ROBERT L. EHRLICH, JR., Governor

Ch. 415

(ii) performs utilization review for the purpose of making claims or
payment decisions on behalf of the employer's or labor union's health insurance or
health benefit plan.

(2) "Employee assistance program" does not include a health care service
plan operated by a hospital solely for employees, or members of an employee's family,
of that hospital.

[(e)] (F) (1) "Grievance" means a protest filed by a patient or [a health care
provider on behalf of a patient] AN AUTHORIZED REPRESENTATIVE with a private
review agent through the private review agent's internal grievance process regarding
an adverse decision concerning a patient.

(2) "Grievance" does not include a verbal request for reconsideration of a
utilization review determination.

[(f)](G) "Grievance decision" means a final determination by a private review
agent that arises from a grievance filed with the private review agent under its
internal grievance process regarding an adverse decision concerning a patient.

[(g)](H) "Health care facility" means:

(1) a hospital as defined in § 19-301 of the Health—General Article;

(2) a related institution as defined in § 19-301 of the Health—General
Article;

(3)     an ambulatory surgical facility or center which is any entity or part
thereof that operates primarily for the purpose of providing surgical services to
patients not requiring hospitalization and seeks reimbursement from third party
payers as an ambulatory surgical facility or center;

(4)     a facility that is organized primarily to help in the rehabilitation of
disabled individuals;

(5) a home health agency as defined in § 19-401 of the Health—General
Article;

(6) a hospice as defined in § 19-901 of the Health—General Article;

(7) a facility that provides radiological or other diagnostic imagery
services;

(8)     a medical laboratory as defined in § 17-201 of the Health—General
Article; or

(9)     an alcohol abuse and drug abuse treatment program as defined in §
8-403 of the Health—General Article.

[(h)](I) "Health care provider" means:

(1) an individual who:

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