Ch. 415

2004 LAWS OF MARYLAND

(2) the determination has been made by the patient's physician or
psychologist in conjunction with a member of the medical staff of the facility who has
privileges to make the admission; and

(3) the hospital immediately notifies the private review agent of:

(i) the admission of the patient; and

(ii) the reasons for the admission.

[(c)] (D) (1) A private review agent that requires a health-care provider to
submit a treatment plan in order for the private review agent to conduct utilization
review of proposed or delivered services for the treatment of a mental illness,
emotional disorder, or a substance abuse disorder:

(i) shall accept the uniform treatment plan form adopted by the
Commissioner under § 15-10B-03(d) of this subtitle as a properly submitted
treatment plan form; and

(ii) may not impose any requirement to:

1. modify the uniform treatment plan form or its content; or

2. submit additional treatment plan forms.

(2) A uniform treatment plan form submitted under the provisions of
this subsection:

(i) shall be properly completed by the health care provider; and

(ii) may be submitted by electronic transfer.

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] AND THE
AUTHORIZED REPRESENTATIVES.

(b) A private review [agent's internal grievance process] AGENT shall meet
the same requirements established under §§ 15-10A-02 through 15-10A-05 of this

title.

(e) A private review agent may not charge a fee to a patient or [health care
provider] THE AUTHORIZED REPRESENTATIVE for filing a grievance.

15-10B-09.1.

(A) A grievance decision shall be made based on the professional judgment of:

(1) (i) a physician who is board certified or eligible in the same
specialty as the treatment under review; or

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