1030

LAWS OF MARYLAND

Ch. 21

CONFIDENTIAL AS POSSIBLE;

(2)  BY THE HEALTH MAINTENANCE ORGANIZATION'S OWN
INTERNAL QUALITY OF CARE COMMITTEE AUDIT PROCEDURES, IF THE
DEPARTMENT APPROVES THE PROCEDURES; OR

(3)  BY A PROFESSIONAL STANDARDS REVIEW
ORGANIZATION, AS DESCRIBED IN TITLE XI OF THE SOCIAL
SECURITY ACT, THAT IS CERTIFIED BY THE DEPARTMENT OF HEALTH
AND HUMAN SERVICES AS CAPABLE OF SERVING INDIVIDUALS IN THE
AREA WHERE THE HEALTH MAINTENANCE ORGANIZATION OPERATES WHO
ARE RECEIVING BENEFITS UNDER TITLE XVIII OR TITLE XIX OF THE
SOCIAL SECURITY ACT OR TITLE III OF THE PUBLIC HEALTH
SERVICE ACT, IF THE PROFESSIONAL STANDARDS REVIEW
ORGANIZATION IS ACTING CONSISTENTLY WITH ITS CERTIFICATION.

(J) INTERNAL PEER REVIEW.

WITH THE APPROVAL OF THE DEPARTMENT, THE HEALTH
MAINTENANCE ORGANIZATION SHALL PROVIDE CONTINUOUS INTERNAL
PEER REVIEW FOR MONITORING AND EVALUATING PATIENT RECORDS
FOR:

(1)  QUALITY OF CARE; AND

(2)  OVER USE AND UNDER USE OF PROVIDER CARE.

(K) INTERNAL GRIEVANCE SYSTEM.

THE HEALTH MAINTENANCE ORGANIZATION SHALL PROVIDE AN
INTERNAL GRIEVANCE SYSTEM TO RESOLVE ADEQUATELY ANY
GRIEVANCES INITIATED BY ANY OF ITS MEMBERS, IN A MANNER
APPROVED BY THE DEPARTMENT ON MATTERS CONCERNING QUALITY OF
CARE AND BY THE COMMISSIONER ON ALL OTHER MATTERS COVERED BY
THIS SUBTITLE, UNDER RULES AND REGULATIONS ADOPTED UNDER
THIS SUBTITLE.

(L) PARTICIPATION BY MEMBERS.

THE HEALTH MAINTENANCE ORGANIZATION SHALL ESTABLISH
PROCEDURES TO OFFER EACH MEMBER AN OPPORTUNITY TO
PARTICIPATE IN MATTERS OF POLICY AND OPERATION.

(M) MEDICAL RECORDS SYSTEM.

THE HEALTH MAINTENANCE ORGANIZATION SHALL MAINTAIN A
HEALTH AND MEDICAL RECORDS SYSTEM THAT:

(1)  UNDER PROCEDURES ASSURING MAXIMUM
CONFIDENTIALITY, IS READILY ACCESSIBLE TO AUTHORIZED
PERSONS;

(2)  CAN ACCURATELY DOCUMENT USE BY EACH MEMBER;
AND