(215 ILCS 125/4-5) (from Ch. 111 1/2, par. 1408.5)
Sec. 4-5.
Organ Transplants.
No contract or evidence
of coverage issued by a health maintenance organization which provides
coverage for health care services shall deny reimbursement for
an otherwise covered expense incurred for any organ transplantation
procedure solely on the basis that such procedure is deemed experimental or
investigational unless supported by the determination of the Office of
Health Care Technology Assessment within the Agency for Health Care Policy
and Research within the federal Department of Health and Human Services
that such procedure is either experimental or investigational or that there
is insufficient data or experience to determine whether an organ
transplantation procedure is clinically acceptable. If a health maintenance
organization has made written request, or had one made on its behalf by a
national organization, for determination by the Office of Health Care
Technology Assessment within the Agency for Health Care Policy and Research
within the federal Department of Health and Human Services as to
whether a specific organ transplantation procedure is clinically acceptable
and said organization fails to respond to such a request within a period of
90 days, the failure to act may be deemed a determination that the
procedure is deemed to be experimental or investigational.
(Source: P.A. 87-218.)
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