Washington § 70.14.110 - Health technology clinical committee determinations.

(1) The committee shall determine, for each health technology selected for review under RCW 70.14.100: (a) The conditions, if any, under which the health technology will be included as a covered benefit in health care programs of participating agencies; and (b) if covered, the criteria which the participating agency administering the program must use to decide whether the technology is medically necessary, or proper and necessary treatment.

(2) In making a determination under subsection (1) of this section, the committee:

(a) Shall consider, in an open and transparent process, evidence regarding the safety, efficacy, and cost-effectiveness of the technology as set forth in the systematic assessment conducted under RCW 70.14.100(4);

(b) Shall provide an opportunity for public comment; and

(c) May establish ad hoc temporary advisory groups if specialized expertise is needed to review a particular health technology or group of health technologies, or to seek input from enrollees or clients of state purchased health care programs. Advisory group members are immune from civil liability for any official act performed in good faith as a member of the group. As a condition of appointment, each person shall agree to the terms and conditions imposed by the administrator regarding conflicts of interest.

(3) Determinations of the committee under subsection (1) of this section shall be consistent with decisions made under the federal medicare program and in expert treatment guidelines, including those from specialty physician organizations and patient advocacy organizations, unless the committee concludes, based on its review of the systematic assessment, that substantial evidence regarding the safety, efficacy, and cost-effectiveness of the technology supports a contrary determination.

(4) The health care authority shall publish receipt of submissions for new technology assessment and rereview assessments on the authority's website within 30 days of receipt. The committee shall review, complete its determination, and communicate its decision for a new technology assessment or rereview assessment to the submitting party within 180 days of the initial date of submission. In the case of an adverse determination, the committee shall provide the submitting party with a written substantive explanation of the rationale for the adverse determination within 180 days of the initial date of submission.

Captions not law—Conflict with federal requirements—2006 c 307: See notes following RCW 70.14.080.