Indiana § 27-13-36-1 Medical director; individual to develop treatment policies and consult
with treating providers

Indiana Statutes

§ 27-13-36-1 — Medical director; individual to develop treatment policies and consult with treating providers

Indiana § 27-13-36-1

Title 27INSURANCE

Art. 13HEALTH MAINTENANCE ORGANIZATIONS

Ch. 36Patient Protection; Clinical Decision Making; Access

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Bluebook

Ind. Code § 27-13-36-1 (2026).

Text

(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

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(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.