Ch. 332

1997 LAWS OF MARYLAND

A. FACULTY APPOINTMENTS;

B. AUTHORSHIP OF A SIGNIFICANT BODY OF
PEER-REVIEWED CLINICAL LITERATURE IN THE PERTINENT SPECIALTY OR
SUBSPECIALTY AREA OR

C. A DEMONSTRATED HISTORY OF LEADERSHIP IN LOCAL
STATE OR NATIONAL PROFESSIONAL ASSOCIATIONS AND NONPROFIT PATIENT AND
COMMUNITY ADVOCACY ORGANIZATIONS THAT ADDRESS THE DISEASE OR
CONDITION AND THE SPECIALTY OR SUBSPECIALTY AREA IN QUESTION; OR

4. HAVE A DEMONSTRATED HISTORY OF SUBSTANTIAL
EXPERIENCE AND PRACTICAL KNOWLEDGE IN THE SPECIALTY OR SUBSPECIALTY
AREA IN QUESTION.

(G) A CARRIER'S DECISION TO PROVIDE COVERAGE FOR AN EMERGING
MEDICAL OR SURGICAL TREATMENT SHALL RESULT FROM THE CONSENSUS OF
OPINION FROM ITS OWN ANALYSIS AND THE KNOWLEDGE PROVIDED TO THE
CARRIER FROM THE PROCESS IDENTIFIED BY THE CARRIER IN SUBSECTION (F) OF
THIS SECTION.

(H) EACH CARRIER. IN CONJUNCTION WITH THE CLINICAL EXPERTS
IDENTIFIED BY THE CARRIER UNDER SUBSECTION (F)(2) OF THIS SECTION, SHALL
DECIDE THE PATIENT SELECTION CRITERIA FOR AN EMERGING MEDICAL OR
SURGICAL TREATMENT FOR WHICH COVERAGE BY THE CARRIER IS TO BE
PROVIDED.

(I) EACH CARRIER SHALL PROVIDE A DESCRIPTION OF THE PROCESS
IDENTIFIED BY THE CARRIER UNDER SUBSECTION (F) OF THIS SECTION TO
ENROLLEES AND CONTRACTING PROVIDERS AND ALL OTHER PROVIDERS ON
REQUEST.

(J) (1) A CARRIER'S COVERAGE DECISION ON AN EMERGING MEDICAL OR
SURGICAL TREATMENT SHALL BE IN COMPLIANCE WITH § 19-1305.2 OF THE HEALTH
- GENERAL ARTICLE, WHEN BEING APPEALED BY AN ENROLLEE.

(2) A CARRIER MAY REEVALUATE ANNUALLY WHETHER SCIENTIFIC
ADVANCES WARRANT A CHANGE IN THE CARRIER'S COVERAGE AND PAYMENT
POLICY FOR AN EMERGING MEDICAL OR SURGICAL TREATMENT.

(K) (1) EACH CARRIER SHALL FILE ANNUALLY WITH THE COMMISSIONER A
SUMMARY DESCRIPTION OF THE CLINICAL ISSUES AND DIAGNOSTIC AND
THERAPEUTIC SERVICES THAT WERE EVALUATED AND THE CONCLUSION OF THE
EVALUATION. INCLUDING THE OPINIONS OF THE CLINICAL EXPERTS.

(3) (2) THE COMMISSIONER SHALL

(I) MAKE EACH CARRIER'S REPORT FILING UNDER PARAGRAPH
(1) OF THIS SUBSECTION AVAILABLE TO THE PUBLIC FOR INSPECTION AND REVIEW;
AND

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