•668                                  LAWS OF MARYLAND                              Ch. 808

CHAPTER 808
(House Bill 817)

AN ACT to add new Section 477D to Article 48A of the Annotated Code of
Maryland (1972 Replacement Volume and 1972 Supplement), title "Insurance
Code," subtitle "26. Group and Blanket Health Insurance," to follow
immediately after Section 477C 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
over-use 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 477D 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 "26. Group and Blanket Health
Insurance," to follow immediately after Section 477C thereof and to read as
follows:

477D.

(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 THOSE PERSONS, OR BOTH.

[I (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, PROGRAM 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 UNDER 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.