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Provider Manual

Technology Assesment

Last Updated on August 23, 2018

Technology Assessment is a formal review process of new medical technology and new applications of existing medical technology to ensure that members have equitable access to safe and effective care. When assessing new technology, Security Health Plan uses information through the Centers for Medicare and Medicaid Services (CMS), Hayes Medical Technology Assessment, MEDLINE literature search, other specialty academy reviews, professionally published scientific evidence and other resources such as vendors and manufacturers.

The following criteria must be met for coverage to be considered:

  • The technology has been demonstrated by independent, appropriately designed peer-review studies to improve the health status of the members, either in terms of improvement in objective measures of mortality or morbidity, or in the overall quality of life.
  • The technology is at least as effective as existing non-investigational methods.
  • The technology has been shown to be safe and/or non-toxic.
  • The technology has the final approval of the U.S. Food and Drug Administration or other government bodies, when subject to such approval. Interim approvals are not a sufficient basis for evaluation of clinical use.
  • The technology is recognized as safe and effective by the appropriate specialties of the United States medical profession for the clinical indication(s) for which it is intended.
  • The scientific evidence must permit conclusions or convincing arguments based on established medical facts concerning the effect of the technology on medical outcomes such as length of life, quality of life and/or functional ability.
  • Coverage of new technology is consistent with insurance industry standards.

The Security Health Plan Utilization Management Work Group and Policy and Procedure Committee is responsible for the final determination of inclusion in the benefit package for health care services, behavioral health, procedures, medical equipment and supplies.