Sec. 24. (a) A limited service health maintenance organization that provides dental care services shall appoint a dental director who has an unlimited license to practice dentistry under IC 25-14 or an equivalent license issued by another state.
(b) The dental director appointed under subsection (a) is responsible for oversight of treatment policies, protocols, quality assurance activities, credentialing of participating providers, and utilization management decisions of the limited service health maintenance organization.
(c) A limited service health maintenance organization that provides dental care services shall contract with or employ at least one (1) individual who holds an unlimited license to practice dentistry under IC 25-14 or an equivalent license issued by another state to do the following:
(1) Develop, in consultation with a group of appropriate providers, the limited service health maintenance organization's treatment policies, protocols, and quality assurance activities.
(2) Respond when a treating provider requests in writing that a dentist reconsider an adverse utilization review decision.
(d) A limited service health maintenance organization that provides dental care services that receives a written request for reconsideration of an adverse utilization review decision from a treating provider shall:
(1) review the decision as expeditiously as possible; and
(2) provide a response to the treating provider not more than ten (10) business days after receiving the request.
(e) A limited service health maintenance organization that provides dental care services shall provide participating providers with an opportunity to comment on the following:
(1) Treatment policies.
(2) Protocols.
(3) Quality assurance activities.
(4) Credentialing policies and procedures.
(5) Utilization management policies and procedures.
As added by P.L.91-2000, SEC.1.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 34. Limited Service Health Maintenance Organizations
27-13-34-0.1. Application of Certain Amendments to Chapter
27-13-34-1. "Enrollee" Defined
27-13-34-2. "Evidence of Coverage" Defined
27-13-34-3. "Limited Health Services" Defined
27-13-34-4. "Limited Service Health Maintenance Organization" Defined
27-13-34-5. "Provider" Defined
27-13-34-6. "Subscriber" Defined
27-13-34-7. Certificate of Authority Required; Foreign Entities
27-13-34-8. Application for Certificate of Authority; Requirements
27-13-34-9. Issuance of Certificate of Authority; Application Deficiencies; Denial of Application
27-13-34-10. Powers of Limited Service Health Maintenance Organization
27-13-34-11. Modification of Documents; Filing; Disapproval
27-13-34-12. Applicable Statutes
27-13-34-13. Evidence of Coverage; Required Information
27-13-34-14. Examinations by Commissioner
27-13-34-15. Required Contract Terms and Conditions; Exemptions
27-13-34-18. Fidelity Bonds; Deposit in Place of Bond
27-13-34-19. Annual Reports; Additional Reports
27-13-34-20. Suspension or Revocation of Certificate of Authority
27-13-34-21. Chapter Violations; Fines and Penalties
27-13-34-22. Supervision, Rehabilitation, or Liquidation; Remedies and Measures
27-13-34-24. Dental Care Services and Director; Review of Adverse Decisions; Complaints