reglab/housing_qa huggingface dataset:
MD. Insurance Code Ann. §  15-10B-12 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-12 - Private Review Agent -- Penalties

    (a)    (1)    A person who violates any provision of § 15-10B-11 of this subtitle is guilty of a misdemeanor and on conviction is subject to a penalty not exceeding $1,000.        (2)    Each day a violation is continued after the first conviction is a separate offense.    (b)    In addition to the provisions of subsection (a) of this section, if any person violates any provision of § 15-10B-11 of this subtitle, the Commissioner may:        (1)    deny, suspend, or revoke the certificate to do business as a private review agent;        (2)    issue an order to cease and desist from acting as a private review agent without holding a certificate issued under this subtitle;        (3)    require a private review agent to make restitution to a patient who has suffered actual economic damage because of the violation; and        (4)    impose an administrative penalty of up to $5,000 for each violation of any provision of this subtitle.
MD. Insurance Code Ann. §  15-10B-13 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-13 - Right to Hearing and Appeal From Action of Commissioner

    Any person aggrieved by an order of the Commissioner under this subtitle has the right to a hearing and the right to appeal from the action of the Commissioner in accordance with §§ 2-210 through 2-215 of this article.
MD. Insurance Code Ann. §  15-10B-14 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-14 - Waiver of Requirements for Review of Certain Patients

    The Commissioner may waive the requirements of this subtitle for a private review agent that operates solely under contract with the federal government for utilization review of patients eligible for hospital services under Title XVIII of the Social Security Act.
MD. Insurance Code Ann. §  15-10B-15 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-15 - List of Private Review Agents

    The Commissioner shall periodically provide a list of private review agents issued certificates and the renewal date for those certificates to any person on request.
MD. Insurance Code Ann. §  15-10B-16 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-16 - Reporting Requirements

    The Commissioner may establish reporting requirements to:         (1)    evaluate the effectiveness of private review agents; and        (2)    determine if the utilization review programs are in compliance with the provisions of this section and applicable regulations.
MD. Insurance Code Ann. §  15-10B-17 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-17 - Patient Referrals by Private Review Agents

    (a)    (1)    Except as provided in paragraph (2) of this subsection, this section does not apply to:            (i)    a private review agent referring an individual to a health care provider or facility that participates in a health maintenance organization;            (ii)    a preferred provider organization network of participating health care providers or facilities to which the individual would otherwise be referred as part of the individual’s membership or insurance contract; or            (iii)    an employee assistance program referring an individual to a network of participating health care providers or facilities in accordance with a contract with the individual’s employer or labor union to provide comprehensive mental health and substance abuse services.        (2)    A private review agent or any other individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may not approve or fail to approve a course of treatment based on whether the treatment is delivered by a provider who is a participating or nonparticipating provider in the preferred provider organization or employee assistance program network.    (b)    A private review agent or any individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may not:        (1)    refer a patient who has undergone utilization review by the private review agent to:            (i)    a health care facility in which the private review agent owns a significant beneficial interest; or            (ii)    the private review agent’s own health care practice;        (2)    pay or agree to pay any sum to, or accept or agree to accept any sum from, any person for bringing or referring a patient to the private review agent; or        (3)    provide for different insurance coverage or benefits based on receiving the service from a health care facility or health care provider in which the private review agent owns a significant beneficial interest.    (c)    A private review agent or any individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may refer a patient who has undergone utilization review by the private review agent to another health care provider regulated under the Health Occupations Article if:        (1)    (i)    the patient or provider requests the private review agent to provide the patient with the name of a health care provider appropriate to meet the health care needs of the patient; or            (ii)    the patient has no attending physician; and        (2)    the private review agent provides the patient with the names of at least two health care providers appropriate to meet the health care needs of the patient.
MD. Insurance Code Ann. §  15-10B-18 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-18 - Withdrawal and Submission of Certificate

    (a)    A private review agent shall advise the Commissioner, in writing, of its intention to withdraw its certificate within 60 days of intention to cease operations as a private review agent.    (b)    A private review agent shall submit its certificate to the administration within 30 days after the date that the private review agent ceased operations.
MD. Insurance Code Ann. §  15-10B-19 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-19 - Examination by Commissioner

