Code of Maryland Regulations (Last Updated: April 6, 2021) |
Title 10. Maryland Department of Health |
Part 5. |
Subtitle 67. MARYLAND HEALTHCHOICE PROGRAM |
Chapter 10.67.13. Maryland Medicaid Managed Care Program: Independent Review Organization (IRO) |
Sec. 10.67.13.05. Assignment of an Expert Reviewer
Latest version.
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A. The IRO shall ensure that an expert reviewer:
(1) Has appropriate clinical expertise in the treatment of the specific medical condition being reviewed and holds a nonrestricted license as a health care provider in the United States; and
(2) Has no history of disciplinary investigations, actions, or sanctions, including loss of staff privileges or participation restrictions that have been taken or are pending by any hospital, governmental agency or unit, or regulatory body.
B. Upon request by the Department, the independent review organization shall provide to the Department information demonstrating compliance with the requirements in §A of this regulation.