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Ch. 703 LAWS OF MARYLAND
(2) THE HEALTH MAINTENANCE ORGANIZATION SHALL MEET
THE REQUIREMENTS OF SUBTITLE 13 OF THIS TITLE AND ALL REGULATIONS
FOR THE PERFORMANCE OF UTILIZATION REVIEW.
Article 48A - Insurance Code
354HH.
(A) EVERY NONPROFIT HEALTH SERVICE PLAN PROPOSING TO ISSUE
OR DELIVER A HEALTH INSURANCE POLICY OR CONTRACT OR ADMINISTER A
HEALTH BENEFIT PROGRAM WHICH PROVIDES FOR THE COVERAGE OF
HOSPITAL BENEFITS AND THE UTILIZATION REVIEW OF THOSE BENEFITS
SHALL: MEET THE REQUIREMENTS OF SUBTITLE 13 OF TITLE 19 OF THE
HEALTH - GENERAL ARTICLE.
(1) HAVE A CERTIFICATE IN ACCORDANCE WITH SUBTITLE 13
OF TITLE 19 OF THE HEALTH - GENERAL ARTICLE;
(2) CONTRACT WITH A PRIVATE REVIEW AGENT THAT HAS A
CERTIFICATE IN ACCORDANCE WITH SUBTITLE 13 OF TITLE 19 OF THE
HEALTH - GENERAL ARTICLE; OR
(3) CONTRACT WITH OR DELEGATE TO A HOSPITAL
UTILIZATION REVIEW PROGRAM APPROVED UNDER § 19-319(D) OF THE
HEALTH - GENERAL ARTICLE.
(B) NOTWITHSTANDING ANY OTHER PROVISION OF THIS ARTICLE,
FOR CLAIMS WHERE THE MEDICAL NECESSITY OF THE PROVISION OF A
COVERED BENEFIT IS DISPUTED, A NONPROFIT HEALTH SERVICE PLAN THAT
DOES NOT MEET THE REQUIREMENTS OF SUBSECTION (A) OF THIS SECTION
SHALL PAY ANY PERSON OR HOSPITAL ENTITLED TO REIMBURSEMENT UNDER
THE POLICY, CONTRACT, OR CERTIFICATE IN ACCORDANCE WITH THE
DETERMINATION OF MEDICAL NECESSITY BY THE HOSPITAL UTILIZATION
REVIEW PROGRAM APPROVED UNDER SECTION 19-319(D) OF THE HEALTH -
GENERAL ARTICLE.
370Y.
(A) EVERY INSURER PROPOSING TO ISSUE OR DELIVER A HEALTH
INSURANCE POLICY OR CONTRACT OR ADMINISTER A HEALTH BENEFIT
PROGRAM WHICH PROVIDES FOR THE COVERAGE OF HOSPITAL BENEFITS AND
THE UTILIZATION REVIEW OF SUCH BENEFITS SHALL: MEET THE
REQUIREMENTS OF SUBTITLE 13 OF TITLE 19 OF THE HEALTH - GENERAL
ARTICLE.
(1) HAVE A CERTIFICATE IN ACCORDANCE WITH SUBTITLE 13
OF TITLE 19 OF THE HEALTH - GENERAL ARTICLE;
(2) CONTRACT WITH A PRIVATE REVIEW AGENT THAT HAS A
CERTIFICATE IN ACCORDANCE WITH SUBTITLE 13 OF TITLE 19 OF THE
HEALTH - GENERAL ARTICLE; OR
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