Ch. 461                                    2003 LAWS OF MARYLAND

(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;

(ii) The program plan of the health maintenance organization to
determine if it is adequate and being followed;

(iii) The professional standards and practices of the health
maintenance organization in every area of services provided;

(iv) The grievances relating specifically to the delivery of medical
care, including their final disposition;

(v) The physical facilities and equipment; and

(vi) A statistically representative sample of member records.

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