PARRIS N. GLENDENING, Governor

Ch. 332

(2) A CARRIER SHALL HAVE THE RIGHT TO REEVALUATE AREAS OF
DISPUTE BETWEEN THE CARRIER AND THE 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.

(I) (1) EACH CARRIER SHALL FILE ANNUALLY WITH THE COMMISSIONER A
DETAILED REPORT ON ALL THE CLINICAL AREAS AND DIAGNOSTIC AND
THERAPEUTIC SERVICES EVALUATED THAT WERE PART OF EMERGING MEDICAL
AND SURGICAL TREATMENTS, IN CONSULTATION WITH THE CLINICAL EXPERTS
IDENTIFIED BY THE CARRIER UNDER SUBSECTION (E)(3) OF THIS SECTION, 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 CLINICAL EXPERTS FROM
THE REVIEW OF PUBLISHED, PEER REVIEWED MEDICAL LITERATURE; AND

(III) FOR EACH DIAGNOSTIC OR THERAPEUTIC SERVICE, A
SUMMARY OF THE OPINIONS OF THE CLINICAL EXPERTS ON WHETHER THE
DIAGNOSTIC OR THERAPEUTIC SERVICE IS CONSIDERED A STANDARD OF CARE FOR
THE LOCAL COMMUNITY.

(E) EACH CARRIER SHALL ESTABLISH OR SUBSCRIBE OR CONTRACT TO
PROVIDE A SYSTEMATIC, SCIENTIFIC PROCESS TO FOLLOW FOR EVALUATING
EMERGING MEDICAL AND SURGICAL TREATMENTS TO ENSURE THAT SUBSCRIBERS
HAVE ACCESS TO THE LATEST APPROPRIATE TREATMENTS.

(F) THE PROCESS ESTABLISHED OR SUBSCRIBED TO OR CONTRACTED FOR
BY A CARRIER UNDER SUBSECTION (E) OF THIS SECTION SHALL INCLUDE:

(1) A COMPREHENSIVE REVIEW OF MEDICAL LITERATURE AND DATA
EVALUATION; AND

(2) INPUT FROM PHYSICIANS AND OTHER RECOGNIZED EXPERTS:

(I) WHO ARE NOT EMPLOYEES OF THE CARRIER; AND

(II) WHO:

1. ARE CURRENTLY TREATING PATIENTS FOR THE DISEASE
OR CONDITION BEING EVALUATED:

2. ARE BOARD CERTIFIED IN THE PERTINENT SPECIALTY
OR SUBSPECIALTY AREA OF THE DISEASE OR CONDITION BEING EVALUATED:

3. ARE GENERALLY RECOGNIZED BY THEIR PEERS TO BE
AUTHORITATIVE RESOURCES IN THE CLINICAL AREA BEING EVALUATED AS
EVIDENCED BY:

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