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PARRIS N. GLENDENING, Governor
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S.B. 190
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to supply additional information demonstrating compliance with the requirements of
this subtitle and the opportunity to request a hearing.
(2) If an applicant or certificate holder requests a hearing, the
Commissioner shall send a hearing notice by certified mail, return receipt requested,
at least 30 days before the hearing,
(3) The Commissioner shall hold the hearing in accordance with Title 10,
Subtitle 2 of the State Government Article.]
15-10B-11.
A PRIVATE REVIEW AGENT MAY NOT;
(1) VIOLATE ANY PROVISION OF THIS SUBTITLE OR ANY RULE OR
REGULATION ADOPTED UNDER THIS SUBTITLE;
(2) FAIL TO MEET THE REQUIREMENTS FOR CERTIFICATION UNDER
THIS SUBTITLE;
(3) OBTAIN OR ATTEMPT TO OBTAIN CERTIFICATION BASED ON
INACCURATE INFORMATION;
(4) FRAUDULENTLY OR DECEPTIVELY OBTAIN OR USE A CERTIFICATE;
(5) FAIL TO MAKE AVAILABLE THE SERVICES OF SUFFICIENT NUMBERS
OF REGISTERED NURSES, MEDICAL RECORDS TECHNICIANS, OR SIMILARLY
QUALIFIED PERSONS SUPPORTED AND SUPERVISED BY APPROPRIATE PHYSICIANS
TO CARRY OUT ITS UTILIZATION REVIEW ACTIVITIES;
(6) FAIL TO MEET ANY APPLICABLE REGULATIONS THE COMMISSIONER
ADOPTS UNDER THIS SUBTITLE RELATING TO THE QUALIFICATIONS OF PRIVATE
REVIEW AGENTS OR THE PERFORMANCE OF UTILIZATION REVIEW;
(7) FAIL TO PROTECT THE CONFIDENTIALITY OF MEDICAL RECORDS IN
ACCORDANCE WITH APPLICABLE STATE AND FEDERAL LAWS; OR
(8) USE CRITERIA AND STANDARDS TO CONDUCT UTILIZATION REVIEW
UNLESS THE CRITERIA AND STANDARDS USED BY THE PRIVATE REVIEW AGENT ARE:
(I) OBJECTIVE;
(II) CLINICALLY VALID;
(III) COMPATIBLE WITH ESTABLISHED PRINCIPLES OF HEALTH
CARE; OR
(IV) FLEXIBLE ENOUGH TO ALLOW DEVIATIONS FROM NORMS
WHEN JUSTIFIED ON A CASE-BY-CASE BASIS; OR
(9) ACT AS A PRIVATE REVIEW AGENT WITHOUT HOLDING A
CERTIFICATE ISSUED UNDER THIS SUBTITLE.
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- 3767 -
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