(215 ILCS 165/15.14) (from Ch. 32, par. 609.14)
Sec. 15.14.
Coverage for Organ Transplantation Procedures.
No voluntary
health services plan corporation providing coverage under this Act for hospital
or medical expenses 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 voluntary health services plan corporation 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.)
|