Title 33, Chapter 20A, Section 40
( 33-20A-40)
(a) For the purposes of this article, in making a determination as to whether a treatment is medically necessary and appropriate, the expert reviewer shall use the definition provided in paragraph (5) of Code Section 33-20A-31. (b) For the purposes of this article, in making a determination as
to whether a treatment is experimental, the expert reviewer shall
determine: (1) Whether such treatment has been approved by the federal Food
and Drug Administration; or (2) Whether medical and scientific evidence demonstrates that the
expected benefits of the proposed treatment would be greater than
the benefits of any available standard treatment and that the
adverse risks of the proposed treatment will not be substantially
increased over those of standard treatments. For either determination, the expert reviewer shall apply prudent
professional practices and shall assure that at least two documents
of medical and scientific evidence support the decision. |