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S.B. 190
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VETOES
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(3) THE HOSPITAL IMMEDIATELY NOTIFIES THE PRIVATE REVIEW
AGENT OF:
(I) THE ADMISSION OF THE PATIENT; AND
(II) THE REASONS FOR THE ADMISSION.
[(g)] (E) (1) A private review agent that requires a health care provider to
submit a treatment plan in order for the private review agent to conduct utilization
review of proposed or delivered services for the treatment of a mental illness,
emotional disorder, or a drug abuse or alcohol abuse disorder:
(i) shall accept the uniform treatment plan form adopted by the
Commissioner under § 15-10B-03(d) of this subtitle as a properly submitted
treatment plan form; and
(ii) may not impose any requirement to:
1. modify the uniform treatment plan form or its content; or
2. submit additional treatment plan forms.
(2) A uniform treatment plan form submitted under the provisions of
this subsection:
(i) shall be properly completed by the health care provider; and
(ii) may be submitted by electronic transfer.
[15-10B-07.
(a) Except as specifically provided in § 15-10B-06 of this subtitle:
(1) except as provided in paragraph (2) of this subsection, all adverse
decisions shall be made by a physician or a panel of other appropriate health care
providers with at least 1 physician on the panel.
(2) when the health care service under review is a dental service, the
adverse decision shall be made by a licensed dentist or a panel of other appropriate
health care providers with at least 1 licensed dentist on the panel.
(3) in the event a patient or health care provider, including a physician,
intermediate care facility described in § 8-403(e) of the Health - General Article, or
hospital seeks reconsideration or appeal of an adverse decision by a private review
agent, the final determination of the appeal of the adverse decision shall be made
based on the professional judgment of:
(i) a physician or a panel of other appropriate health care
providers with at least 1 physician on the panel who is board certified or eligible in
the same specialty as the treatment under review; or
(ii) when the adverse decision involves a dental service, a licensed
dentist, or a panel of appropriate health care providers with at least 1 dentist on the
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- 3760 -
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