ROBERT L. EHRLICH, JR., Governor                            Ch. 415

15-10A-03.

(a) (1) Within [30 working] 45 days after the date of receipt of a grievance
decision, a member or [a health care provider] THE AUTHORIZED REPRESENTATIVE,
who filed the grievance on behalf of the member under § [15-10A-02(b)(2)(iii)]
15-10A-02(B)(1) of this subtitle, may file a complaint with the Commissioner for review
of the grievance decision.

(2) Whenever the Commissioner receives a complaint under 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.

(3) Except for an emergency case under subsection [(b)(1)(ii)] (B)(2) of
this section, the carrier that is the subject of a complaint filed under paragraph (1) of
this subsection shall provide to the Commissioner any information requested by the
Commissioner no later than [7 working] 10 days from the date the carrier receives
the request for information.

(b) [(1)] In developing procedures to be used in reviewing and deciding
complaints, the Commissioner shall:

[(i)](1) allow [a health care provider] AN AUTHORIZED
REPRESENTATIVE to file a complaint on behalf of a member; and

[(ii)] (2) establish an expedited procedure for use in an emergency
case for the purpose of making a final decision on a complaint within 21 hours after
the complaint is filed with the Commissioner.

[(2) For purposes of using the expedited procedure for an emergency case
under paragraph (1)(ii) of this subsection, the Commissioner shall define by
regulation the standards required for a grievance to be considered an emergency
case.]

(e) (1) Except as provided in paragraph (2) of this subsection and except for
an emergency case under subsection [(b)(l)(ii)] (B)(2) of this section, the
Commissioner shall make a final decision on a complaint:

(i) within [30 working] 45 days after a complaint regarding a
pending health care service is filed; and

(ii) within [45 working] 60 days after a complaint is filed regarding
a retrospective denial of services already provided.

(2) The Commissioner may extend the period within which a final
decision is to be made under paragraph (1) of this subsection for up to an additional
[30 working] 45 days if the Commissioner has not yet received:

(i) information requested by the Commissioner; and

(ii) the information requested is necessary for the Commissioner to
render a final decision on the complaint.

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