ROBERT L. EHRLICH, JR., Governor                             Ch. 261

[(e)] (F) (1) The health maintenance organization shall have an internal
peer review system that will evaluate the utilizational services and the quality of
health care provided to its members.

(2) The review system shall:

(i) Provide for review by appropriate health professionals of the
process followed in the provision of health services;

(ii) Use systematic data collection of performances and patient
results;

(iii) Provide interpretation of this data to the practitioners;

(iv) Review and update continuing education programs for health
professionals providing services to its members;

(v) Identify needed change and proposed modifications to
implement the change; and

(vi) Maintain written records of the internal peer review process.

[(f)] (G) (1) Except as provided in paragraph (5) of this subsection, the
Department shall conduct an annual external review of the quality of the health
services of the health maintenance organization in a manner that the Department
considers to be appropriate.

(2)     The external review shall be conducted by:

(i) A panel of physicians and other health professionals that
consists of persons who:

1.       Have been approved by the Department;

2.       Have substantial experience in the delivery of health care
in a health maintenance organization setting, but who are not members of the health
maintenance organization staff or performing professional services for the health
maintenance organization; and

3.       Reside outside the area serviced by the health
maintenance organization;

(ii) The Department; or

(iii) A federally approved professional standards review
organization.

(3)     The final decision on the type of external review that is to be
employed rests solely with the Secretary.

(4)     The external review shall consist of a review and evaluation of:
(i) An internal peer review system and reports;

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