    (a)    Whenever the Commissioner considers it advisable, the Commissioner shall examine the affairs, transactions, accounts, records, and assets of each private review agent at least once every 5 years.    (b)    The Commissioner shall examine the affairs, transactions, accounts, records, and assets of each private review agent that applies for a certificate of registration under § 15-10B-03 of this subtitle.    (c)    The examination shall be conducted in accordance with § 2-207 of this article.    (d)    The expense of the examination shall be paid in accordance with § 2-208 of this article.    (e)    The reports of the examination and investigation shall be issued in accordance with § 2-209 of this article.
MD. Insurance Code Ann. §  15-10B-20 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10B - Private Review Agents|Section 15-10B-20 - Examination by Commissioner -- Pharmacy Benefit Manager

    (a)    In addition to the requirements under § 15-10B-19 of this subtitle, the Commissioner shall conduct an examination of any pharmacy benefit manager registered as a private review agent to determine whether the pharmacy benefit manager is acting in compliance with this subtitle.    (b)    The examination shall be conducted:        (1)    in accordance with § 2-207 of this article; and        (2)    at least once every 3 years.    (c)    The expense of the examination shall be paid in accordance with § 2-208 of this article.    (d)    The reports of the examination shall be issued in accordance with § 2-209 of this article.    (e)    Within 30 days after the completion of a final report of an examination under this section, the Commissioner shall submit a copy of the report to the Senate Finance Committee and the House Health and Government Operations Committee in accordance with § 2–1257 of the State Government Article.
MD. Insurance Code Ann. §  15-10C-01 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10C - Medical Directors|Section 15-10C-01 - Definitions

    (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.
MD. Insurance Code Ann. §  15-10C-02 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10C - Medical Directors|Section 15-10C-02 - Establishment of Regulations by Commissioner

    The Commissioner, in consultation with the Department and the Board, shall establish and adopt by regulation standards for:         (1)    the certification of medical directors;        (2)    the renewal, suspension, and revocation of a certificate; and        (3)    the issuance of a temporary certificate.
MD. Insurance Code Ann. §  15-10C-03 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10C - Medical Directors|Section 15-10C-03 - Requirements for Application of Medical Director

    (a)    To be certified as a medical director under this subtitle, an applicant shall:        (1)    submit an application to the Commissioner on the form required by the Commissioner; and        (2)    pay to the Commissioner an application fee of no more than $100 established by the Commissioner by regulation.    (b)    The application shall include:        (1)    a description of the applicant’s professional qualifications, including medical education information and, if appropriate, board certifications and licensure status;        (2)    the utilization management procedures and policies to be used by the health maintenance organization; and        (3)    certification by the medical director that the utilization management procedures and policies are:            (i)    objective;            (ii)    clinically valid;            (iii)    compatible with established principles of health care; and            (iv)    flexible enough to allow deviations from the norms when justified on a case by case basis.    (c)    The delegation by a medical director of any of the medical director’s responsibilities under this subtitle to an associate medical director or an assistant medical director does not prevent the medical director, regardless of the delegation, from being held responsible for any violation of this subtitle.
MD. Insurance Code Ann. §  15-10C-04 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10C - Medical Directors|Section 15-10C-04 - Suspension or Revocation by Commissioner of Certificate of Medical Director

    (a)    Subject to the hearing procedures in §§ 2-210 through 2-214 of this article, the Commissioner may suspend, revoke, or refuse to renew a certificate of a medical director if the Commissioner finds a pattern that the utilization management procedures and policies used by the medical director in making utilization review decisions or used by a private review agent employed by or under contract with the health maintenance organization over whose utilization review decisions the medical director has responsibility are not:        (1)    objective;        (2)    clinically valid;        (3)    compatible with established principles of health care; or        (4)    flexible enough to allow deviations from the norms when justified on a case by case basis.    (b)    The Commissioner may consult with an independent review organization or medical expert that meets the requirements of § 15-10A-05 of this title, the Department, the Board, or any other appropriate entity for purposes of taking an action described under subsection (a) of this section.
MD. Insurance Code Ann. §  15-10D-03 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10D - Complaint Process for Coverage Decisions|Section 15-10D-03 - Obligations of Carrier

