VETOES

(II) A HEALTH INSURER, NONPROFIT HEALTH SERVICE
PLAN, HEALTH INSURANCE SERVICE ORGANIZATION, OR PREFERRED
PROVIDER ORGANIZATION AUTHORIZED TO OFFER HEALTH INSURANCE
POLICIES OR CONTRACTS IN THIS STATE IN ACCORDANCE WITH ARTICLE
48A OF THE CODE.

(D)  "UTILIZATION REVIEW PLAN" MEANS A DESCRIPTION OF THE
STANDARDS GOVERNING UTILIZATION REVIEW ACTIVITIES PERFORMED BY A
PRIVATE REVIEW AGENT.

(E)  "COMMISSIONER" MEANS THE INSURANCE COMMISSIONER.

(F)  "CERTIFICATE" MEANS A CERTIFICATE OF REGISTRATION
GRANTED BY THE SECRETARY TO A PRIVATE REVIEW AGENT.

19-1302.

THE PURPOSES OF THIS SUBTITLE ARE:

(1)  TO PROMOTE THE DELIVERY OF QUALITY HEALTH CARE IN
A COST EFFECTIVE MANNER;

(2)  TO FOSTER GREATER COORDINATION BETWEEN PAYORS AND
PROVIDERS CONDUCTING UTILIZATION REVIEW ACTIVITIES;

(3)  TO PROTECT PATIENTS, BUSINESS, AND PROVIDERS BY
ENSURING THAT PRIVATE REVIEW AGENTS ARE QUALIFIED TO PERFORM
UTILIZATION REVIEW ACTIVITIES AND TO MAKE INFORMED DECISIONS ON
THE APPROPRIATENESS OF MEDICAL CARE; AND

(4)  TO ENSURE THAT PRIVATE REVIEW AGENTS MAINTAIN THE
CONFIDENTIALITY OF MEDICAL RECORDS REQUIRED BY STATE AND FEDERAL
LAW.

19-1303.

A PRIVATE REVIEW AGENT SHALL BE CERTIFIED BY THE DEPARTMENT
BEFORE THE AGENT MAY CONDUCT A UTILIZATION REVIEW IN THE STATE.

19-1304.

(A) (1) AFTER CONSULTATION WITH THE COMMISSIONER, PAYORS,
AND PROVIDERS OF HEALTH CARE, INCLUDING THE MEDICAL AND
CHIRURGICAL FACULTY OF MARYLAND, THE HEALTH INSURANCE ASSOCIATION
OF AMERICA, AND THE MARYLAND HOSPITAL ASSOCIATION, AND THE

MARYLAND ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS, THE

SECRETARY SHALL ADOPT REGULATIONS TO IMPLEMENT THE PROVISIONS OF
THIS SUBTITLE.

(2) TO QUALIFY FOR CERTIFICATION TO CONDUCT A
UTILIZATION REVIEW, AN APPLICANT SHALL MEET THE REQUIREMENTS THAT
THE DEPARTMENT ADOPTS.

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