Maine § 1829. - Notice to medical utilization review entity

§ 1829.. Notice to medical utilization review entity

1.  Definitions.  As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A. "Medical utilization review entity" means a person, corporation, organization or other entity that provides medical utilization review services as defined in Title 24‑A, section 2773.   [PL 1991, c. 548, Pt. A, §17 (RPR).]

B. "Emergency treatment" means treatment of a case involving accidental bodily injury or the sudden and unexpected onset of a critical condition requiring medical or surgical care for which a person seeks immediate medical attention within 24 hours of the onset.   [PL 1991, c. 548, Pt. A, §17 (RPR).]

2.  Notification requirement.  If a hospital provides emergency treatment to a person who is insured or otherwise covered under a policy or contract that requires review of hospitalization by a medical utilization review entity, the hospital must notify the medical utilization review entity covering that person, unless the person is:

A. Released from the hospital no more than 48 hours after admission; or   [PL 1991, c. 548, Pt. A, §17 (RPR).]

B. Covered under an insurance policy or contract that is not subject to Title 24, section 2302‑B, Title 24‑A, section 2749‑A or Title 24‑A, section 2847‑A.   [PL 1993, c. 645, Pt. A, §2 (AMD).]

The notification must include the name of the person admitted, the general medical nature of the admission and the telephone number of the admitting physician or other health care provider treating the person.  

3.  Timing of notification.  Notification must be made within 2 business days after the hospital determines the identity of the utilization review entity and receives written authorization to release the information by the patient or other person authorized to permit release of the information.

4.  Exemption.  The hospital is exempt from this requirement if:

A. The hospital receives a written confirmation from the admitting physician, the patient or a representative of the patient that the medical utilization review entity has been notified; or   [PL 1991, c. 548, Pt. A, §17 (RPR).]

B. The hospital is not able to obtain written authorization to release the information, following a good faith effort by the hospital to obtain that authorization.   [PL 1991, c. 548, Pt. A, §17 (RPR).]

5.  Immunity from liability for notification.  Neither the hospital nor any of its employees or representatives may be held liable for damages resulting from the notification required by this section.