§ 34-30-15-7 Health care provider under investigation; health maintenance organization

Codes > Indiana Code > Title 34 > Article 30 : Chapter 15 > 34-30-15-7 Health

34-30-15-7 Health care provider under investigation; health maintenance organization

    Sec. 7. (a) This section applies to:

        (1) a health maintenance organization (as defined in IC 27-13-1-19); or

        (2) a limited service health maintenance organization (as defined in IC 27-13-34-4).

    (b) Before:

        (1) taking corrective action against a professional health care provider who is under contract with but not employed by the health maintenance organization or limited service health maintenance organization; or

        (2) taking action to terminate a contract with a professional health care provider who is not employed by the health maintenance organization or limited service health maintenance organization;

    based upon an evaluation of patient care rendered by the professional health care provider, the organization shall grant the health care provider affected by the action one (1) evidentiary hearing before a peer review committee of the organization and, at the health provider's request, an appeal of the peer review committee's decision.

    (c) Unless otherwise agreed to by the organization and the health care provider, the appeal must be limited to a review of the record of the hearing before the peer review committee and a review of all or part of the peer review committee's decision.

    (d) The appeal must be held before the governing board of the organization or, at the governing board's discretion, before a committee of the governing board.

    (e) The health care provider is entitled to submit written materials in support of the appeal and, at the discretion of the governing board or committee of the board conducting the appeal, the health care provider may be allowed to present oral argument in support of the appeal.