R9-22-203. Experimental Services

A. Experimental services are not covered. A service is not experimental if: 1. It is generally and widely accepted as a standard of care in the practice of medicine in the United States and is a safe and effective treatment for the condition for which it is intended or used. 2. The service does not meet the standard in subsection (A)(1), but the service has been demonstrated to be safe and effective for the condition for which it is intended or used based on the weight of the evidence in peer-reviewed articles in medical journals published in the United States. 3. The service does not meet the standard in subsection (A)(2) because the condition for which the service is intended or used is rare, but the service has been demonstrated to be safe and effective for the condition for which it is intended or used based on the weight of opinions from specialists who provide the service or related services. B. The following factors shall be considered when evaluating the weight of peer-reviewed articles or the opinions of specialists: 1. The mortality rate and survival rate of the service as compared to the rates for alternative non-experimental services. 2. The types, severity, and frequency of complications associated with the services as compared with the complications associated with alternative non-experimental services. 3. The frequency with which the service has been performed in the past. 4. Whether there is sufficient historical information regarding the service to provide reliable data regarding risks and benefits. 5. The reputation and experience of the authors and/or specialists and their record in related areas. 6. The extent to which medical science in the area develops rapidly and the probability that more definite data will be available in the foreseeable future. 7. Whether the peer reviewed article describes a random controlled trial or an anecdotal clinical case study.