DCS Comprehensive Health Plan

Request for New Technology, Experimental or Investigational Therapies, and Clinical Trials

Policy No.

Responsible Area

Last Date

Effective Revised

HS-CC-01

Health Coordination

08/31/2023

08/31/2023

Statement/Purpose

This policy sets forth the guidelines used for determination of coverage of a new technology, experimental or investigation therapies.

Definitions

[List definitions not commonly known that are specific to the policy]

Policy

[Policies are the guiding principles and/or rules that ensure consistency and compliance with DCS CHP’s mission, values and strategic goals]

Procedure

[Procedure are high-level actions that guide adherence to policy. Procedures describe the methods used to comply with policy]

Reviewed and Revised Date (Month/Year)

Reason for Review

Revision Description

02/2024

Annual Review

Added updates based upon ACOM 103 revisions and updated reporting requirements.

03/2022

Annual Review

Added and revised pertinent information required for health plan integration.