    (a)    It is a violation of this subtitle for a carrier to fail to fulfill the carrier’s obligations to provide or reimburse for health care services specified in the carrier’s policies or contracts with members.    (b)    If, in rendering a coverage decision or appeal decision, a carrier fails to fulfill the carrier’s policies or contracts with members, the Commissioner may:        (1)    issue an administrative order that requires the carrier to:            (i)    cease inappropriate conduct or practices by the carrier or any of the personnel employed or associated with the carrier;            (ii)    fulfill the carrier’s contractual obligations;            (iii)    provide a health care service or payment that has been denied improperly; or            (iv)    take appropriate steps to restore the carrier’s ability to provide a health care service or payment that is provided under a contract; or        (2)    impose any penalty or fine or take any action as authorized:            (i)    for an insurer, nonprofit health service plan, or dental plan organization, under this article; or            (ii)    for a health maintenance organization, under the Health - General Article or under this article.
MD. Insurance Code Ann. §  15-10D-04 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10D - Complaint Process for Coverage Decisions|Section 15-10D-04 - Regulations

    The Commissioner may adopt any necessary regulations to carry out the provisions of this subtitle.
MD. Insurance Code Ann. §  15-10D-05 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 10D - Complaint Process for Coverage Decisions|Section 15-10D-05 - Requirements of Notice by Carrier

    A carrier shall provide the notices required to be provided to members under this subtitle in a culturally and linguistically appropriate manner as described in the Affordable Care Act.
MD. Insurance Code Ann. §  15-1102 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 11 - Miscellaneous Health Insurance Policies and Contracts and Health Benefit Plans|Section 15-1102 - Franchise Health Insurance Policies

    (a)    In this section, “employee” includes:        (1)    an officer, manager, or retired employee of an employer;        (2)    a sole proprietor if the employer is a sole proprietorship; and        (3)    a partner if the employer is a partnership.    (b)    Health insurance on a franchise plan is the form of health insurance:        (1)    that is issued to:            (i)    three or more employees of a corporation, partnership, sole proprietorship, or governmental corporation, agency, or department; or            (ii)    ten or more members, employees, or employees of members of a labor union, or trade, professional, or other association, that is organized in good faith for purposes other than obtaining insurance, has a constitution or bylaws, and has had an active existence for at least 2 years;        (2)    under which the individuals insured, with or without their dependents, are issued the same form of an individual policy that varies only as to amounts and kinds of coverage applied for; and        (3)    under which the premiums on the individual policies may be paid to the insurer periodically by:            (i)    the employer, with or without payroll deductions;            (ii)    the labor union or association for its members; or            (iii)    a designated person acting on behalf of the employer, labor union, or association.
MD. Insurance Code Ann. §  15-1103 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 11 - Miscellaneous Health Insurance Policies and Contracts and Health Benefit Plans|Section 15-1103 - Transportation Ticket Health Insurance Policies

    (a)    In this section, “transportation ticket policy” means a ticket policy of health insurance that:        (1)    has as its dominant feature the protection of the insured from a transportation hazard; and        (2)    is sold at transportation stations, ticket offices, or travel bureaus by:            (i)    vending machines;            (ii)    employees of railroads, steam lines, airlines, or other organizations engaged in transporting individuals on common carriers;            (iii)    individuals or employees of persons engaged in selling transportation on common carriers; or            (iv)    other qualified agents.    (b)    A transportation ticket policy may not be issued or delivered in the State unless it conforms to the requirements and provisions of §§ 15-102, 15-201, 15-202, 15-203, 15-205, and 15-207 through 15-226 of this title, subject to § 15-202(c) of this title that relates to inapplicable or inconsistent provisions.
MD. Insurance Code Ann. §  15-1104 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 11 - Miscellaneous Health Insurance Policies and Contracts and Health Benefit Plans|Section 15-1104 - Limited Benefit Group Health Insurance Contracts

