2019 Indiana Code
Title 27. Insurance
Article 13. Health Maintenance Organizations
Chapter 36. Patient Protection; Clinical Decision Making; Access to Personnel and Facilities
27-13-36-1. Medical director; individual to develop treatment policies and consult with treating providers
Sec. 1. (a) Each health maintenance organization shall appoint a medical director who has an unlimited license to practice medicine under IC 25-22.5 or an equivalent license issued by another state.
(b) The medical director is responsible for oversight of treatment policies, protocols, quality assurance activities, and utilization management decisions of the health maintenance organization.
(c) A health maintenance organization shall contract with or employ at least one (1) individual who holds an unlimited license to practice medicine under IC 25-22.5 to do the following:
(1) Develop, in consultation with a group of appropriate providers, the health maintenance organization's treatment policies, protocols, and quality assurance activities.
(2) Consult with the treating provider before an adverse utilization review decision is made.
(d) Compliance with the National Committee on Quality Assurance standards or guidelines is sufficient to meet the requirements of this section.
As added by P.L.69-1998, SEC.14. Amended by P.L.124-2018, SEC.98.
