Indiana 2022 Regular Session

Indiana House Bill HB1373 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~HB1373.1~~
2		-	~~January 20, 2022~~
	1	+
	2	+	Introduced Version
3	3		HOUSE BILL No. 1373
4	4		_____
5		-	DIGEST OF ~~HB 1373 (Updated January 19, 2022 3:26 pm - DI 77)~~
6		-	Citations Affected: IC 16-18; IC 16-21; IC 16-28; ~~IC 16-31; IC 27-1;~~
7		-	IC 27-8; IC 27-13.
8		-	Synopsis: Ambulance services. Provides for the attending physician,
9		-	~~or the physician's designee,~~ of a patient needing transportation by
10		-	~~ambulance to sign an order that~~ states the level of ambulance service
11		-	~~needed for the patient and the~~ condition or diagnosis of the patient that
12		-	~~makes the transportation of~~ the patient by ambulance necessary.
13		-	~~Amends the law on emergency~~ medical services to make that law apply
14		-	~~to nonemergency ambulance~~ services as well as emergency ambulance
15		-	~~services. Requires a health~~ plan to fairly negotiate rates and terms with
16		-	~~any ambulance service~~ provider willing to become a participating
17		-	~~provider with respect to the~~ health plan. Requires a health plan to pay
18		-	~~ambulance service benefits~~ directly to a nonparticipating ambulance
19		-	~~service provider~~ (nonparticipating provider) that provides ambulance
20		-	~~service to a~~ covered individual if the covered individual executes a
21		-	~~written~~ assignment of benefits in favor of the nonparticipating provider.
	5	+	DIGEST OF INTRODUCED BILL
	6	+	Citations Affected: IC 16-18-2-13.4; IC 16-21-2-5; IC 16-28-8-8;
	7	+	IC 16-31; IC 27-1-2.3; IC 27-8; IC 27-13-7-27.
	8	+	Synopsis: Ambulance services. Provides for the attending physician
	9	+	of a patient needing transportation by ambulance to sign an order that
	10	+	states the level of ambulance service needed for the patient and the
	11	+	condition or diagnosis of the patient that makes the transportation of
	12	+	the patient by ambulance necessary. Amends the law on emergency
	13	+	medical services to make that law apply to nonemergency ambulance
	14	+	services as well as emergency ambulance services. Requires a health
	15	+	plan to fairly negotiate rates and terms with any ambulance service
	16	+	provider willing to become a participating provider with respect to the
	17	+	health plan. Requires a health plan to pay ambulance service benefits
	18	+	directly to a nonparticipating ambulance service provider
	19	+	(nonparticipating provider) that provides ambulance service to a
	20	+	covered individual if the covered individual executes a written
	21	+	assignment of benefits in favor of the nonparticipating provider.
22	22		Provides that a nonparticipating provider that provides ambulance
23	23		service to a covered individual and that is paid less for the service by
24	24		the health plan than the amount it billed may bill the covered individual
25	25		for the balance. Provides that if the dispute concerning the amount to
26	26		be paid to the nonparticipating provider for the ambulance service is
27	27		not resolved through negotiation, the health plan operator or the
28	28		nonparticipating provider may initiate binding arbitration to resolve the
29	29		dispute. Provides that an accident and sickness insurance policy or
30	30		HMO contract that provides coverage for emergency medical services
	31	+	must also provide reimbursement for: (1) emergency ambulance
	32	+	services; and (2) specialty care transport; provided by an emergency
	33	+	medical services provider organization. Provides that reimbursement
31	34		(Continued next page)
32	35		Effective: July 1, 2022.
33	36		Barrett, Zent, Vermilion, Fleming
34	37		January 11, 2022, read first time and referred to Committee on Public Health.
35		-	January 20, 2022, amended, reported — Do Pass.
36		-	HB 1373—LS 7176/DI 55 Digest Continued
37		-	must also provide reimbursement for: (1) emergency ambulance
38		-	services; and (2) specialty care transport; provided by an emergency
39		-	medical services provider organization. Provides that reimbursement
40		-	provided for basic and 0advanced life support services through an
41		-	accident and sickness insurance policy or HMO contract must be
42		-	provided on an equal basis regardless of whether the services involve
43		-	transportation of the patient by ambulance.