    (a)    (1)    In this section the following words have the  meanings indicated.        (2)    “Employer sponsored health benefit plan” means any  plan, fund, or program that:            (i)    is established or maintained by an employer  under the Employee Retirement Income Security Act of 1974;            (ii)    offers coverage for health benefits; and            (iii)    is treated by the employer or any eligible employee or dependent as part of a plan, fund, or program under  the United States Internal Revenue Code, 26 U.S.C. § 106, § 125, or §  162.        (3)    “Group health insurance” has the meaning stated in § 15–302 of this title.        (4)    “Limited benefit group health insurance contract”  means a group health insurance contract that provides health  insurance benefits, but is not required to provide all the benefits  required under Subtitles 7 and 8 of this title.        (5)    “Special eligible employee” means an employee who:            (i)    is eligible for health coverage under the terms of an employer sponsored health benefit plan;            (ii)    works:                1.    on a temporary or substitute basis; or                2.    less than 30 hours in a normal workweek;  and            (iii)    is not eligible for coverage under any group health insurance contract, nonprofit health service plan  contract, or health maintenance organization contract issued to  the employee’s employer because the employee meets the criteria of item (ii) of this paragraph.    (b)    A limited benefit group health insurance contract may be  issued only by an insurer or nonprofit health service plan to an  employer if the limited group health insurance contract is issued  to provide health coverage only for:        (1)    special eligible employees; or        (2)    special eligible employees and their dependents.    (c)    An insurer or nonprofit health service plan that sells a limited benefit group health insurance contract, as a condition of  sale, may require the employer to:        (1)    collect payment for premiums due under the limited benefit group health insurance contract through payroll  deduction;        (2)    contribute to the premium payments applicable to  the coverage of a special eligible employee; and        (3)    offer coverage to any dependent of a special  eligible employee.    (d)    A limited benefit group health insurance contract shall  comply with:        (1)    this title, except Subtitles 7 and 8 of this title; and        (2)    notwithstanding item (1) of this subsection, §§ 15–802, 15–812, 15–815, 15–830, 15–831, 15–832, and 15–833 of this title.    (e)    An insurer or nonprofit health service plan shall  disclose in the group certificate and in enrollment material  provided to each special eligible employee that the limited benefit  group health insurance contract does not provide comprehensive  health coverage.
MD. Insurance Code Ann. §  15-1106 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 11 - Miscellaneous Health Insurance Policies and Contracts and Health Benefit Plans|Section 15-1106 - Rescission of Health Benefit Plan

    (a)    (1)    In this section the following words have the meanings indicated.        (2)    “Carrier” means:            (i)    an insurer;            (ii)    a nonprofit health service plan; or            (iii)    a health maintenance organization.        (3)    “Evidence of individual insurability” has the meaning stated in § 15–1105 of this subtitle.        (4)    “Health benefit plan” has the meaning stated in § 15–1301 of this title.    (b)    If a carrier conditions coverage for a health benefit plan on evidence of individual insurability, the carrier may not rescind a contract or a certificate on the basis of written information submitted on or with, or omitted from, an application for the health benefit plan unless the carrier completed medical underwriting and resolved all reasonable medical questions related to the written information submitted on or with, or omitted from, the application before issuing the health benefit plan.    (c)    The carrier shall have the burden of persuasion that its rescission of a health benefit plan complies with subsection (b) of this section.
MD. Insurance Code Ann. §  15-1202 (2021)
2021 Maryland Statutes|Insurance|Title 15 - Health Insurance|Subtitle 12 - Maryland Health Insurance Reform Act|Section 15-1202 - Scope of Subtitle

    (a)    This subtitle applies only to a health benefit plan that:        (1)    covers eligible employees of small employers in the State; and        (2)    is issued or renewed on or after July 1, 1994, if:            (i)    any part of the premium or benefits is paid by or on behalf of the small employer;            (ii)    any eligible employee or dependent is reimbursed, through wage adjustments or otherwise, by or on behalf of the small employer for any part of the premium;            (iii)    the health benefit plan is treated by the employer or any eligible employee or dependent as part of a plan or program under the United States Internal Revenue Code, 26 U.S.C. § 106, § 125, or § 162; or            (iv)    the small employer allows eligible employees to pay for the health benefit plan through payroll deductions.    (b)    This subtitle applies to any health benefit plan offered by an association, a professional employer organization, or any other entity, including a plan issued under the laws of another state, if the health benefit plan covers eligible employees of one or more small employers and meets the requirements of subsection (a) of this section.