PARRIS N. GLENDENING, Governor                             Ch. 378

(II) ANNUALLY IN ITS DISCLOSURE FILING WITH THE
COMMISSIONER.

(6) THE CARRIER SHALL DISCLOSE IN ITS FILING WITH THE
COMMISSIONER ANY HONORARIA OR OTHER FEES PAID TO CONICAL EXPERTS FOR
THEIR SERVICES.

(E) A CARRIER'S DECISION TO PAY FOR EMERGING MEDICAL AND SURGICAL
TREATMENTS SHALL RESULT FROM THE CONSENSUS OF OPINION FROM ITS OWN
ANALYSIS AND THE KNOWLEDGE PROVIDED TO THE CARRIER FROM LOCAL
CLINICAL EXPERTS.

(F) (1) EACH CARRIER AND THE LOCAL CONICAL EXPERTS IDENTIFIED BY
THE CARRIER SHALL JOINTLY DECIDE THE APPROPRIATE PATIENT SELECTION
CRITERIA FOR EMERGING MEDICAL AND SURGICAL TREATMENTS FOR THE
CARRIER'S AND THE LOCAL EXPERTS REVIEW AND FOR WHICH COVERAGE AND
PAYMENT IS EXTENDED.

(2)     A CARRIER MAY USE THE PATIENT SELECTION CRITERIA AND
OTHER GUIDELINES JOINTLY AGREED ON WITH THE LOCAL CLINICAL EXPERTS TO
APPROVE OR DENY COVERAGE AND PAYMENT FOR EMERGING MEDICAL AND
SURGICAL TREATMENTS FOR ENROLLEES.

(G) (1) A CARRIER'S MEDICAL DIRECTOR AND MEDICAL POLICY STAFF
MAY NOT MAKE COVERAGE AND PAYMENT DECISIONS ON LIFESAVING EMERGING
MEDICAL AND SURGICAL TREATMENTS WITHOUT FIRST CONSULTING THE LOCAL
CLINICAL EXPERTS IDENTIFIED BY THE CARRIER.

(2) WHENEVER A CARRIER'S MEDICAL DIRECTOR OR MEDICAL POLICY
STAFF AND THE LOCAL CONICAL EXPERTS IDENTIFIED BY THE CARRIER DISAGREE
ON COVERAGE AND PAYMENT DECISIONS, THE OPINION OF THE LOCAL CLINICAL
EXPERTS SHALL PREVAIL.

(3) A CARRIER SHALL HAVE THE RIGHT TO REEVALUATE AREAS OF
DISPUTE BETWEEN THE CARRIER AND THE IDENTIFIED LOCAL CLINICAL EXPERTS
ANNUALLY TO DETERMINE WHETHER SCIENTIFIC ADVANCES WARRANT A CHANGE
IN THE CARRIER'S COVERAGE AND PAYMENT POLICY FOR EMERGING MEDICAL
AND SURGICAL TREATMENTS.

(H) (1) EACH YEAR EACH CARRIER SHALL FILE WITH THE COMMISSIONER
A DETAILED REPORT ON ALL THE CLINICAL AREAS AND DIAGNOSTIC AND
THERAPEUTIC SERVICES THAT WERE EVALUATED IN CONSULTATION WITH LOCAL
CLINICAL EXPERTS IDENTIFIED BY THE CARRIER DURING THE PAST YEAR.

(2)     THE REPORT SHALL INCLUDE:

(I) A SUMMARY DESCRIPTION OF EACH CLINICAL ISSUE OR
DIAGNOSTIC OR THERAPEUTIC SERVICE THAT WAS EVALUATED;

(II) FOR EACH DIAGNOSTIC OR THERAPEUTIC SERVICE, A
SUMMARY OF THE FINDINGS OF THE CARRIER AND THE LOCAL CONICAL EXPERTS
FROM THE REVIEW OF PUBLISHED, PEER-REVIEWED MEDICAL LITERATURE;

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