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PARRIS N. GLENDENING, Governor
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S.B. 190
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(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;
(2) PAY OR AGREE TO PAY ANY SUM TO, OR ACCEPT OR AGREE TO
ACCEPT ANY SUM FROM, ANY PERSON FOR BRINGING OR REFERRING A PATIENT TO
THE PRIVATE REVIEW AGENT; OR
(3) PROVIDE FOR DIFFERENT INSURANCE COVERAGE OR BENEFITS
BASED ON RECEIVING THE SERVICE FROM A HEALTH CARE FACILITY OR HEALTH
CARE PROVIDER IN WHICH THE PRIVATE REVIEW AGENT OWNS A SIGNIFICANT
BENEFICIAL INTEREST.
(C) 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 REFER A PATIENT WHO HAS UNDERGONE UTILIZATION REVIEW
BY THE PRIVATE REVIEW AGENT TO ANOTHER HEALTH CARE PROVIDER REGULATED
UNDER THE HEALTH OCCUPATIONS ARTICLE IF:
(1) (I) THE PATIENT OR PROVIDER REQUESTS THE PRIVATE REVIEW
AGENT TO PROVIDE THE PATIENT WITH THE NAME OF A HEALTH CARE PROVIDER
APPROPRIATE TO MEET THE HEALTH CARE NEEDS OF THE PATIENT; OR
(II) THE PATIENT HAS NO ATTENDING PHYSICIAN; AND
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- 3771 -
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