Ch. 754

LAWS OF MARYLAND

(1)  By personnel outside the health maintenance
organization who:

(i) Act in a manner that is approved by the
Department; and

(ii) Use methods that will assure objective
evaluation and keep the identity of patients as confidential as
possible;

(2)  By the health maintenance organization's own
internal quality of care committee audit procedures, if the
Department approves the procedures; or

(3)  By a professional standards review organization,
as described in Title XI of the Social Security Act, that is
certified by the Department of Health and Human Services as
capable of serving individuals in the area where the health
maintenance organization operates who are receiving benefits
under Title XVIII or Title XIX of the Social Security Act or
Title III of the Public Health Service Act, if the professional
standards review organization is acting consistently with its
certification.

[(j)] (K) With the approval of the Department, the health
maintenance organization shall provide continuous internal peer
review for monitoring and evaluating patient records for:

(1)  Quality of care; and

(2)  Over use and under use of provider care.

(k)] (L) The health maintenance organization shall provide
an internal grievance system to resolve adequately any grievances
initiated by any of its members, in a manner approved by the
Department on matters concerning quality of care and by the
Commissioner on all other matters covered by this subtitle, under
rules and regulations adopted under this subtitle.

[(1)] (M) The health maintenance organization shall
establish procedures to offer each member an opportunity to
participate in matters of policy and operation.

[(m)] (N) The health maintenance organization shall
maintain a health and medical records system that:

(1)  Under procedures assuring maximum
confidentiality, is readily accessible to authorized persons;

(2)  Can accurately document use by each member; and

(3)  At a minimum:

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