44		-	HB 1373—LS 7176/DI 55HB 1373—LS 7176/DI 55 January 20, 2022
	38	+	2022 IN 1373—LS 7176/DI 55 Digest Continued
	39	+	provided for advanced life support services through an accident and
	40	+	sickness insurance policy or HMO contract must be provided on an
	41	+	equal basis regardless of whether the services involve transportation of
	42	+	the patient by ambulance.
	43	+	2022 IN 1373—LS 7176/DI 552022 IN 1373—LS 7176/DI 55 Introduced
45	44		Second Regular Session of the 122nd General Assembly (2022)
46	45		PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
47	46		Constitution) is being amended, the text of the existing provision will appear in this style type,
48	47		additions will appear in this style type, and deletions will appear in this style type.
49	48		Additions: Whenever a new statutory provision is being enacted (or a new constitutional
50	49		provision adopted), the text of the new provision will appear in this style type. Also, the
51	50		word NEW will appear in that style type in the introductory clause of each SECTION that adds
52	51		a new provision to the Indiana Code or the Indiana Constitution.
53	52		Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
54	53		between statutes enacted by the 2021 Regular Session of the General Assembly.
55	54		HOUSE BILL No. 1373
56	55		A BILL FOR AN ACT to amend the Indiana Code concerning
57	56		health.
58	57		Be it enacted by the General Assembly of the State of Indiana:
59	58		1 SECTION 1. IC 16-18-2-13.4 IS ADDED TO THE INDIANA
60	59		2 CODE AS A NEW SECTION TO READ AS FOLLOWS
61	60		3 [EFFECTIVE JULY 1, 2022]: Sec. 13.4. (a) "Ambulance service" or
62	61		4 "ambulance services", for purposes of IC 16-31, means:
63	62		5 (1) the transportation of patients by ambulance; and
64	63		6 (2) any basic life support administered to patients before or
65	64		7 during the transportation.
66	65		8 (b) The term includes:
67	66		9 (1) emergency ambulance services; and
68	67		10 (2) ambulance services that are not emergency ambulance
69	68		11 services.
70	69		12 SECTION 2. IC 16-21-2-5 IS AMENDED TO READ AS
71	70		13 FOLLOWS [EFFECTIVE JULY 1, 2022]: Sec. 5. (a) The governing
72	71		14 board of the hospital is the supreme authority in the hospital and is
73	72		15 responsible for the following:
74		-	HB 1373—LS 7176/DI 55 2
	73	+	2022 IN 1373—LS 7176/DI 55 2
75	74		1 (1) The management, operation, and control of the hospital.
76	75		2 (2) The appointment, reappointment, and assignment of privileges
77	76		3 to members of the medical staff, with the advice and
78	77		4 recommendations of the medical staff, consistent with the
79	78		5 individual training, experience, and other qualifications of the
80	79		6 medical staff.
81	80		7 (3) Establishing requirements for appointments to and continued
82	81		8 service on the hospital's medical staff, consistent with the
83	82		9 appointee's individual training, experience, and other
84	83		10 qualifications, including the following requirements:
85	84		11 (A) Proof that a medical staff member has qualified as a health
86	85		12 care provider under IC 16-18-2-163(a).
87	86		13 (B) The performance of patient care and related duties in a
88	87		14 manner that is not disruptive to the delivery of quality medical
89	88		15 care in the hospital setting.
90	89		16 (C) Standards of quality medical care that recognize the
91	90		17 efficient and effective utilization of hospital resources,
92	91		18 developed by the medical staff.
93	92		19 (4) Upon recommendation of the medical staff, establishing
94	93		20 protocols within the requirements of this chapter and 410
95	94		21 IAC 15-1.2-1 for the admission, treatment, and care of patients
96	95		22 with extended lengths of stay.
97	96		23 (b) The protocols established under subsection (a)(4) must
98	97		24 provide that:
99		-	25 (1) a patient's attending physician ~~or the physician's designee~~
100		-	26 ~~must sign an order when~~ the patient needs ambulance services
101		-	27 ~~other than emergency~~ ambulance services; and
102		-	28 (2) the order signed by a patient's physician ~~or the physician's~~
103		-	29 ~~designee under subdivision~~ (1) must state:
	98	+	25 (1) a patient's attending physician must sign an order when
	99	+	26 the patient needs ambulance services other than emergency
	100	+	27 ambulance services; and
	101	+	28 (2) the order signed by a patient's physician under subdivision
	102	+	29 (1) must state:
104	103		30 (A) the level of ambulance service needed for the patient;
105	104		31 and
106	105		32 (B) the condition or diagnosis of the patient that makes the
107	106		33 transportation of the patient by ambulance necessary.
