<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".19" citation="COMAR 10.07.01.19" title_num="10" subtitle_num="07" chapter_num="01" heading="Reports to the Secretary.">
  <paragraph num="A.">
    <text>Each hospital shall report annually to the Secretary the following summary statistics on the activity of its utilization review program:</text>
    <paragraph num="(1)">
      <text>The number of discharges and total patient days reviewed under the program;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For each of the procedures requiring pre-authorization for inpatient treatment, the number of patients:</text>
      <paragraph num="(a)">
        <text>Reviewed; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Approved for inpatient treatment;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>For each of the procedures requiring an objective second opinion, the number of patients:</text>
      <paragraph num="(a)">
        <text>Undergoing the procedure at the hospital;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Admitted non-electively for the procedure;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Admitted electively after the patient had obtained a second opinion; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Admitted electively but for whom the requirement of a second opinion was waived, including a tabulation of the reasons for waivers;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>For admissions reviewed concurrently or retrospectively, the number of all reviewed admissions disapproved, and reasons for disapproval;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The number of all reviewed days of hospitalization disapproved, by reason for disapproval;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>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.</text>
  </paragraph>
</regulation>