§ 27-13-34-24 — Dental care services and director; review of adverse decisions; complaints

(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.

Legislative History

As added by P.L.91-2000, SEC.1.