Maryland § 15-10B-17

§ 15-10B-17.

    (a)    (1)    Except as provided in paragraph (2) of this subsection, this section does not apply to:

            (i)    a private review agent referring an individual to a health care provider or facility that participates in a health maintenance organization;

            (ii)    a preferred provider organization network of participating health care providers or facilities to which the individual would otherwise be referred as part of the individual’s membership or insurance contract; or

            (iii)    an employee assistance program referring an individual to a network of participating health care providers or facilities in accordance with a contract with the individual’s employer or labor union to provide comprehensive mental health and substance abuse services.

        (2)    A private review agent or any other individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may not approve or fail to approve a course of treatment based on whether the treatment is delivered by a provider who is a participating or nonparticipating provider in the preferred provider organization or employee assistance program network.

    (b)    A private review agent or any individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may not:

        (1)    refer a patient who has undergone utilization review by the private review agent to:

            (i)    a health care facility in which the private review agent owns a significant beneficial interest; or

            (ii)    the private review agent’s own health care practice;

        (2)    pay or agree to pay any sum to, or accept or agree to accept any sum from, any person for bringing or referring a patient to the private review agent; or

        (3)    provide for different insurance coverage or benefits based on receiving the service from a health care facility or health care provider in which the private review agent owns a significant beneficial interest.

    (c)    A private review agent or any individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may refer a patient who has undergone utilization review by the private review agent to another health care provider regulated under the Health Occupations Article if:

        (1)    (i)    the patient or provider requests the private review agent to provide the patient with the name of a health care provider appropriate to meet the health care needs of the patient; or

            (ii)    the patient has no attending physician; and

        (2)    the private review agent provides the patient with the names of at least two health care providers appropriate to meet the health care needs of the patient.