INSURANCE - COVERAGE
(RESOLUTION 16-17) RESOLVED, that the ISMA support adoption of the AMA model legislation “Ensuring Transparency in Prior Authorization Act.” (RESOLUTION 15-39) RESOLVED, that the ISMA support and engage in state legislation that will improve step therapy protocols by ensuring they are safe for patients, clinically grounded and transparent to patients and health care providers. State legislation should: 1) ensure step therapy programs are based on clinical guidelines developed by independent clinical experts, 2) ensure the exceptions process for step therapy is transparent and accessible for patient and health care providers, and 3) establish a basic framework for when it is medically appropriate to exempt patients from step therapy. (RESOLUTION 15-32) RESOLVED, that the ISMA support and engage in legislation requiring counties to provide adequate insurance for public health medical liability for county health officers that would cover the expanded scope of health officers’ orders, policies and services where necessary. (READOPTED 12-53, HOD; RESOLUTION 02-31) RESOLVED, that the ISMA use whatever means possible to encourage and/or require third-party payers to notify physicians and insurees of services or diagnoses that will not be covered by their plans prior to membership or participation in said plans; and be it further, RESOLVED, that third-party payers be required to make available to physicians and insurees a list of all services that will not be covered by their plans. This list should be available prior to membership or participation in said plans. Physicians and insurees should be notified immediately of any changes; and be it further, RESOLVED, that physicians shall not be prohibited from collecting from patients for non-covered services. (RESOLUTION 11-15) RESOLVED, that the ISMA support a patient's right to a determination of medical necessity and payment approval for elective procedures (such as reduction mammoplasty) with properly submitted medical evidence prior to the procedure and, if denied, have the reason for denial and the right to due process. (READOPTED 10-56, HOD; RESOLUTION 00-22) RESOLVED, that the ISMA support efforts by the Indiana Legislative Commission on Autism, the Indiana Resource Center for Autism and other appropriate agencies in their efforts to legislate health care insurance for autistic children; and be it further, RESOLVED, that the ISMA encourage and support appropriate state agencies, advocates and legislators in their efforts to extend legislated health care insurance coverage for treatment of children with autism spectrum disorders to all state and federally regulated health insurance programs. (RESOLUTION 10-16) RESOLVED, that the ISMA support state legislation requiring: An employer to have a 30-day time limit to notify an insurance company/network that an employee is no longer eligible under their medical plan A health plan to enter the non-eligibility of the employee within 10 days of notification from the employer, enabling the provider to verify coverage before services are rendered (RESOLUTION 10-15) RESOLVED, that if a reasonable pattern of requesting and obtaining prior authorizations can be confirmed, the ISMA seek and/or support any and all efforts, including legislative efforts if necessary, to mandate that care provided in good faith by physicians or other providers CANNOT be denied SOLELY on the basis of failure to have an authorization. Full consideration of medical necessity and appropriateness of services provided MUST be factored into any denial decision; and be it further, RESOLVED, that this resolution be carried forward by our delegation to the AMA. (RESOLUTION 09-04) RESOLVED, that the ISMA support legislation that upon denial of coverage for prescribed medications requiring prior authorization, insuring entities shall provide a list of alternative FDA-approved medications appropriate to the diagnosis. (RESOLUTION 08-28) RESOLVED, that the ISMA support legislation requiring physician assistants to carry their own malpractice insurance policies. (RESOLUTION 07-34) RESOLVED, that the ISMA support passage of legislation by the Indiana General Assembly that would provide all citizens with health insurance coverage, improve affordability, ensure patients' choice of medical providers, and focus on disease prevention and health promotion; and be it further, RESOLVED, that any such legislation to provide all citizens with health insurance coverage also achieve reduction in health insurance administrative costs by requiring uniform administrative processes including, but not limited to, claim submission, procedure authorization, prescription drug access and claim payment. (11/19/78, BOT) Reaffirmed the necessity of working for the development of a catastrophic insurance program in the private sector that would be available to all citizens of the state of Indiana and to take the lead in publicizing this program and assuring coverage.