(a) (1) After consultation with representatives of payors, health care practitioners, and freestanding ambulatory care facilities, the Secretary shall by regulation establish: (i) Procedures to implement the provisions of this subtitle; and (ii) Standards to ensure quality of care and patient safety that shall include: 1. Procedures for credentialing and practitioner performance evaluation; 2. Qualifications of health care practitioners and support personnel; 3. Procedures to be followed in the event of an emergency, including a requirement that in the event of an emergency the patient be transported to the nearest appropriate emergency care facility; 4. Procedures for quality control of any biomedical equipment; 5. Procedures for postoperative recovery; 6. Procedures for discharge; 7. Procedures for ensuring that an anesthesia practitioner is not precluded from providing the highest level of anesthesia support that may be required to safely treat patients undergoing procedures in a freestanding ambulatory surgical facility performed in a nonsterile procedure room or a sterile operating room; 8. The use of ultrasound imaging in a freestanding birthing center; 9. Minimum perinatal care standards for a freestanding birthing center that meet or exceed the Maryland Perinatal System Standards that a freestanding birthing center shall meet as a condition of licensure; and 10. Any other procedures that the Secretary considers necessary for quality of care and patient safety. (2) The procedures for practitioner performance evaluation required under paragraph (1)(ii)1 of this subsection shall include a review of care provided to patients at the freestanding ambulatory care facility by members of the medical staff. (3) The review of care shall: (i) Be undertaken for cases chosen at random and for cases with unexpected adverse outcomes; (ii) Be based on objective review standards; (iii) Include a review of the appropriateness of the plan of care for the patient, particularly any medical procedures performed on the patient, in relation to the patient's condition; and (iv) Except as provided in paragraph (4) of this subsection, be conducted by at least two members of the medical staff who: 1. As appropriate, are of the same specialty as the member of the medical staff under review; and 2. Have been trained in the freestanding ambulatory care facility's policies and procedures regarding practitioner performance evaluation. (4) A review of the care provided by a member of the medical staff who is a solo practitioner shall be conducted by an external reviewer. (5) A freestanding ambulatory care facility shall take into account the results of the practitioner performance evaluation process for a member of the medical staff in the reappointment process. (b) If appropriate certification by Medicare is available, obtaining the certification shall be a condition of licensure for: (1) An ambulatory surgical facility; and (2) A kidney dialysis center. (c) Each freestanding ambulatory care facility shall provide assurances satisfactory to the Secretary that the freestanding ambulatory care facility does not discriminate against patients, including discrimination based on ability to pay for nonelective procedures. (d) The Secretary may delegate to the Kidney Disease Commission the Secretary's authority under § 19-3B-07 of this subtitle to inspect kidney dialysis centers. (e) (1) Except as provided in paragraph (2) of this subsection, the Department shall survey freestanding ambulatory care facilities in accordance with federal regulations. (2) The Department shall survey each freestanding birthing center at least once per calendar year.
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