adverse decision when a patient was not insured by or an enrollee of the entity the
private review agent is affiliated with and except for when determinations of
appropriateness or medical necessity, the services would not be covered in whole or in
part under the policy or contract.

Senate Bill 350, which was passed by the General Assembly and signed by me on May
27, 1999, accomplishes the same purpose. Therefore, it is not necessary for me to sign
House Bill 345.

Sincerely,

Parris N. Glendening
Governor

House Bill 345

AN ACT concerning

Health Insurance - Private Review Agents Coverage Determinations and

Retroactive Adverse Decisions

FOR the purpose of altering the circumstances under which a private review agent
may retrospectively render an adverse decision regarding preauthorized or
approved health care services; and generally relating to private review agents
and retroactive adverse decisions in health insurance repealing certain
circumstances under which a private review agent may render a retroactive
adverse decision for preauthorized health care services based on a lack of
coverage for an individual or a specific health care service; requiring that
certain group health insurance contracts contain a provision requiring certain
entities to continue to pay the premium for an insured individual until notice of
termination of coverage for that individual has been received by the carrier; and
generally relating to coverage determinations by insurers and retroactive
adverse decisions based on such determinations.

BY repealing and reenacting, with amendments,
Article - Insurance
Section 15-10B-07(c)
Annotated Code of Maryland
(1997 Volume and 1998 Supplement)

BY adding to

Article - Insurance

Section 15-303(f)

Annotated Code of Maryland

(1997 Volume and 1998 Supplement)

BY adding to

Article - Health - General
Section 19-706(ff)