Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 1
Subtitle 07 - HOSPITALS
Chapter 10.07.01 - Acute General Hospitals and Special Hospitals
Section 10.07.01.19 - Reports to the Secretary
Universal Citation: MD Code Reg 10.07.01.19
Current through Register Vol. 51, No. 19, September 20, 2024
A. Each hospital shall report annually to the Secretary the following summary statistics on the activity of its utilization review program:
(1) The number of discharges and total
patient days reviewed under the program;
(2) For each of the procedures requiring
pre-authorization for inpatient treatment, the number of patients:
(a) Reviewed; and
(b) Approved for inpatient
treatment;
(3) For each
of the procedures requiring an objective second opinion, the number of
patients:
(a) Undergoing the procedure at the
hospital;
(b) Admitted
non-electively for the procedure;
(c) Admitted electively after the patient had
obtained a second opinion; and
(d)
Admitted electively but for whom the requirement of a second opinion was
waived, including a tabulation of the reasons for waivers;
(4) For admissions reviewed concurrently or
retrospectively, the number of all reviewed admissions disapproved, and reasons
for disapproval;
(5) The number of
all reviewed days of hospitalization disapproved, by reason for
disapproval;
(6) A summary of the
findings of re-admission review, including the frequency and proportion of
these cases, the diagnoses or treatments involved, and the reasons
found;
(7) A listing and
description of quality care problems found by the agent in the course of
reviewing patient records in furtherance of its duties under the utilization
review plan.
B. The Secretary shall be allowed access to hospital patient records and to the records of the hospital's utilization review agent pertaining to review activities under the plan for the purpose of enforcing these regulations.
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