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.

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Terms Used In Indiana Code 27-13-34-24

  • Contract: A legal written agreement that becomes binding when signed.
  • in writing: include printing, lithographing, or other mode of representing words and letters. See Indiana Code 1-1-4-5
  • limited service health maintenance organization: means a corporation, partnership, limited liability company, or other entity that undertakes to provide or arrange a limited health service on a prepayment basis or other basis. See Indiana Code 27-13-34-4
  • Oversight: Committee review of the activities of a Federal agency or program.
  • provider: means a physician, a dentist, an optometrist, a health facility, or other person or institution that is licensed or otherwise authorized to deliver or furnish limited health service. See Indiana Code 27-13-34-5
     (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.

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