New Technology Assessment
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Published: October, 2001
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PacifiCare Behavioral Health identifies and evaluates proposed
advancements in behavioral health treatment in order to ensure
that PBH members receive the highest quality care to meet
their individual needs. The Technology Assessment Committee,
a subcommittee of the PBH Utilization Management Committee,
is responsible for review and evaluation of proposed advancements.
The Technology Assessment Committee is comprised of the PBH
Corporate Medical Director (chair), PBH Director of Clinical
Services (co-chair), PBH Regional Medical Directors, PBH Director
of Quality Improvement, and practitioners associated with
a university or research institute who are subject-matter
experts.
The committee meets annually or more often as needed and
reviews requests for evaluation of proposed advancements submitted
in writing from the PBH Professional Advisory Committee, the
PBH Consumer Advisory Committee, the PBH Executive Clinical
Group, PBH staff, PBH network providers and PBH members. The
only advancements that are considered for inclusion in the
category of approved services are those that have been subjected
to rigorous scientific study as determined by the Technology
Assessment Committee and have been shown to have demonstrated
effectiveness and acceptable risks.
The committee forwards a report of their actions to the Utilization
Management Committee, which in turn forwards actions to the
Corporate Quality Improvement Committee. The Medical Director
reviews these recommendations for final approval. The Quality
Improvement Committee reports any newly approved service to
the Provider/Network Management Department. The Provider/Network
Management Department ensures network ability to provide the
new services and establishes contractual rates for reimbursement.
Findings are also forwarded to the PBH Legal and Regulatory
Department for inclusion in the Evidence of Coverage and Disclosure
form as either a covered benefit or an exclusion.
The member, staff member, provider, or Advisory Committee
who initiated the request is notified in writing of the outcome
of the Medical Director's decision.
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