108	107		34 SECTION 3. IC 16-28-8-8 IS ADDED TO THE INDIANA CODE
109	108		35 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
110	109		36 1, 2022]: Sec. 8. When a patient receiving care at a health facility,
111	110		37 due to the patient's condition or diagnosis, needs ambulance
112	111		38 services other than emergency ambulance services, the patient's
113		-	39 attending physician or the physician's designee must sign an order
114		-	40 that states:
115		-	41 (1) the level of ambulance service needed for the patient; and
116		-	42 (2) the condition or diagnosis of the patient that makes the
117		-	HB 1373—LS 7176/DI 55 3
118		-	1 transportation of the patient by ambulance necessary.
119		-	2 SECTION 4. IC 16-31-2-2, AS AMENDED BY P.L.187-2021,
120		-	3 SECTION 57, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
121		-	4 JULY 1, 2022]: Sec. 2. (a) The commission is composed of fourteen
122		-	5 (14) members. The governor shall appoint the members for four (4)
123		-	6 year terms as follows:
124		-	7 (1) One (1) must be appointed from a volunteer fire department
125		-	8 that provides emergency medical service.
126		-	9 (2) One (1) must be appointed from a full-time municipal fire or
127		-	10 police department that provides emergency medical service.
128		-	11 (3) One (1) must be a nonprofit provider of emergency ambulance
129		-	12 services organized on a volunteer basis other than a volunteer fire
130		-	13 department.
131		-	14 (4) One (1) must be a provider of private ambulance services.
132		-	15 (5) One (1) must be a state licensed paramedic.
133		-	16 (6) One (1) must be a licensed physician who:
134		-	17 (A) has a primary interest, training, and experience in
135		-	18 emergency medical services; and
136		-	19 (B) is currently practicing in an emergency medical services
137		-	20 facility.
138		-	21 (7) One (1) must be a chief executive officer of a hospital that
139		-	22 provides emergency ambulance services.
140		-	23 (8) One (1) must be a registered nurse who has supervisory or
141		-	24 administrative responsibility in a hospital emergency department.
142		-	25 (9) One (1) must be a licensed physician who:
143		-	26 (A) has a primary interest, training, and experience in trauma
144		-	27 care; and
145		-	28 (B) is practicing in a trauma facility.
146		-	29 (10) One (1) must be a state certified emergency medical service
147		-	30 technician.
148		-	31 (11) One (1) must be an individual who:
149		-	32 (A) represents the public at large; and
150		-	33 (B) is not in any way related to providing emergency medical
151		-	34 services.
152		-	35 (12) One (1) must be a program director (as defined in 836
153		-	36 IAC 4-2-2(12)(B)(iii)) for a commission certified advanced life
154		-	37 support training institution.
155		-	38 (13) One (1) must be the executive director of the department of
156		-	39 homeland security appointed under IC 10-19-3-1 or the designee
157		-	40 of the executive director.
158		-	41 (14) One (1) must be a representative of an entity that provides air
159		-	42 ambulance services.
160		-	HB 1373—LS 7176/DI 55 4
161		-	1 (b) The chief executive officer of a hospital appointed under
162		-	2 subsection (a)(7) may designate another administrator of the hospital
163		-	3 to serve for the chief executive officer on the commission.
164		-	4 (c) Not more than eight (8) members may be from the same political
165		-	5 party.
166		-	6 SECTION 5. IC 16-31-2-7, AS AMENDED BY P.L.185-2015,
167		-	7 SECTION 16, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
168		-	8 JULY 1, 2022]: Sec. 7. (a) The commission shall do the following:
169		-	9 (1) Develop and promote, in cooperation with state, regional, and
170		-	10 local public and private organizations, agencies, and persons, a
171		-	11 statewide program for the provision of emergency medical
172		-	12 services that must include the following:
173		-	13 (A) Preparation of state, regional, and local emergency
174		-	14 ambulance service plans.
175		-	15 (B) Provision of consultative services to state, regional, and
176		-	16 local organizations and agencies in developing and
177		-	17 implementing emergency ambulance service programs.
178		-	18 (C) Promotion of a statewide system of emergency medical
179		-	19 service facilities by developing minimum standards,
180		-	20 procedures, and guidelines in regard to personnel, equipment,
181		-	21 supplies, communications, facilities, and location of such
182		-	22 centers.
