Ch. 703                                          LAWS OF MARYLAND

19-1306(B)(2) OF THIS SUBTITLE SHALL BE SUFFICIENT TO PAY FOR
THE ADMINISTRATIVE COSTS OF THE CERTIFICATE PROGRAM AND ANY OTHER
COSTS ASSOCIATED WITH CARRYING OUT THE PROVISIONS OF THIS
SUBTITLE.

19-1305.

IN CONJUNCTION WITH THE APPLICATION, THE PRIVATE REVIEW
AGENT SHALL SUBMIT INFORMATION THAT THE SECRETARY REQUIRES
INCLUDING:

(1)  A UTILIZATION REVIEW PLAN THAT INCLUDES:

(I)  SPECIFIC A DESCRIPTION OF REVIEW STANDARDS
AND PROCEDURES TO BE USED IN EVALUATING PROPOSED OR DELIVERED
HOSPITAL CARE;

(II)  THOSE CIRCUMSTANCES, IF ANY, UNDER WHICH
UTILIZATION REVIEW MAY BE DELEGATED TO A HOSPITAL UTILIZATION
REVIEW PROGRAM; AND

(III)  THE PROVISIONS BY WHICH PATIENTS,
PHYSICIANS, OR HOSPITALS MAY SEEK RECONSIDERATION OR APPEAL OF
ADVERSE DECISIONS BY THE PRIVATE REVIEW AGENT;

(2)  THE TYPE AND QUALIFICATIONS OF THE PERSONNEL
EITHER EMPLOYED OR UNDER CONTRACT TO PERFORM THE UTILIZATION
REVIEW;

(3)  THE PROCEDURES AND POLICIES TO ENSURE THAT A
REPRESENTATIVE OF THE PRIVATE REVIEW AGENT IS REASONABLY
ACCESSIBLE TO PATIENTS AND PROVIDERS 5 DAYS A WEEK DURING NORMAL
BUSINESS HOURS IN THIS STATE;

(4)  THE POLICIES AND PROCEDURES TO ENSURE THAT ALL
APPLICABLE STATE AND FEDERAL LAWS TO PROTECT THE CONFIDENTIALITY
OF INDIVIDUAL MEDICAL RECORDS ARE FOLLOWED;

(5)  A COPY OF THE MATERIALS DESIGNED TO INFORM
APPLICABLE PATIENTS AND PROVIDERS OF THE REQUIREMENTS OF THE
UTILIZATION REVIEW PLAN; AND

(6)  A LIST OF THE THIRD PARTY PAYORS FOR WHICH THE
PRIVATE REVIEW AGENT IS PERFORMING UTILIZATION REVIEW IN THIS
STATE.

19-1306.

(A) A CERTIFICATE EXPIRES ON THE SECOND ANNIVERSARY OF ITS
EFFECTIVE DATE UNLESS THE CERTIFICATE IS RENEWED FOR A 2-YEAR
TERM AS PROVIDED IN THIS SECTION.

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