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Welcome to the new AASCIF Committee Forum. This section was created as a way for AASCIF members  to connect with peers from other Funds. Here you can ask questions and share information about a particular workers' compensation topic important to you.

AASCIF Forum » Law » How do you ensure safe health care delivery?


Started by (guest) Jun 27 2022, 18:33
(guest)
Jun 27 2022, 18:33
In Washington we have a statutorily created committee, the Health Technology Clinical Committee whose job it is to do the research and make decisions about which medical devices and procedures any state payer can authorize. We've been challenged on whether we can just say no if the committee excluded it, or do we have to do an individual analysis of the necessity following a state supreme court decision, Murray v. DLI.
Here's what we'd like to learn from you:

• Does your state have a statutory committee that reviews evidence on health care services and devices for safety, efficacy and cost-effectiveness and determines whether they should be covered benefits?
• Are you required to comply with those determinations?
• If not, under what circumstances can you make a divergent determination?
• For example, are you allowed to make a medical necessity determination on an individual basis? Is there an appeal process for individuals who are denied coverage?
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