IC 27-13-39
    Chapter 39. Patient Protection; Experimental Treatments

IC 27-13-39-1
Procedures regarding experimental treatments
    Sec. 1. (a) A health maintenance organization shall develop andimplement a procedure to evaluate whether to provide coverage fornew medical technologies and new applications of existing medicaltechnologies, including medical treatments, procedures, drugs, anddevices.
    (b) A health maintenance organization shall maintain theprocedure required under subsection (a) in writing. The writtenprocedure shall describe the process used to determine whether thehealth maintenance organization will provide coverage for newmedical technologies and new uses of existing medical technologies.
    (c) The procedure required under this section shall include areview of information from appropriate governmental regulatorybodies and published scientific literature about new medicaltechnologies and new uses of existing medical technologies.
    (d) A health maintenance organization shall include appropriateprofessionals in the decision making process to determine whethernew medical technologies and new uses of existing medicaltechnologies qualify for coverage.
As added by P.L.69-1998, SEC.17.

IC 27-13-39-2
Disclosure of coverage limitations
    Sec. 2. (a) A health maintenance organization that limits coveragefor experimental treatments, procedures, drugs, or devices mustclearly state the limitations in any contract, policy, agreement, orcertificate of coverage.
    (b) The disclosure required under subsection (a) must include thefollowing:
        (1) A description of the process used to make the determinationregarding a limitation under subsection (a).
        (2) A description of the criteria the health maintenanceorganization uses to determine whether a treatment, procedure,drug, or device is experimental, as provided in section 1 of thischapter.
As added by P.L.69-1998, SEC.17.

IC 27-13-39-3
Written explanation of denial of coverage of experimentaltreatment; review
    Sec. 3. (a) If a health maintenance organization denies coveragefor a treatment, procedure, drug, or device on the grounds that thetreatment, procedure, drug, or device is experimental, the healthmaintenance organization shall provide the enrollee with a writtenexplanation that includes the following:
        (1) The basis for the denial.        (2) The enrollee's right to appeal the health maintenanceorganization's decision as provided in IC 27-8-16-8,IC 27-8-17-12, and IC 27-13-10.
        (3) The telephone number of:
            (A) an individual employed by the health maintenanceorganization whom; or
            (B) a department of the health maintenance organizationthat;
        the enrollee may contact for assistance in initiating an appeal ofthe health maintenance organization's decision.
    (b) An enrollee is entitled to a review that takes not more thanseventy-two (72) hours if the enrollee's health situation is lifethreatening or is an emergency.
As added by P.L.69-1998, SEC.17.