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Medical Policy

Under state law, the Uniform Medical Plans (UMP Classic, CDHP, and UMP Plus) must follow coverage decisions made by the Health Technology Clinical Committee (HTCC). The HTCC is a committee of independent health care professionals that reviews selected health technologies (services) to determine appropriate coverage, if any, for the services.  These may include medical or surgical devices and procedures, medical equipment, and diagnostic tests.  In public meetings, the HTCC considers public comments and scientific evidence regarding the safety, medical effectiveness, and cost-effectiveness of the services in making its determination.  Determinations from the HTCC will either be covered, covered with conditions, or not covered.  When the HTCC determines that a service is not covered, that means the service is not medically necessary in any circumstance. If the HTCC has determined that a service or treatment may be covered, then it will be covered only in cases where it meets the HTCC's specific coverage criteria.

Final decisions and ongoing reviews may be accessed on the HTCC website

HTCC decisions supersede Regence Medical Policy.

Procedures that are subject to HTCC decision and require pre-authorization can be found on the UMP Pre-authorization List.

Procedures denied due to an HTCC decision will be member responsibility.