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

15-10A-04.

(a) The Commissioner shall:

(1)     notwithstanding the provisions of § 15-10A-03(c)(1)(ii) of this
subtitle, for the purpose of making final decisions on complaints, prioritize complaints
regarding pending health care services over complaints regarding health care services
already delivered;

(2)     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

(3)     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 §
2-210 of this article.

(B) THE PROVISIONS OF § 15-10A-02(E) SHALL BE APPLIED IN ANY HEARING
REQUESTED IN ACCORDANCE WITH SUBSECTION (A) OF THIS SECTION.

[(b)](C) (1) For emergency cases, the Commissioner shall send written
notification of the Commissioner's final decision within [ 1 working day] 3 DAYS after
the Commissioner or the Commissioner's designee has informed the member or [a
health care provider] AN AUTHORIZED REPRESENTATIVE who filed the complaint on
behalf of the member of the final decision through an oral communication.

(2) The Commissioner shall include in the notice the information
required under subsection (a)(3) of this section.

[(c)](D) (1) 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.

(2) If, in rendering an adverse decision or grievance decision, a carrier
fails to fulfill the carrier's obligations to provide or reimburse for health care services
specified in the carrier's policies or contracts with members, the Commissioner may:

(i) issue an administrative order that requires the carrier to:

1.       cease inappropriate conduct or practices by the carrier or
any of the personnel employed or associated with the carrier;

2.       fulfill the carrier's contractual obligations;

3.       provide a health care service or payment that has been
denied improperly; or

4.       take appropriate steps to restore the carrier's ability to
provide a health care service or payment that is provided under a contract; or

(ii) impose any penalty or fine or take any action as authorized:

1. for an insurer, nonprofit health service plan, or dental
plan organization, under this article; or

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