514F.5 Experimental treatment review. 1. A carrier, as defined in section 513B.2, or a plan established pursuant to chapter 509A for public employees, that limits coverage for experimental medical treatment, drugs,or devices, shall develop and implement a procedure to evaluate experimental medicaltreatments and shall submit a description of the procedure to the division of insurance. Theprocedure shall be in writing and must describe the process used to determine whetherthe carrier or chapter 509A plan will provide coverage for new medical technologies andnew uses of existing technologies. The procedure, at a minimum, shall require a reviewof information from appropriate government regulatory agencies and published scientificliterature concerning new medical technologies, new uses of existing technologies, and theuse of external experts in making decisions. A carrier or chapter 509A plan shall includeappropriately licensed or qualified professionals in the evaluation process. The procedureshall provide a process for a person covered under a plan or contract to request a review of adenial of coverage because the proposed treatment is experimental. n the evaluation process. The procedureshall provide a process for a person covered under a plan or contract to request a review of adenial of coverage because the proposed treatment is experimental. A review of a particulartreatment need not be reviewed more than once a year. 2. A carrier or chapter 509A plan that limits coverage for experimental treatment, drugs, or devices shall clearly disclose such limitations in a contract, policy, or certificate of coverage. 99 Acts, ch 41, §6; 2017 Acts, ch 148, §91 Sat Dec 23 00:45:34 2023 Iowa Code 2024, Section 514F.5 (16, 0)
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