1540                                          LAWS OF MARYLAND                                      Ch. Ill

(II) THE PATIENT IS A SUBSCRIBER OR MEMBER OF A
HEALTH MAINTENANCE ORGANIZATION AS DEFINED IN § 19-701 OF THIS
TITLE.

(4)(6) WHERE FEDERAL REGULATIONS OR GUIDELINES FOR A
FEDERALLY MANDATED FEDERALLY MANDATED UTILIZATION REVIEW PROGRAM
FOR FEDERALLY INSURED PATIENTS DIFFER FROM STANDARDS ESTABLISHED
UNDER PARAGRAPH (2)(3) OF THIS SUBSECTION, THE SECRETARY MAY
WAIVE A SPECIFIC STANDARD IF THE PROGRAM ACHIEVES THE SAME
OBJECTIVES AS THE STANDARDS ESTABLISHED BY THE SECRETARY.

Article 48A - Insurance Code

354CC.

EVERY CONTRACT OR CERTIFICATE ISSUED OR DELIVERED IN THIS
STATE BY A NONPROFIT HEALTH SERVICE PLAN WHICH PROVIDES COVERAGE
FOR AN INPATIENT SERVICE IN AN ACUTE GENERAL HOSPITAL SHALL
PROVIDE COVERAGE FOR:

(I)  A CORRESPONDING OUTPATIENT SERVICE WHICH THAT IS
FURNISHED TO THE INSURED IN LIEU OF THE INPATIENT SERVICE BY
REASON OF THE DENIAL RESULTING FROM A UTILIZATION REVIEW PROGRAM
OF A REQUEST BY THE ATTENDING PHYSICIAN FOR AN INPATIENT
ADMISSION.; AND

(II) AN OBJECTIVE SECOND OPINION GIVEN THE INSURED
WHEN REQUIRED BY A UTILIZATION REVIEW PROGRAM UNDER SECTION
19-319 OF THE HEALTH - GENERAL ARTICLE.

470V.

EVERY HEALTH INSURANCE POLICY ISSUED OR DELIVERED IN THIS
STATE WHICH PROVIDES COVERAGE FOR AN INPATIENT SERVICE IN AN
ACUTE GENERAL HOSPITAL SHALL PROVIDE COVERAGE FOR:

(I) A CORRESPONDING OUTPATIENT SERVICE WHICH THAT IS
FURNISHED TO THE INSURED IN LIEU OF THE INPATIENT SERVICE BY
REASON OF THE DENIAL RESULTING FROM A UTILIZATION REVIEW PROGRAM
OF A REQUEST BY THE ATTENDING PHYSICIAN FOR AN INPATIENT
ADMISSION.; AND

(II) AN OBJECTIVE SECOND OPINION GIVEN THE INSURED
WHEN REQUIRED BY A UTILIZATION REVIEW PROGRAM UNDER SECTION
19-319 OF THE HEALTH - GENERAL ARTICLE.

477CC.

EVERY GROUP OR BLANKET HEALTH INSURANCE POLICY ISSUED OR
DELIVERED IN THIS STATE WHICH PROVIDES COVERAGE FOR AN INPATIENT
SERVICE IN AN ACUTE GENERAL HOSPITAL SHALL PROVIDE COVERAGE FOR: