- (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.