Ch. 807                          MARVIN MANDEL, Governor                              1667

CHAPTER 807
(House Bill 816)

AN ACT to add new Section 470D to Article 48A of the Annotated Code of
Maryland (1972 Replacement Volume and 1972 Supplement), title "Insurance
Code," subtitle "25. Health Insurance," to follow immediately after Section
470C thereof; to require all health insurers under this subtitle to [[submit,
concurrent with their annual statement to the Insurance Commissioner, a
resume of their activities and efforts in the control of the overuse and abuse of
hospital health and medical services provided to those insured under their
policies and certificates]] set up certain record keeping procedures and to
submit a resume of these records to the Insurance Commissioner.

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That new Section 470D be and it is hereby added to Article 48A
of the Annotated Code of Maryland (1972 Replacement Volume and 1972
Supplement), title "Insurance Code," subtitle "25. Health Insurance," to follow
immediately after Section 470C thereof and to read as follows:

470D.

(A) EVERY INSURER UNDER THIS SUBTITLE HAS THE
RESPONSIBILITY TO SET UP [[REVIEW]] RECORD KEEPING
PROCEDURES SO AS TO [ [EFFECTIVELY]] PERMIT REVIEW FOR
OVER-UTILIZATION AND ABUSE OF THE USE OF HOSPITAL,
HEALTH AND MEDICAL SERVICES THAT MAY RESULT FROM THE
ACTIONS OR ACTIVITIES OF THEIR POLICY OR CERTIFICATE
HOLDERS, OR THE PROVIDERS OF HOSPITAL, HEALTH, AND
MEDICAL SERVICES TO THE INSURED PERSONS, OR BOTH.

[[(B) EVERY INSURER SHALL DEVELOP AND IMPLEMENT AN
EFFECTIVE PROGRAM OF UTILIZATION CONTROL BASED ON THE
INFORMATION AND KNOWLEDGE DEVELOPED THROUGH ITS
REVIEW OF THE OVER-UTILIZATION AND ABUSE OF HOSPITAL,
HEALTH AND MEDICAL SERVICES.]]

[[(C)]] (B) EVERY INSURER SHALL, CONCURRENT WITH THE
FILING OF ITS ANNUAL STATEMENT WITH THE INSURANCE
COMMISSIONER, SUBMIT A RESUME OF THE [[REVIEWS
CONDUCTED, PROGRAMS IMPLEMENTED AND THE EFFECTS OF ITS
UTILIZATION PROGRAMS UPON OVERUSE, ABUSE AND
OVER-UTILIZATION BY ITS INSURED OR THE PROVIDERS OF
HOSPITAL, HEALTH, AND MEDICAL SERVICES TO THE INSURED
PERSONS]] RECORDS KEPT AS REQUIRED BY SUBSECTION (A) OF
THIS SECTION.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take
effect July 1, 1973.

Approved May 24, 1973.