|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2006 LAWS OF MARYLAND
|
|
|
|
|
Ch. 331
|
|
|
|
|
|
|
|
|
|
|
|
|
|
determination, by telephone on an expedited basis, within a period of time not to
exceed 24 hours of the health care provider seeking the reconsideration.
(2) IF AN INITIAL DETERMINATION IS MADE BY A PRIVATE REVIEW
AGENT NOT TO AUTHORIZE OR CERTIFY AN EMERGENCY INPATIENT ADMISSION FOR
THE TREATMENT OF A MENTAL, EMOTIONAL, OR SUBSTANCE ABUSE DISORDER AND
THE HEALTH CARE PROVIDER BELIEVES THE DETERMINATION WARRANTS AN
IMMEDIATE RECONSIDERATION, A PRIVATE REVIEW AGENT SHALL PROVIDE THE
HEALTH CARE PROVIDER THE OPPORTUNITY TO SPEAK WITH THE PHYSICIAN THAT
RENDERED THE DETERMINATION, BY TELEPHONE ON AN EXPEDITED BASIS, WITHIN
A PERIOD OF TIME NOT TO EXCEED 2 HOURS OF THE HEALTH CARE PROVIDER
SEEKING THE RECONSIDERATION.
(c) For emergency inpatient admissions, a private review agent may not
render an adverse decision solely because the hospital did not notify the private
review agent of the emergency admission within 24 hours or other prescribed period
of time after that admission if the patient's medical condition prevented the hospital
from determining:
(1) the patient's insurance status; and
(2) if applicable, the private review agent's emergency admission
notification requirements.
(d) ALU SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION, A private review
agent may not render an adverse decision as to an admission of a patient during the
first [24] 72 hours after admission when:
(1) (I) the admission is based on a determination that the patient is in
imminent danger to self or others;
(2) (II) the determination has been made by the patient's physician or
psychologist in conjunction with a member of the medical staff of the facility who has
privileges to make the admission; and
(3) (III) the hospital immediately notifies the private review agent of:
(i) 1. the admission of the patient; and
(ii) 2. the reasons for the admission.
(2) A PRIVATE REVIEW AGENT MAY NOT RENDER AN ADVERSE DECISION
AS TO AN ADMISSION OF A PATIENT TO A HOSPITAL FOR UP TO 72 HOURS, AS
DETERMINED TO BE MEDICALLY NECESSARY BY THE PATIENT'S TREATING
PHYSICIAN, WHEN:
(I) THE ADMISSION IS AN INVOLUNTARY ADMISSION UNDER §§
10-615 AND 10-617(A) OF THE HEALTH - GENERAL ARTICLE; AND
(II) THE HOSPITAL IMMEDIATELY NOTIFIES THE PRIVATE REVIEW
AGENT OF:
1. THE ADMISSION OF THE PATIENT; AND
- 1790 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 |
