§ 24 §2302-A — Utilization review data

1.
Report required.
On or before April 1st of each year, every nonprofit hospital or medical service organization which issues or administers a program or contract in this State that contains a provision whereby in nonemergency cases the insured is required to be prospectively evaluated through a prehospital admission certification, preinpatient service eligibility program or any similar preutilization review or screening procedure prior to the delivery of contemplated hospitalization, inpatient or outpatient health care or medical services which are prescribed or ordered by a duly licensed physician shall file a report on the results of that evaluation for the preceding year with the superintendent which shall contain the following:
2.
Maine residents.
This section is applicable to evaluations, appeals and complaints relating to Maine residents only.
3.
Confidentiality.
Any information provided pursuant to this section may not identify the names of patients. If patient names are identified in information provided pursuant to this section, the patient names are confidential.

Legislative History

PL 1987, c. 168, §1 (NEW). PL 2023, c. 123, §1 (AMD).