§ 15-10C-01

Maryland § 15-10C-01

• Jurisdiction: Maryland
• Article gin: Insurance
• Title: 15

Text

(a) In this subtitle the following words have the meanings indicated.

(b) “Board” means the State Board of Physicians established under Title 14 of the Health Occupations Article.

(c) “Certificate” means a certificate issued by the Commissioner under this subtitle to act as a medical director.

(d) “Department” means the Maryland Department of Health.

(e) “Health maintenance organization” has the meaning stated in § 19–701 of the Health – General Article.

(f) (1) “Medical director” means a physician employed by or under contract with a health maintenance organization who is responsible for:

(i) the establishment or maintenance of the policies and procedures at the health maintenance organization for:

1. quality assurance; and

2. utilization management;

(ii) compliance with the quality assurance and utilization management policies and procedures of the health maintenance organization; and

(iii) oversight of utilization review decisions of private review agents employed by or under contract with the health maintenance organization.

(2) “Medical director” includes an associate medical director or an assistant medical director, as defined by the Commissioner by regulation.