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This entry was published on 2014-09-22
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SECTION 4916
Oversight and surveillance of the external appeal process
Public Health (PBH) CHAPTER 45, ARTICLE 49, TITLE 2
§ 4916. Oversight and surveillance of the external appeal process. 1.
The commissioner shall have the power to:

(a) review the activities of the health care plans and external appeal
agents pursuant to this title, including the extent to which such plans
and agents adhere to the standards and time frames required pursuant to
this title;

(b) investigate complaints by enrollees regarding requests for and
processing of external appeals; and

(c) conduct random audits of health care plans and external appeal
agents to determine compliance with the provisions of this title.

2. Each health care plan and external appeal agent shall annually, in
such form as the commissioner shall require, report the number of
external appeals requested by enrollees and the outcomes of any such
external appeals.

3. The commissioner shall annually report, by plan and agent, such
information to the governor and the legislature, provided that no such
information shall be included which would otherwise be deemed
confidential information within the meaning of this chapter.