Ch. 415                                    2004 LAWS OF MARYLAND

(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 (b)(2)(ii) and (h)] SUBSECTION (C)(2)(II) of this
section, a member or [a health care provider] AN AUTHORIZED REPRESENTATIVE
may file a complaint with the Commissioner if the member or the [health care
provider] AUTHORIZED REPRESENTATIVE does not receive a grievance decision from
the carrier on or before the 30th [working] day on which the grievance is [filed]
RECEIVED BY THE CARRIER.

(3) Whenever the Commissioner receives a complaint under paragraph
(1) or (2) of this subsection, the Commissioner shall notify the carrier that is the
subject of the complaint within [5 working] 7 days after the date the complaint is
filed with the Commissioner.

[(e)] (F) Each carrier shall:

(1) file for review with the Commissioner and submit to the Health
Advocacy Unit a copy of its internal grievance process established under this subtitle;

and

(2) [update the initial filing annually to reflect any changes made] FILE
ANY REVISIONS TO THE INTERNAL GRIEVANCE PROCESS WITH THE COMMISSIONER
AT LEAST 30 DAYS BEFORE ITS INTENDED USE.

[(f)] (G) [For nonemergency cases, when] WHEN a carrier renders an adverse
decision, the carrier shall:

(1) document the adverse decision in writing after the carrier has
provided oral communication of the decision to the member or the [health care
provider acting on behalf of the member] AUTHORIZED REPRESENTATIVE; and

(2) send, [within 5 working days after the adverse decision has been
made] WITHIN THE TIME PERIODS DESCRIBED IN SUBSECTION (I) OF THIS SECTION,
a written notice to the member and [a health care provider acting on behalf of the
member] THE AUTHORIZED REPRESENTATIVE that:

(i) states in detail in clear, understandable language the specific
factual bases for the carrier's decision;

(ii) references the specific criteria and standards, including
interpretive guidelines, on which the decision was based, and may not solely use
generalized terms such as "experimental procedure not covered", "cosmetic procedure
not covered", "service included under another procedure", or "not medically
necessary";

(iii) states the name, business address, and business telephone
number of:

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