Ch. 529                                    1996 LAWS OF MARYLAND

(3)     The final decision on the type of external review that is to be employed
rests solely with the [Department] SECRETARY.

(4)     The external review shall consist of a review and evaluation of:

(i) An internal peer review system and reports;

(ii) The program plan of the health maintenance organization to
determine if it is adequate and being followed;

(iii) The professional standards and practices of the health
maintenance organization in every area of services provided;

(iv) The grievances relating specifically to the delivery of medical care,
including their final, disposition;

(v) The physical facilities and equipment; and

(vi) A statistically representative sample of member records.

(5)     (I) THE SECRETARY MAY WAIVE THE APPLICATION OF THIS
SUBSECTION TO A HEALTH MAINTENANCE ORGANIZATION THAT HAS BEEN
ACCREDITED BY A NATIONALLY RECOGNIZED ACCREDITING ENTITY, IF THE
SECRETARY DETERMINES THAT THE STANDARDS OF THE EXTERNAL REVIEW

ORGANIZATION ARE SUBSTANTIALLY EQUIVALENT TO THE STATE'S

REQUIREMENTS FOR HEALTH MAINTENANCE ORGANIZATIONS UNDER THIS
SUBTITLE.

(II) THE HEALTH MAINTENANCE ORGANIZATION SHALL:

1. SUBMIT COPIES OF ITS APPLICATION FOR

ACCREDITATION, ITS INITIAL ACCREDITATION CERTIFICATION, AND SUBSEQUENT
APPLICATIONS AND RECERTIFICATIONS; AND

2. MAKE AVAILABLE FOR INSPECTION BY THE SECRETARY
A FINAL REPORT ISSUED BY THE NATIONALLY RECOGNIZED ACCREDITING ENTITY
THAT THE SECRETARY HAS DETERMINED MEETS THE STATE'S STANDARDS FOR
HEALTH MAINTENANCE ORGANIZATIONS UNDER THIS SUBTITLE.

(III) IN ADDITION TO INFORMATION REQUIRED UNDER
SUBPARAGRAPH (II) OF THIS PARAGRAPH, THE HEALTH MAINTENANCE
ORGANIZATION SHALL SUBMIT TO THE DEPARTMENT AND MAKE AVAILABLE TO
THE PUBLIC A COPY OF ANY SUMMARY REPORTS MADE BY THE NATIONALLY
RECOGNIZED ACCREDITING ENTITY THAT HAS BEEN DETERMINED BY THE
SECRETARY TO MEET THE STATE'S STANDARDS FOR HEALTH MAINTENANCE
ORGANIZATIONS UNDER THIS SUBTITLE.

(IV) EXCEPT AS PROVIDED IN SUBPARAGRAPH (III) OF THIS
PARAGRAPH, ALL INFORMATION AND DOCUMENTS AND COPIES OBTAINED BY OR
DISCLOSED TO THE SECRETARY, OR ANY OTHER PERSON, IN THE COURSE OF AN
EXAMINATION OR INVESTIGATION MADE FOR PURPOSES OF SUBPARAGRAPH (I) OF
THIS PARAGRAPH ARE CONFIDENTLY AND ARE NOT SUBJECT TO SUBPOENA AND
MAY NOT BE MADE PUBLICLY AVAILABLE BY THE SECRETARY OR ANY OTHER

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