Ch. 415                                    2004 LAWS OF MARYLAND

1. PROVIDES A DESCRIPTION OF ANY ADDITIONAL
MATERIAL OR INFORMATION REQUIRED FROM THE MEMBER OR AUTHORIZED
REPRESENTATIVE; AND

2. PROVIDES AN EXPLANATION OF WHY THE ADDITIONAL
MATERIAL OR INFORMATION IS NECESSARY.

[(g) If within 5 working days after a member or a health care provider, who has
filed a grievance on behalf of a member, files a grievance with the carrier, and if the
carrier does not have sufficient information to complete its internal grievance process,
the carrier shall:

(1) notify the member or health care provider that it cannot proceed with
reviewing the grievance unless additional information is provided; and

(2) assist the member or health care provider in gathering the necessary
information without further delay.

(h) A carrier may extend the 30-day or 45-day period required for making a
final grievance decision under subsection (b)(2)(ii) of this section with the written
consent of the member or the health care provider who filed the grievance on behalf of
the member.]

[(i)] (H) (1) [For nonemergency cases, when] WHEN a carrier renders a
grievance decision, the carrier shall:

(i) document the grievance 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

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

1. states in detail in clear, understandable language the
specific factual bases for the carrier's decision;

2. references the specific criteria and standards, including
interpretive guidelines, on which the grievance decision was based;

3. states the name, business address, and business telephone
number of:

A. the medical director or associate medical director, as
appropriate, who made the grievance decision if the carrier is a health maintenance
organization; or

B. the designated employee or representative of the carrier
who has responsibility for the carrier's internal grievance process if the carrier is not
a health maintenance organization; [and]

4. includes the following information:
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