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PARRIS N. GLENDENING, Governor
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Ch. 123
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decision as to the admission of a patient during the first 24 hours the patient is in an
inpatient facility or until the next business day of the private review agent, whichever
is later. The hospital shall immediately notify the private review agent that a patient
has been admitted and shall state the reasons for the admission.]
15-10B-08.
(A) IF A CARRIER DELEGATES ITS INTERNAL GRIEVANCE PROCESS TO A
PRIVATE REVIEW AGENT, THE PRIVATE REVIEW AGENT SHALL ESTABLISH AN
INTERNAL GRIEVANCE PROCESS FOR ITS PATIENTS AND HEALTH CARE PROVIDERS
ACTING ON BEHALF OF A PATIENT.
(B) A PRIVATE REVIEW AGENT'S INTERNAL GRIEVANCE PROCESS SHALL
MEET THE SAME REQUIREMENTS ESTABLISHED UNDER §§ 15-10A-02 THROUGH
15-10A-05 OF THIS TITLE.
(C) AN INTERNAL GRIEVANCE PROCESS ESTABLISHED BY A PRIVATE REVIEW
AGENT UNDER THIS SECTION MAY NOT CHARGE A FEE TO A PATIENT OR HEALTH
CARE PROVIDER FOR FILING A GRIEVANCE.
15-10B-09.
(a) In this section, "attending provider" means an obstetrician, pediatrician, or
other physician or certified nurse midwife or pediatric nurse practitioner attending
the mother or newborn child.
(b) Except as provided in subsections (c) and (d) of this section, the criteria
and standards used by a private review agent or health maintenance organization in
performing utilization review of hospital services related to maternity and newborn
care, including length of stay, shall be in accordance with the medical criteria outlined
in the most current version of the "Guidelines for Perinatal Care" prepared by the
American Academy of Pediatrics and the American College of Obstetricians and
Gynecologists.
(c) Subject to the provisions of subsection (d) of this section, a private review
agent or health maintenance organization performing utilization review of hospital
services related to maternity and newborn care shall authorize a minimum coverage
of:
(1) 48 hours of inpatient hospitalization care following an uncomplicated
vaginal delivery; and
(2) 96 hours of inpatient hospitalization care following an uncomplicated
cesarean section.
(d) (1) The private review agent or health maintenance organization may
authorize a shorter length of stay than that provided in subsection (c) of this section
if the mother, in consultation with her attending provider, decides that less time is
needed for recovery.
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- 759 -
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