31.10.18.05

.05 Procedures for Emergency Cases.

A. An expedited review of an adverse decision in accordance with this regulation is required if the:

(1) Adverse decision is rendered for health care services that are proposed but have not been delivered; and

(2) Services are necessary to treat a condition or illness that, without immediate medical attention, would:

(a) Seriously jeopardize the life or health of the member of the memberís ability to regain maximum functions;

(b) Cause the member to be in danger to self or others; or

(c) Cause the member to continue using intoxicating substances in an imminently dangerous manner.

B. The content of any written notice by a carrier of an adverse decision or grievance decision under this regulation shall comply with Regulation .04 of this chapter and Insurance Article, §15-10A-02(f) and (i), Annotated Code of Maryland.