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PARRIS N. GLENDENING, Governor
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S.B. 190
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(i) be provided in accordance with generally accepted standards of
nursing practice for home care of a mother and newborn child;
(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
(iii) include any services required by the attending provider.
(e) (1) The private review agent or health maintenance organization may
not require additional documentation from, require additional utilization review of, or
otherwise provide financial disincentives for an attending provider who orders care
for which coverage is required to be provided under this section, § 19-703 of the
Health - General Article, or § 15-811 of this article.
(2) The private review agent, hospital, or health maintenance
organization may not deny, limit, or otherwise impair the participation of an
attending provider under a contract or any privilege granted an attending provider
who advocates more than 48 hours of inpatient hospital care following a complicated
vaginal delivery or more than 96 hours of inpatient hospital care following a
complicated cesarean section.
15-10B-09.1.
A GRIEVANCE DECISION SHALL BE MADE BASED ON THE PROFESSIONAL
JUDGMENT OF:
(1) A PHYSICIAN, OR A PANEL OF OTHER APPROPRIATE HEALTH CARE
SERVICE REVIEWERS WITH AT LEAST ONE PHYSICIAN ON THE PANEL WHO IS BOARD
CERTIFIED OR ELIGIBLE IN THE SAME SPECIALTY AS THE TREATMENT UNDER
REVIEW;
(2) WHEN THE ADVERSE GRIEVANCE DECISION INVOLVES A DENTAL
SERVICE, A LICENSED DENTIST, OR A PANEL OF APPROPRIATE HEALTH CARE
SERVICE REVIEWERS WITH AT LEAST ONE DENTIST ON THE PANEL WHO IS A
LICENSED DENTIST WHO SHALL CONSULT WITH A DENTIST WHO IS BOARD
CERTIFIED OR ELIGIBLE IN THE SAME SPECIALTY AS THE SERVICE UNDER REVIEW;
OR
(3) WHEN THE ADVERSE GRIEVANCE DECISION INVOLVES A MENTAL
HEALTH OR SUBSTANCE ABUSE SERVICE, A LICENSED PHYSICIAN, OR A PANEL OF
OTHER APPROPRIATE HEALTH CARE SERVICE REVIEWERS WITH AT LEAST ONE
PHYSICIAN, SELECTED BY THE PRIVATE REVIEW AGENT WHO:
(I) IS BOARD CERTIFIED OR ELIGIBLE IN THE SAME SPECIALTY AS
THE TREATMENT UNDER REVIEW; OR
(II) IS ACTIVELY PRACTICING OR HAS DEMONSTRATED EXPERTISE
IN THE ALCOHOL, DRUG ABUSE, OR MENTAL HEALTH SERVICE OR TREATMENT
UNDER REVIEW.
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- 3765 -
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