31.10.18.07

.07 Requirements for Internal Grievance Process.

An internal grievance process shall:

A. Meet the requirements established under this chapter; and

B. Include an expedited procedure for use in an emergency case for purposes of rendering a grievance decision within 24 hours after filing the grievance pursuant to the carrier's internal grievance process, that includes an explanation about:

(1) Who will make the determination whether an emergency case exists when a grievance asserts an emergency case,

(2) How the determination will be made about the existence of an emergency case,

(3) How the disclosure to the member, the memberís representative, or health care provider required by Insurance Article, §15-10A-02(g), Annotated Code of Maryland, will be provided when the grievance asserts that an emergency case exists; and

(4) How the notice to the member and, if applicable, the memberís representative and health care provider required by Insurance Article, §15-10A-02(i), Annotated Code of Maryland, will be provided when the grievance asserts that an emergency case exists.