§ 34-30-15-7 — Health care providers under investigation; health maintenance organizations

(a) This section applies to:
(1) a health maintenance organization (as defined in IC 27-13-1-19); or
(2) a limited service health maintenance organization (as defined
in IC 27-13-34-4).
(b) Before:
(1) taking corrective action against a professional health care
provider who is under contract with but not employed by the
health maintenance organization or limited service health
maintenance organization; or
(2) taking action to terminate a contract with a professional health
care provider who is not employed by the health maintenance
organization or limited service health maintenance organization;
based upon an evaluation of patient care rendered by the professional
health care provider, the organization shall grant the health care
provider affected by the action one (1) evidentiary hearing before a
peer review committee of the organization and, at the health provider's
request, an appeal of the peer review committee's decision.
(c) Unless otherwise agreed to by the organization and the health
care provider, the appeal must be limited to a review of the record of
the hearing before the peer review committee and a review of all or part
of the peer review committee's decision.
(d) The appeal must be held before the governing board of the
organization or, at the governing board's discretion, before a committee
of the governing board.
(e) The health care provider is entitled to submit written materials
in support of the appeal and, at the discretion of the governing board or
committee of the board conducting the appeal, the health care provider
may be allowed to present oral argument in support of the appeal.
[Pre-1998 Recodification Citation: 34-4-12.6-2(g).]

Legislative History

As added by P.L.1-1998, SEC.26.