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Session Laws, 2000
Volume 797, Page 1971   View pdf image
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PARRIS N. GLENDENING, Governor
Ch. 329
(i) include an expedited procedure for use in an emergency case for
purposes of rendering a grievance decision within 24 hours of the date a grievance is
filed with the carrier; (ii) provide that a carrier render a final decision in writing on a
grievance within 30 working days after the date on which the grievance is filed
unless: 1. the grievance involves an emergency case under item (i) of this paragraph; 2. the member or a health care provider filing a grievance on
behalf of a member agrees in writing to an extension for a period of no longer than 30
working days; or 3. the grievance involves a retrospective denial under item
(iv) of this paragraph; (iii) allow a grievance to be filed on behalf of a member by a health
care provider; and (iv) provide that a carrier render a final decision in writing on a
grievance within 45 working days after the date on which the grievance is filed when
the grievance involves a retrospective denial. (3) For purposes of using the expedited procedure for an emergency case
that a carrier is required to include under paragraph (2)(i) of this subsection, the
Commissioner shall define by regulation the standards required for a grievance to be
considered an emergency case. (c) Except as provided in subsection (d) of this section, the carrier's internal
grievance process shall be exhausted prior to filing a complaint with the
Commissioner under this subtitle. (d) (1) (i) A member or a health care provider filing a complaint on behalf
of a member may file a complaint with the Commissioner without first filing a
grievance with a carrier and receiving a final decision on the grievance if the member
or the health care provider provides sufficient information and supporting
documentation in the complaint that demonstrates a compelling reason to do so. (ii) The Commissioner shall define by regulation the standards that
the Commissioner shall use to decide what demonstrates a compelling reason under
subparagraph (i) of this paragraph. (2) Subject to subsections (h)(2)(ii) and (h) of this section, a member or a
health care provider may file a complaint with the Commissioner if the member or
the health care provider does not receive a grievance decision from the carrier on or
before the 30th working day on which the grievance is filed.
- 1971 -


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Session Laws, 2000
Volume 797, Page 1971   View pdf image
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