAL FEE SET BY THE
DEPARTMENT; AND

(3)  SUBMITS TO THE DEPARTMENT:

(I)  A RENEWAL APPLICATION ON THE FORM THAT THE
DEPARTMENT REQUIRES; AND

(II)  SATISFACTORY EVIDENCE OF COMPLIANCE WITH
EACH REQUIREMENT UNDER THIS SUBTITLE.

(D) (C) THE DEPARTMENT SHALL RENEW THE CERTIFICATION OF
EACH CERTIFIED PRIVATE REVIEW AGENT IF THE REQUIREMENTS OF THIS
SUBTITLE ARE MET.

(E) (D) THE DEPARTMENT MAY DELEGATE TO THE COMMISSIONER THE
AUTHORITY TO RENEW A CERTIFICATE FOR ANY HEALTH INSURER OR
NONPROFIT HEALTH SERVICE PLAN REGULATED UNDER ARTICLE 48A OF THE
CODE OR ANY HEALTH MAINTENANCE ORGANIZATION ISSUED A CERTIFICATE
OF AUTHORITY IN ACCORDANCE WITH SUBTITLE 7 OF THIS TITLE THAT
MEETS THE REQUIREMENTS OF THIS SUBTITLE.

19-1307.

(A) (1) THE DEPARTMENT SHALL DENY A CERTIFICATE TO ANY
APPLICANT IF, ON REVIEW OF THE APPLICATION, THE DEPARTMENT FINDS
THAT THE APPLICANT PROPOSING TO CONDUCT UTILIZATION REVIEW DOES
NOT:

(I)  HAVE AVAILABLE THE SERVICES OF A SUFFICIENT
NUMBER OF REGISTERED NURSES, MEDICAL RECORDS TECHNICIANS, OR
SIMILARLY QUALIFIED PERSONS SUPPORTED AND SUPERVISED BY
APPROPRIATE PHYSICIANS TO CARRY OUT ITS UTILIZATION REVIEW
ACTIVITIES; AND

(II)  HAVE AVAILABLE THE SERVICES OF A

SUFFICIENT NUMBER OF DOCTORS OF MEDICINE OR OSTEOPATHY WHO ARE
PRACTICING PHYSICIANS AND WHO ARE SUFFICIENTLY KNOWLEDGEABLE OF
THE STANDARDS OF CARE IN THIS STATE TO ENSURE THE ADEQUATE REVIEW
OF MEDICAL AND SURGICAL SPECIALTY AND SUBSPECIALTY CASES;

(III) UTILIZE ONLY A PHYSICIAN TRAINED IN THE
RELEVANT SPECIALTY OR SUBSPECIALTY TO MAKE A FINAL DETERMINATION
THAT CARE RENDERED IS MEDICALLY INAPPROPRIATE; AND

(IV) SATISFY ANY REGULATIONS ADOPTED BY THE
DEPARTMENT UNDER THIS SUBTITLE RELATING TO THE QUALIFICATIONS OF
PRIVATE REVIEW AGENTS OR THE PERFORMANCE OF UTILIZATION REVIEW.

(2) THE DEPARTMENT SHALL DENY A CERTIFICATE TO ANY
APPLICANT THAT DOES NOT PROVIDE SATISFACTORY ASSURANCES TO THE
DEPARTMENT THAT:

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