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PARRIS N. GLENDENING, Governor
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S.B. 164
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(2) AS PART OF THE REVIEW OF A COMPLAINT, THE COMMISSIONER OR
A DESIGNEE OF THE COMMISSIONER MAY CONSIDER ALL OF THE FACTS OF THE
CASE AND ANY OTHER EVIDENCE THAT THE COMMISSIONER OR DESIGNEE OF THE
COMMISSIONER CONSIDERS APPROPRIATE.
(H) (I) THE COMMISSIONER SHALL;
(1) MAKE AND ISSUE IN WRITING A FINAL DECISION ON ALL
COMPLAINTS FILED WITH THE COMMISSIONER UNDER THIS SUBTITLE THAT ARE
WITHIN THE COMMISSIONER'S JURISDICTION; AND
(2) PROVIDE NOTICE IN WRITING TO ALL PARTIES TO A COMPLAINT OF
THE OPPORTUNITY AND TIME PERIOD FOR REQUESTING A HEARING TO BE HELD IN
ACCORDANCE WITH TITLE 10 SUBTITLE 2 OF THE STATE GOVERNMENT ARTICLE TO
CONTEST A FINAL DECISION OF THE COMMISSIONER MADE AND ISSUED UNDER THIS
SUBTITLE.
15-10D-04. 15-10D-03.
(A) IT IS A VIOLATION OF THIS SUBTITLE FOR A CARRIER TO FAIL TO FULFILL
THE CARRIER'S OBLIGATIONS TO PROVIDE OR REIMBURSE FOR HEALTH CARE
SERVICES SPECIFIED IN THE CARRIER'S POLICIES OR CONTRACTS WITH MEMBERS.
(B) IF, IN RENDERING A COVERAGE DECISION OR APPEAL DECISION, A
CARRIER FAILS TO FULFILL THE CARRIER'S POLICIES OR CONTRACTS WITH
MEMBERS, THE COMMISSIONER MAY:
(1) ISSUE AN ADMINISTRATIVE ORDER THAT REQUIRES THE CARRIER
TO:
(I) CEASE INAPPROPRIATE CONDUCT OR PRACTICES BY THE
CARRIER OR ANY OF THE PERSONNEL EMPLOYED OR ASSOCIATED WITH THE
CARRIER;
(II) FULFILL THE CARRIER'S CONTRACTUAL OBLIGATIONS;
(III) PROVIDE A HEALTH CARE SERVICE OR PAYMENT THAT HAS
BEEN DENIED IMPROPERLY; OR
(IV) TAKE APPROPRIATE STEPS TO RESTORE THE CARRIER'S
ABILITY TO PROVIDE A HEALTH CARE SERVICE OR PAYMENT THAT IS PROVIDED
UNDER A CONTRACT; OR
(2) IMPOSE ANY PENALTY OR FINE OR TAKE ANY ACTION AS
AUTHORIZED:
(I) FOR AN INSURER, NONPROFIT HEALTH SERVICE PLAN, OR
DENTAL PLAN ORGANIZATION, UNDER THIS ARTICLE; OR
(II) FOR A HEALTH MAINTENANCE ORGANIZATION, UNDER THE
HEALTH - GENERAL ARTICLE OR UNDER THIS ARTICLE.
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- 3739 -
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