Under state law, the Uniform Medical Plans 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. HTCC determinations are coverage decisions that apply to state purchased health care programs. 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 covered by the plan. If the HTCC has determined that a service or treatment may be covered by the plan, 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.