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 and
implement a procedure to evaluate whether to provide coverage for
new medical technologies and new applications of existing medical
technologies, including medical treatments, procedures, drugs, and
devices.
(b) A health maintenance organization shall maintain the
procedure required under subsection (a) in writing. The written
procedure shall describe the process used to determine whether the
health maintenance organization will provide coverage for new
medical technologies and new uses of existing medical technologies.
(c) The procedure required under this section shall include a
review of information from appropriate governmental regulatory
bodies and published scientific literature about new medical
technologies and new uses of existing medical technologies.
(d) A health maintenance organization shall include appropriate
professionals in the decision making process to determine whether
new medical technologies and new uses of existing medical
technologies 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 coverage
for experimental treatments, procedures, drugs, or devices must
clearly state the limitations in any contract, policy, agreement, or
certificate of coverage.
(b) The disclosure required under subsection (a) must include the
following:
(1) A description of the process used to make the determination
regarding a limitation under subsection (a).
(2) A description of the criteria the health maintenance
organization uses to determine whether a treatment, procedure,
drug, or device is experimental, as provided in section 1 of this
chapter. As added by P.L.69-1998, SEC.17.
IC 27-13-39-3 Written explanation of denial of coverage of experimental
treatment; review
Sec. 3. (a) If a health maintenance organization denies coverage
for a treatment, procedure, drug, or device on the grounds that the
treatment, procedure, drug, or device is experimental, the health
maintenance organization shall provide the enrollee with a written
explanation that includes the following:
(1) The basis for the denial.
(2) The enrollee's right to appeal the health maintenance
organization'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 maintenance
organization whom; or
(B) a department of the health maintenance organization
that;
the enrollee may contact for assistance in initiating an appeal of
the health maintenance organization's decision.
(b) An enrollee is entitled to a review that takes not more than
seventy-two (72) hours if the enrollee's health situation is life
threatening or is an emergency. As added by P.L.69-1998, SEC.17.
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 and
implement a procedure to evaluate whether to provide coverage for
new medical technologies and new applications of existing medical
technologies, including medical treatments, procedures, drugs, and
devices.
(b) A health maintenance organization shall maintain the
procedure required under subsection (a) in writing. The written
procedure shall describe the process used to determine whether the
health maintenance organization will provide coverage for new
medical technologies and new uses of existing medical technologies.
(c) The procedure required under this section shall include a
review of information from appropriate governmental regulatory
bodies and published scientific literature about new medical
technologies and new uses of existing medical technologies.
(d) A health maintenance organization shall include appropriate
professionals in the decision making process to determine whether
new medical technologies and new uses of existing medical
technologies 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 coverage
for experimental treatments, procedures, drugs, or devices must
clearly state the limitations in any contract, policy, agreement, or
certificate of coverage.
(b) The disclosure required under subsection (a) must include the
following:
(1) A description of the process used to make the determination
regarding a limitation under subsection (a).
(2) A description of the criteria the health maintenance
organization uses to determine whether a treatment, procedure,
drug, or device is experimental, as provided in section 1 of this
chapter. As added by P.L.69-1998, SEC.17.
IC 27-13-39-3 Written explanation of denial of coverage of experimental
treatment; review
Sec. 3. (a) If a health maintenance organization denies coverage
for a treatment, procedure, drug, or device on the grounds that the
treatment, procedure, drug, or device is experimental, the health
maintenance organization shall provide the enrollee with a written
explanation that includes the following:
(1) The basis for the denial.
(2) The enrollee's right to appeal the health maintenance
organization'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 maintenance
organization whom; or
(B) a department of the health maintenance organization
that;
the enrollee may contact for assistance in initiating an appeal of
the health maintenance organization's decision.
(b) An enrollee is entitled to a review that takes not more than
seventy-two (72) hours if the enrollee's health situation is life
threatening or is an emergency. As added by P.L.69-1998, SEC.17.
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 and
implement a procedure to evaluate whether to provide coverage for
new medical technologies and new applications of existing medical
technologies, including medical treatments, procedures, drugs, and
devices.
(b) A health maintenance organization shall maintain the
procedure required under subsection (a) in writing. The written
procedure shall describe the process used to determine whether the
health maintenance organization will provide coverage for new
medical technologies and new uses of existing medical technologies.
(c) The procedure required under this section shall include a
review of information from appropriate governmental regulatory
bodies and published scientific literature about new medical
technologies and new uses of existing medical technologies.
(d) A health maintenance organization shall include appropriate
professionals in the decision making process to determine whether
new medical technologies and new uses of existing medical
technologies 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 coverage
for experimental treatments, procedures, drugs, or devices must
clearly state the limitations in any contract, policy, agreement, or
certificate of coverage.
(b) The disclosure required under subsection (a) must include the
following:
(1) A description of the process used to make the determination
regarding a limitation under subsection (a).
(2) A description of the criteria the health maintenance
organization uses to determine whether a treatment, procedure,
drug, or device is experimental, as provided in section 1 of this
chapter. As added by P.L.69-1998, SEC.17.
IC 27-13-39-3 Written explanation of denial of coverage of experimental
treatment; review
Sec. 3. (a) If a health maintenance organization denies coverage
for a treatment, procedure, drug, or device on the grounds that the
treatment, procedure, drug, or device is experimental, the health
maintenance organization shall provide the enrollee with a written
explanation that includes the following:
(1) The basis for the denial.
(2) The enrollee's right to appeal the health maintenance
organization'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 maintenance
organization whom; or
(B) a department of the health maintenance organization
that;
the enrollee may contact for assistance in initiating an appeal of
the health maintenance organization's decision.
(b) An enrollee is entitled to a review that takes not more than
seventy-two (72) hours if the enrollee's health situation is life
threatening or is an emergency. As added by P.L.69-1998, SEC.17.
