Ch. 703                                          LAWS OF MARYLAND

(B)  "UTILIZATION REVIEW" MEANS A SYSTEM FOR REVIEWING THE
APPROPRIATE AND EFFICIENT ALLOCATION OF HOSPITAL RESOURCES AND
SERVICES GIVEN OR PROPOSED TO BE GIVEN TO A PATIENT OR GROUP OF
PATIENTS.

(C)  "PRIVATE REVIEW AGENT" MEANS A NONHOSPITAL-AFFILIATED
PERSON OR ENTITY PERFORMING UTILIZATION REVIEW THAT IS EITHER
AFFILIATED WITH, UNDER CONTRACT WITH, OR ACTING ON BEHALF OF: A

BUSINESS ENTITY, HEALTH MAINTENANCE ORGANIZATION, PREFERRED

PROVIDER ORGANIZATION, HEALTH INSURER, NONPROFIT HEALTH SERVICE
PLAN, HEALTH INSURANCE SERVICE ORGANIZATION OR OTHER THIRD PARTY
PAYOR.

(I) A MARYLAND BUSINESS ENTITY; OR

(II) A THIRD PARTY THAT PROVIDES OR ADMINISTERS
HOSPITAL BENEFITS TO CITIZENS OF THIS STATE, INCLUDING:

1. A HEALTH MAINTENANCE ORGANIZATION
ISSUED A CERTIFICATE OF AUTHORITY IN ACCORDANCE WITH SUBTITLE 7
OF THIS TITLE; OR

2. A HEALTH INSURER, NONPROFIT HEALTH
SERVICE PLAN, HEALTH INSURANCE SERVICE ORGANIZATION, OR PREFERRED
PROVIDER ORGANIZATION AUTHORIZED TO OFFER HEALTH INSURANCE
POLICIES OR CONTRACTS IN THIS STATE IN ACCORDANCE WITH ARTICLE
48A OF THE CODE.

(D)  "UTILIZATION REVIEW PLAN" MEANS A DESCRIPTION OF THE
STANDARDS GOVERNING UTILIZATION REVIEW ACTIVITIES PERFORMED BY A
PRIVATE REVIEW AGENT.

(E)  "SECRETARY" MEANS THE SECRETARY OF HEALTH AND MENTAL
HYGIENE.

(F) "COMMISSIONER" MEANS THE INSURANCE COMMISSIONER.

(G) "CERTIFICATE" MEANS A CERTIFICATE OF REGISTRATION
GRANTED BY THE SECRETARY TO A PRIVATE REVIEW AGENT.

19-1302.

THE PURPOSE OF THIS SUBTITLE IS TO:

(1)  PROMOTE THE DELIVERY OF QUALITY HEALTH CARE IN A
COST EFFECTIVE MANNER;

(2)  FOSTER GREATER COORDINATION BETWEEN PAYORS AND
PROVIDERS CONDUCTING UTILIZATION REVIEW ACTIVITIES;

(3)  PROTECT PATIENTS, BUSINESS, AND PROVIDERS BY
ENSURING THAT PRIVATE REVIEW AGENTS ARE QUALIFIED TO PERFORM

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