HARRY HUGHES, Governor

1539

CONTINUES.

(I) DELICENSURE OF HOSPITAL; OR

(II) $500 PER DAY FOR EACH DAY THE VIOLATION

(2) (3) THE SECRETARY SHALL, BY REGULATION AND IN
CONSULTATION WITH HEALTH CARE PROVIDERS AND PAYORS, ESTABLISH
MINIMUM STANDARDS FOR A UTILIZATION REVIEW PROGRAM WHICH SHALL
INCLUDE:

(I)  PREADMISSION REVIEW OF ELECTIVE ADMISSIONS;

(II)  POSTADMISSION REVIEW OF EMERGENCY
ADMISSIONS;

(III)  CONCURRENT OR RETROSPECTIVE REVIEW OF ALL
ADMISSIONS AS APPROPRIATE;

(IV)  PREAUTHORIZATION OF CERTAIN SELECTED
PROCEDURES IF PROPOSED TO BE PERFORMED ON AN INPATIENT BASIS;

(V)  PRIOR TO BEFORE PRIOR TO BEFORE ADMISSION,
THE REQUIREMENT OF AN OBJECTIVE SECOND OPINION REGARDING THE
DESIRABILITY OF PERFORMING CERTAIN SELECTED SURGICAL PROCEDURES
ON A NONEMERGENCY BASIS;

(VI)  PREAUTHORIZATION OF LENGTH OF STAY FOR
SURGICAL AND NONSURGICAL ADMISSION; AND CONTINUED STAY REVIEW
BASED ON RECOGNIZED OBJECTIVE CRITERIA; AND

(VII)  DISCHARGE PLANNING REVIEW.

(4) A PATIENT MAY NOT BE CHARGED FOR ANY DAYS
DISALLOWED AS A RESULT OF RETROSPECTIVE REVIEW UNDER PARAGRAPH
(3) OF THIS SUBSECTION UNLESS THE PATIENT REFUSES TO LEAVE THE
HOSPITAL WHEN IT IS MEDICALLY APPROPRIATE TO DO SO AND THE
DISALLOWED DAYS OCCUR:

(I) AFTER THE HOSPITAL HAS NOTIFIED THE PATIENT
IN WRITING OF THE POTENTIAL DISALLOWANCE; OR

(II) AS A DIRECT RESULT OF THE NONCOMPLIANCE BY
THE PATIENT TO TREATMENT OR HOSPITAL REGULATIONS.

(3) (5) A HOSPITAL SHALL BE EXEMPT FROM REQUIRING A
UTILIZATION REVIEW PROGRAM FOR A PATIENT IF:

(I) 1. THE PATIENT IS INSURED BY A THIRD PARTY
PAYOR; AND

2. THE THIRD PARTY PAYOR HAS A

UTILIZATION REVIEW PROGRAM FOR ITS SUBSCRIBERS OR BENEFICIARIES

WHICH MEET THE MINIMUM STANDARDS AS ADOPTED IN SUBSECTION (D)
PARAGRAPH (2) (3) OF THIS SECTION SUBSECTION; OR