§ 15-10B-01. Definitions
West's Annotated Code of MarylandInsurance
MD Code, Insurance, § 15-10B-01
§ 15-10B-01. Definitions
(b)(1) “Adverse decision” means a utilization review determination made by a private review agent that a proposed or delivered health care service:
(c) “Certificate” means a certificate of registration granted by the Commissioner to a private review agent.
(d)(1) “Employee assistance program” means a health care service plan that, in accordance with a contract with an employer or labor union:
2. refer the employee or the employee's family member to health care providers or other community resources for counseling, therapy, or treatment; and
(e)(1) “Grievance” means a protest filed by a patient or a health care provider on behalf of a patient with a private review agent through the private review agent's internal grievance process regarding an adverse decision concerning a patient.
(f) “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) “Health care facility” means:
(h) “Health care provider” means:
(i) “Health care service” means a health or medical care procedure or service rendered by a health care provider licensed or authorized to provide health care services that:
(j) “Health care service reviewer” means an individual who is licensed or otherwise authorized to provide health care services in the ordinary course of business or practice of a profession.
(k) “Private review agent” means:
(2) any person or entity including a hospital-affiliated person performing utilization review for the purpose of making claims or payment decisions for health care services on behalf of the employer's or labor union's health insurance plan under an employee assistance program for employees other than the employees employed by:
(l) “Significant beneficial interest” means the ownership of any financial interest that is greater than the lesser of:
(m) “Utilization review” means a system for reviewing the appropriate and efficient allocation of health care resources and services given or proposed to be given to a patient or group of patients.
Added by Acts 1988, c. 703, § 1, eff. Dec. 1, 1988. Amended by Acts 1991, c. 363, § 1, eff. July 1, 1991; Acts 1992, c. 489, § 1, eff. Oct. 1, 1992; Acts 1992, c. 581, § 1, eff. Oct. 1, 1992; Acts 1994, c. 599, § 1, eff. Oct. 1, 1994; Acts 1997, c. 70, § 4, eff. Oct. 1, 1997. Transferred from Health-General § 19-1301 and amended by Acts 1998, c. 111, §§ 1, 2, eff. Jan. 1, 1999; Acts 1998, c. 112, §§ 1, 2, eff. Jan. 1, 1999. Amended by Acts 2000, c. 123, § 1, eff. Jan. 1, 2001.
MD Code, Insurance, § 15-10B-01, MD INSURANCE § 15-10B-01
Current with legislation effective through July 1, 2023, from the 2023 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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