183		-	23 (D) Promotion of programs for the training of personnel
184		-	24 providing emergency medical services and programs for the
185		-	25 education of the general public in first aid techniques and
186		-	26 procedures. The training shall be held in various local
187		-	27 communities of the state and shall be conducted by agreement
188		-	28 with publicly and privately supported educational institutions
189		-	29 or hospitals licensed under IC 16-21, wherever appropriate.
190		-	30 (E) Promotion of coordination of emergency communications,
191		-	31 resources, and procedures throughout Indiana and, in
192		-	32 cooperation with interested state, regional, and local public
193		-	33 and private agencies, organizations, and persons, the
194		-	34 development of an effective state, regional, and local
195		-	35 emergency communications system.
196		-	36 (F) Organizing and sponsoring a statewide emergency medical
197		-	37 services conference to provide continuing education for
198		-	38 persons providing emergency medical services.
199		-	39 (2) Regulate, inspect, and certify or license services, facilities,
200		-	40 and personnel engaged in providing emergency medical services
201		-	41 as provided in this article.
202		-	42 (3) Adopt rules required to implement an approved system of
203		-	HB 1373—LS 7176/DI 55 5
204		-	1 emergency medical services.
205		-	2 (4) Adopt rules concerning triage and transportation protocols for
206		-	3 the transportation of trauma patients consistent with the field
207		-	4 triage decision scheme of the American College of Surgeons
208		-	5 Committee on Trauma.
209		-	6 (5) Apply for, receive, and accept gifts, bequests, grants-in-aid,
210		-	7 state, federal, and local aid, and other forms of financial
211		-	8 assistance for the support of emergency medical services.
212		-	9 (6) Employ necessary administrative staff.
213		-	10 (b) The commission shall include the provision of the mental health
214		-	11 first aid training program developed under IC 12-21-5-4 in the
215		-	12 promotion of continuing education programs under subsection
216		-	13 (a)(1)(D).
217		-	14 SECTION 6. IC 16-31-3-5, AS AMENDED BY P.L.249-2019,
218		-	15 SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
219		-	16 JULY 1, 2022]: Sec. 5. (a) The department of homeland security shall
220		-	17 waive any rule adopted by the commission under this article for:
221		-	18 (1) a person who provides emergency ambulance service;
222		-	19 (2) an emergency medical technician;
223		-	20 (3) an advanced emergency medical technician;
224		-	21 (4) a paramedic; or
225		-	22 (5) an ambulance;
226		-	23 when operating from a location in an adjoining state by contract with
227		-	24 an Indiana unit of government to provide emergency ambulance or
228		-	25 medical services to patients who are picked up or treated in Indiana.
229		-	26 (b) The department of homeland security may waive any rule,
230		-	27 including a rule establishing a fee adopted by the commission under
231		-	28 this article, for a person who submits facts demonstrating that:
232		-	29 (1) compliance with the rule will impose an undue hardship on
233		-	30 the person; and
234		-	31 (2) either:
235		-	32 (A) noncompliance with the rule; or
236		-	33 (B) compliance with an alternative requirement approved by
237		-	34 the department of homeland security;
238		-	35 will not jeopardize the quality of patient care. However, the
239		-	36 department of homeland security may not waive a rule that sets
240		-	37 forth educational requirements for a person regulated under this
241		-	38 article.
242		-	39 (c) A waiver granted under subsection (b)(2)(B) is conditioned upon
243		-	40 compliance with the alternative requirement approved under subsection
244		-	41 (b).
245		-	42 (d) The department of homeland security shall establish an
246		-	HB 1373—LS 7176/DI 55 6
247		-	1 expiration date for any waiver that is granted.
248		-	2 (e) The department of homeland security may renew a waiver if the
249		-	3 person makes the same demonstration required for the original waiver.
250		-	4 (f) The commission is the ultimate authority for orders issued under
251		-	5 this section.
252		-	6 SECTION 7. IC 16-31-5-1, AS AMENDED BY P.L.197-2016,
253		-	7 SECTION 116, IS AMENDED TO READ AS FOLLOWS
254		-	8 [EFFECTIVE JULY 1, 2022]: Sec. 1. The governing body of a city,
255		-	9 town, township, or county by the governing body's action or in any
256		-	10 combination may do the following:
257		-	11 (1) Establish, operate, and maintain emergency medical services.
258		-	12 (2) Levy taxes under and limited by IC 6-3.6 and expend
259		-	13 appropriated funds of the political subdivision to pay the costs
260		-	14 and expenses of establishing, operating, maintaining, or
261		-	15 contracting for emergency medical services.
