VETOES

Senate Bill No. 658

AN ACT concerning

Health Care Utilization Review - Private Review Agents

FOR the purpose of requiring that a private review agent or
health maintenance organization be certified by the
Department of Health and Mental Hygiene before the agent or
health maintenance organization may conduct utilization
review; requiring certain health plans or insurers proposing
to issue a certain policy, contract, or program to meet the
requirements of this Act; defining certain terms; requiring
an applicant for certification or renewal to comply with
certain procedures adopted by the Secretary of Health and
Mental Hygiene; authorizing the Secretary to adopt
regulations after consulting with certain persons;
authorizing the Insurance Commissioner to issue or renew a
certificate under certain circumstances; authorizing the
Secretary to delegate to the Insurance Commissioner the
authority to issue certain certification; providing that a
certificate is not transferable; requiring an applicant for
certification to submit a utilization review plan; providing
for the contents of the plan; requiring that certain
materials be provided the Department; providing for the term
of a certification and a procedure for its renewal;
requiring the Department to deny an application for renewal
under certain circumstances; authorizing the Department to
revoke a certification under certain circumstances;
authorizing the Department to reprimand a certification
holder or to revoke the certification under certain
circumstances; authorizing certain persons to take a direct
judicial appeal from a final decision of the Secretary;
authorizing the Department to waive the requirements of this
Act for certain private review agents; requiring the
Department to periodically provide a list of private review
agents to certain persons; prohibiting a private review
agent from disclosing or publishing certain medical records
or certain confidential medical information; providing
certain criminal penalties for violation of this Act;
requiring a certain annual report; providing for a delayed
effective date; and generally relating to the certification
of private review agents and health maintenance
organizations conducting utilization review.

BY adding to

Article 48A - Insurance Code

Section 354HH, 370 470Y, and 477-II

Annotated Code of Maryland

(1986 Replacement Volume and 1987 Supplement)

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