|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PARRIS N. GLENDENING, Governor
|
|
|
|
|
|
S.B. 190
|
|
|
|
|
|
|
|
|
|
|
|
|
|
15-10B-14.
THE COMMISSIONER MAY WAIVE THE REQUIREMENTS OF THIS SUBTITLE FOR A
PRIVATE REVIEW AGENT THAT OPERATES SOLELY UNDER CONTRACT WITH THE
FEDERAL GOVERNMENT FOR UTILIZATION REVIEW OF PATIENTS ELIGIBLE FOR
HOSPITAL SERVICES UNDER TITLE XVIII OF THE SOCIAL SECURITY ACT.
[15-10B-15.
A private review agent may not disclose or publish individual medical records or
any other confidential medical information obtained in the performance of utilization
review activities.]
15-10B-15.
THE COMMISSIONER SHALL PERIODICALLY PROVIDE A LIST OF PRIVATE
REVIEW AGENTS ISSUED CERTIFICATES AND THE RENEWAL DATE FOR THOSE
CERTIFICATES TO ANY PERSON ON REQUEST.
[15-10B-16.
(a) (1) Except as provided in paragraph (2) of this subsection, this section
does not apply to:
(i) a private review agent referring an individual to a health care
provider or facility that participates in a health maintenance organization;
(ii) a preferred provider organization network of participating
health care providers or facilities to which the individual would otherwise be referred
as part of the individual's membership or insurance contract; or
(iii) an employee assistance program referring an individual to a
network of participating health care providers or facilities in accordance with a
contract with the individual's employer or labor union to provide comprehensive
mental health and substance abuse services.
(2) A private review agent or any other individual who is either affiliated
with, under contract with, or acting on behalf of a private review agent may not
approve or fail to approve a course of treatment based on whether the treatment is
delivered by a provider who is a participating or nonparticipating provider in the
preferred provider organization or employee assistance program network.
(b) A private review agent or any individual who is either affiliated with,
under contract with, or acting on behalf of a private review agent may not:
(1) refer a patient who has undergone utilization review by the private
review agent to:
(i) a health care facility in which the private review agent owns a
significant beneficial interest; or
(ii) the private review agent's own health care practice;
|
|
|
|
|
|
|
|
|
|
- 3769 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 |
