A. Not later than the date of hire, a medical director seeking temporary certification shall submit to the Commissioner an application for certification on a form specified by the Commissioner.
B. The medical director shall attach the following additional information to the application:
(1) A description of the applicant's professional qualifications, including medical education, medical training and experience, clinical experience, history of malpractice claims, and licensures;
(2) Evidence of one of the following:
(a) An advanced health-related degree;
(b) Current board certification from either the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA); or
(c) A minimum of 5 years clinical experience;
(3) Evidence of licensure status;
(4) Disclosure of any disciplinary action or sanction taken by any hospital, professional board, or regulating entity;
(5) The name, address, phone number, and facsimile number of the health maintenance organization, and the name of the governing authority of the health maintenance organization that the applicant is employed by or contracted with as a medical director; and
(6) The date of hire or expected date of hire.
C. A certificate issued under this regulation is effective for 90 days from the date of the applicant's employment as a medical director with the health maintenance organization.
D. Extension of Temporary Certificate.
(1) Unless the Commissioner extends for good cause under §D(2) of this regulation, a certificate issued under this regulation may not be renewed.
(2) At the Commissioner's discretion, the Commissioner may extend for good cause for a 30-day period a temporary certificate issued under this regulation.