HARRY HUGHES, Governor

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(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.

(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 paragraph (3) of
this subsection; or

(ii) The patient is a subscriber or member of a
health maintenance organization as defined in § 19-701 of this
title.

(6)  Where federal regulations or guidelines for a
federally mandated utilization review program for federally
insured patients differ from standards established under
paragraph (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.

(7)  THE SECRETARY MAY ESTABLISH RECORDKEEPING AND
REPORTING REQUIREMENTS:

(I)  TO EVALUATE THE EFFECTIVENESS OF HOSPITALS'
UTILIZATION REVIEW PROGRAMS; AND

(II)  TO DETERMINE IF THE UTILIZATION REVIEW
PROGRAMS ARE IN COMPLIANCE WITH THE PROVISIONS OF THIS SECTION
AND REGULATIONS ADOPTED BY THE SECRETARY TO ADMINISTER THIS
SECTION.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall
take effect July 1, 1986.

Approved May 27, 1986.