WILLIAM DONALD SCHAEFER, Governor                           Ch. 99

(iv) Preauthorization of certain selected procedures if proposed to be
performed on an inpatient basis;

(v) Continued stay review based on recognized objective criteria;

(vi) Discharge planning review; and

(vii) Readmission review.

(4) (5) A patient may not be charged for any days disallowed as a result of
retrospective review under paragraph (3) (4) of this subsection unless the patient refuses
to leave the hospital when it is medically appropriate to do so and the disallowed days
occur:

(i) After the hospital has notified the patient in writing of the
potential disallowance; or

(ii) As a direct result of the noncompliance by the patient to treatment
or hospital regulations.

(5) (6) A hospital shall be exempt from requiring a utilization review
program for a patient if:

(i) 1. The patient is insured by a third-party payor; and

2. The third-party payor has a utilization review program for its
subscribers or beneficiaries which meets the minimum standards as adopted in paragraph
(3) (4) of this subsection; or

(ii) The patient is a subscriber or member of a health maintenance
organization as defined in § 19-701 of this title.

(6) (7) Where federal regulations or guidelines for a federally mandated
utilization review program for federally insured patients differ from standards established
under paragraph (3) (4) of this subsection, the Secretary may waive a specific standard if
the program achieves the same objectives as the standards established by the Secretary.

(7) (8) The Secretary may establish recordkeeping and reporting
requirements:

(i) To evaluate the effectiveness of hospitals' utilization review
programs; and

(ii) To determine if the utilization review programs are in compliance
with the provisions of this section and regulations adopted by the Secretary to administer
this section.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 1993.

Approved April 26, 1993.

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