VETOES
370 470Y.

(A)  EACH INSURER PROPOSING TO ISSUE OR DELIVER A HEALTH
INSURANCE POLICY OR CONTRACT OR TO 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 TITLE 19, SUBTITLE 13 OF THE HEALTH - GENERAL

ARTICLE.

(1)  HAVE A CERTIFICATE IN ACCORDANCE WITH TITLE 19,
SUBTITLE 13 OF THE HEALTH - GENERAL ARTICLE;

(2)  CONTRACT WITH A PRIVATE REVIEW AGENT THAT HAS A
CERTIFICATE IN ACCORDANCE WITH TITLE 19, SUBTITLE 13 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, AN INSURER 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 TITLE 19, SUBTITLE 13 OF THE HEALTH - GENERAL
ARTICLE.

477-II.

(A)  EACH HEALTH INSURER PROPOSING TO ISSUE OR DELIVER IN
THIS STATE A GROUP OR BLANKET HEALTH INSURANCE POLICY OR TO
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 TITLE 19, SUBTITLE 13 OF
THE HEALTH - GENERAL ARTICLE.

(1)  HAVE A CERTIFICATE IN ACCORDANCE WITH TITLE 19,
SUBTITLE 13 OF THE HEALTH - GENERAL ARTICLE;

(2)  CONTRACT WITH A PRIVATE REVIEW AGENT THAT HAS A
CERTIFICATE IN ACCORDANCE WITH TITLE 19, SUBTITLE 13 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 HEALTH INSURER THAT DOES NOT MEET

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