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31.10.33.00.htm 31.10.33.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 33 Utilization Review of Surgical Treatment of Morbid Obesity Authority: Insurance Article, §2-109(a)1) and 15-893, Annotated Code of Maryland; Ch. 301, Acts of 2005
31.10.33.01.htm 31.10.33.01. 01 Scope.. This chapter establishes the manner in which carriers and private review agents acting on behalf of carriers may apply utilization review criteria and impose documentation requirements to the surgical treatment of the morbid obesity benefit mandated by Insurance Article, §15-839, Annotated Code of Maryland.
31.10.33.02.htm 31.10.33.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Body mass index" has the meaning stated in Insurance Article, §15-839, Annotated Code of Maryland.2) "Carrier" means an insurer, a nonprofit health service plan, or a health maintenance organization.3) "Commissioner" means the Maryland Insurance Commissioner.. 4) "Health maintenance organization" has the meaning stated in Health-General Article, §19-701, Anno
31.10.33.03.htm 31.10.33.03. 03 Utilization Review Criteria for Surgical Treatment of Morbid Obesity.. A. When establishing utilization review criteria for the surgical treatment of morbid obesity as a covered benefit under Insurance Article, §15-839, Annotated Code of Maryland, a carrier or a private review agent acting on behalf of a carrier:1) Shall limit the criteria to the permissible criteria listed in §B of this regulation; and. 2) May not use any criteria that is more restrictive to the member than the
31.10.33.04.htm 31.10.33.04. 04 Documentation Requirements for Structured Diet Programs.. A. The carrier or private review agent acting on behalf of the carrier shall accept any one of the items listed in §B of this regulation as acceptable documentation that the member has completed the structured diet program required by Regulation .03B(4) of this chapter.B. Acceptable documentation of completion of a structured diet program includes:. 1) Physician notes;.
31.10.33.9999.htm 31.10.33.9999. Administrative History Effective date: April 10, 2006 (33:7 Md. R. 676).
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