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PARRIS N. GLENDENING, Governor
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Ch. 123
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(8) USE CRITERIA AND STANDARDS TO CONDUCT UTILIZATION REVIEW
UNLESS THE CRITERIA AND STANDARDS USED BY THE PRIVATE REVIEW AGENT ARE:
(I) OBJECTIVE;
(II) CLINICALLY VALID;
(III) COMPATIBLE WITH ESTABLISHED PRINCIPLES OF HEALTH
CARE; OR
(IV) FLEXIBLE ENOUGH TO ALLOW DEVIATIONS FROM NORMS
WHEN JUSTIFIED ON A CASE-BY-CASE BASIS; OR
(9) ACT AS A PRIVATE REVIEW AGENT WITHOUT HOLDING A
CERTIFICATE ISSUED UNDER THIS SUBTITLE.
[15-10B-12.
The Commissioner may waive the requirements of this subtitle for a private
review agent that operates solely under contract with the federal government for
utilization review of patients eligible for hospital services under Title XVIII of the
Social Security Act.]
15-10B-12.
(A) (1) A PERSON WHO VIOLATES ANY PROVISION OF § 15-10B-11 OF THIS
SUBTITLE IS GUILTY OF A MISDEMEANOR AND ON CONVICTION IS SUBJECT TO A
PENALTY NOT EXCEEDING $1,000.
(2) EACH DAY A VIOLATION IS CONTINUED AFTER THE FIRST
CONVICTION IS A SEPARATE OFFENSE.
(B) IN ADDITION TO THE PROVISIONS OF SUBSECTION (A) OF THIS SECTION, IF
ANY PERSON VIOLATES ANY PROVISION OF § 15-10B-11 OF THIS SUBTITLE, THE
COMMISSIONER MAY:
(1) DENY, SUSPEND, OR REVOKE THE CERTIFICATE TO DO BUSINESS AS
A PRIVATE REVIEW AGENT;
(2) ISSUE AN ORDER TO CEASE AND DESIST FROM ACTING AS A PRIVATE
REVIEW AGENT WITHOUT HOLDING A CERTIFICATE ISSUED UNDER THIS SUBTITLE;
(2) (3) REQUIRE A PRIVATE REVIEW AGENT TO MAKE RESTITUTION TO
A PATIENT WHO HAS SUFFERED ACTUAL ECONOMIC DAMAGE BECAUSE OF THE
VIOLATION, AND
(3) (4) IMPOSE AN ADMINISTRATIVE PENALTY OF UP TO $5,000 FOR
EACH VIOLATION OF ANY PROVISION OF THIS SUBTITLE.
[15-10B-13.
The Commissioner shall periodically provide a list of private review agents
issued certificates and the renewal date for those certificates to any person on
request.]
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- 763 -
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