Ch. 397                                    1996 LAWS OF MARYLAND

(E) (1) IF A PRIVATE REVIEW AGENT OR HEALTH MAINTENANCE
ORGANIZATION RENDERS AN ADVERSE DECISION AND THE ATTENDING PHYSICIAN
BELIEVES THAT THE DECISION WARRANTS AN IMMEDIATE APPEAL, THE
ATTENDING PHYSICIAN SHALL HAVE THE OPPORTUNITY TO APPEAL THE ADVERSE
DECISION BY TELEPHONE ON AN EXPEDITED BASIS.

(2)     AN EXPEDITED APPEAL SHALL CONSIST OF AN IMMEDIATE AND
TIMELY REVIEW BETWEEN THE ATTENDING PHYSICIAN AND THE PRIVATE REVIEW
AGENT OR THE MEDICAL DIRECTOR OF THE HEALTH MAINTENANCE
ORGANIZATION OR A PHYSICIAN AUTHORIZED TO ACT ON BEHALF OF THE HEALTH
MAINTENANCE ORGANIZATION IN THE ABSENCE OF THE MEDICAL DIRECTOR.

(3)     IF A DECISION REGARDING THE EXPEDITED APPEAL IS NOT
RENDERED IN SUFFICIENT TIME TO ALLOW THE MOTHER AND THE NEWBORN
CHILD THE BENEFITS UNDER SUBSECTION (C) OF THIS SECTION, THE PRIVATE
REVIEW AGENT OR THE HEALTH MAINTENANCE ORGANIZATION MAY NOT RENDER
AN ADVERSE DECISION.
(D) (1) THE PRIVATE REVIEW AGENT OR HEALTH MAINTENANCE

ORGANIZATION MAY AUTHORIZE A SHORTER LENGTH OF STAY THAN THAT
PROVIDED IN SUBSECTION (C) OF THIS SECTION IF THE MOTHER, IN CONSULTATION
WITH HER ATTENDING PROVIDER, DECIDES THAT LESS TIME IS NEEDED FOR
RECOVERY.

(2) FOR A MOTHER AND NEWBORN CHILD WHO HAVE A HOSPITAL STAY
SHORTER IN LENGTH THAN THAT PROVIDED UNDER SUBSECTION (C) OF THIS
SECTION, THE PRIVATE REVIEW AGENT OR HEALTH MAINTENANCE ORGANIZATION
PERFORMING UTILIZATION REVIEW SHALL AUTHORIZE AT LEAST ONE HOME VISIT:

(I) ONE HOME VISIT SCHEDULED TO OCCUR WITHIN 24 HOURS AFTER
HOSPITAL DISCHARGE; AND

(II) AN ADDITIONAL HOME VISIT AS MAY BE PRESCRIBED BY THE
ATTENDING PROVIDER

(3) FOR A MOTHER AND NEWBORN CHILD WHO REMAIN IN THE HOSPITAL
FOR AT LEAST THE PERIOD OF TIME PROVIDED UNDER SUBSECTION (C) OF THIS
SECTION. THE PRIVATE REVIEW AGENT OR HEALTH MAINTENANCE ORGANIZATION
PERFORMING UTILIZATION REVIEW SHALL AUTHORIZE A HOME VISIT AS MAY BE
PRESCRIBED BY THE ATTENDING PROVIDER

(4) A HOME VISIT UNDER PARAGRAPH (2) OR (3) OF THIS SUBSECTION
SHALL:

(I) BE PROVIDED IN ACCORDANCE WITH GENERALLY ACCEPTED
STANDARDS OF NURSING PRACTICE FOR HOME CARE OF A MOTHER AND NEWBORN
CHILD; AND

(II) BE PROVIDED BY A REGISTERED NURSE WITH AT LEAST 1 YEAR
OF EXPERIENCE IN MATERNAL AND CHILD HEALTH NURSING OR IN COMMUNITY
HEALTH NURSING WITH AN EMPHASIS ON MATERNAL AND CHILD HEALTH; AND

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