2582

LAWS OF MARYLAND

Ch. 690

(i) May be conducted by an independent,
nonhospital-affiliated review agent;

(ii) Shall be performed by registered nurses,
medical records technicians, or similar qualified personnel
supported and supervised by physicians as may be required; and

(iii) Shall be approved and recertified at
least every 2 years by the Secretary if it meets the minimum
standards established under paragraph (3) of this subsection.

(2)  If a hospital fails to provide the utilization
review program required under this subsection, the Secretary may
impose the following penalties:

(i) Delicensure of hospital; or

(ii) $500 per day for each day the violation
continues.

(3)  The Secretary shall, by regulation and in
consultation with health care providers and payors, establish
minimum standards for a utilization review program, DIRECTED AT
APPROPRIATENESS AND QUALITY OF INPATIENT CARE, which shall
include AS ENUMERATED IN THE FOLLOWING ITEMS;

(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) Before admission, the requirement of an
objective second opinion regarding the desirability of performing
certain selected surgical procedures on a nonemergency basis;

(vi) Continued stay review based on recognized
objective criteria; [and]

(vii) Discharge planning review; AND

(VIII) READMISSION 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: