Md. Code Regs. 10.07.01.17 - Exemptions from Hospital Utilization Review
A. A hospital shall be exempt from carrying
out utilization review procedures for a given patient if the:
(1) Person, corporate entity, or insurance
plan paying for the patient's hospitalization has a utilization review program
that is determined by the Insurance Commissioner and the Secretary to
substantially meet the minimum standards described in these regulations,
including the reporting requirements detailed in Regulation .19 of this
chapter, those programs and amendments to them having been submitted to the
Commissioner for approval;
(2)
Patient is a subscriber or a member of a health maintenance organization as
defined in Health-General Article, ยง19-701, Annotated Code of Maryland;
or
(3) Patient is a Medicare or
Maryland Medical Assistance Program beneficiary, and the services rendered at
the hospital are within the scope of coverage provided by the relevant
program.
B. The
Secretary will issue yearly lists of third-party payers known to have
utilization review plans that qualify for the exemption described in this
regulation.
Notes
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