262		-	16 (3) Except as provided in section 2 of this chapter, authorize,
263		-	17 franchise, or contract for emergency medical services. However:
264		-	18 (A) a county may not provide, authorize, or contract for
265		-	19 emergency medical services within the limits of any city
266		-	20 without the consent of the city; and
267		-	21 (B) a city or town may not provide, authorize, franchise, or
268		-	22 contract for emergency medical services outside the limits of
269		-	23 the city or town without the approval of the governing body of
270		-	24 the area to be served.
271		-	25 (4) Apply for, receive, and accept gifts, bequests, grants-in-aid,
272		-	26 state, federal, and local aid, and other forms of financial
273		-	27 assistance for the support of emergency medical services.
274		-	28 (5) Establish and provide for the collection of reasonable fees for
275		-	29 emergency ambulance services the governing body provides
276		-	30 under this chapter.
277		-	31 (6) Pay the fees or dues for individual or group membership in
278		-	32 any regularly organized volunteer emergency medical services
279		-	33 association on their own behalf or on behalf of the emergency
280		-	34 medical services personnel serving that unit of government.
281		-	35 SECTION 8. IC 16-31-5-2 IS AMENDED TO READ AS
282		-	36 FOLLOWS [EFFECTIVE JULY 1, 2022]: Sec. 2. A city, town, or
283		-	37 county may not adopt an ordinance that restricts a person from
284		-	38 providing emergency ambulance services in the city, town, township,
285		-	39 or county if:
286		-	40 (1) the person is authorized to provide emergency ambulance
287		-	41 services in any part of another county; and
288		-	42 (2) the person has been requested to provide emergency
289		-	HB 1373—LS 7176/DI 55 7
290		-	1 ambulance services:
291		-	2 (A) to the county in which the person is authorized to provide
292		-	3 emergency ambulance services, and those services will
293		-	4 originate in another county; or
294		-	5 (B) from the county in which the person is authorized to
295		-	6 provide emergency ambulance services, and those services
296		-	7 will terminate in another county.
297		-	8 SECTION 9. IC 16-31-13-2, AS ADDED BY P.L.37-2021,
298		-	9 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
299		-	10 JULY 1, 2022]: Sec. 2. (a) If there is not an individual requiring
300		-	11 medical attention or transport, a paramedic, advanced emergency
301		-	12 medical technician, or emergency medical technician may use
302		-	13 emergency ambulance services to transport an operational canine
303		-	14 injured in the line of duty to a veterinary hospital or clinic.
304		-	15 (b) During transport, a paramedic, advanced emergency medical
305		-	16 technician, or emergency medical technician may provide the following
306		-	17 care to an injured operational canine:
307		-	18 (1) Opening and manually maintaining an airway.
308		-	19 (2) Performing cardiopulmonary resuscitation.
309		-	20 (3) Administering oxygen.
310		-	21 (4) Managing ventilation by mask.
311		-	22 (5) Controlling hemorrhage with direct pressure.
312		-	23 (6) Immobilizing fractures.
313		-	24 (7) Bandaging.
314		-	25 (8) Procedures authorized under a written protocol established
315		-	26 and provided by the state veterinarian.
316		-	27 (9) Procedures authorized by the Indiana emergency medical
317		-	28 services commission.
318		-	29 (10) If the paramedic, advanced emergency medical technician,
319		-	30 or emergency medical technician is trained in canine tactical
320		-	31 combat casualty care (K9TCCC), the individual may provide care
321		-	32 within the scope and protocols of the K9TCCC training.
322		-	33 (c) A paramedic, advanced emergency medical technician, or
323		-	34 emergency medical technician may require a member of the law
324		-	35 enforcement department or agency to accompany the injured
325		-	36 operational canine during transport.
326		-	37 (d) Unless there is a written agreement that specifies the party that
327		-	38 is financially responsible for the transportation and treatment cost for
328		-	39 an injured operational canine, the law enforcement agency or other
329		-	40 governmental agency that owns or requested the use of the operational
330		-	41 canine is responsible for the transportation and treatment cost for the
331		-	42 operational canine.
332		-	HB 1373—LS 7176/DI 55 8
333		-	1 (e) A written agreement between a law enforcement agency or other
334		-	2 governmental agency and a provider of emergency ambulance services
335		-	3 that concerns the transport and care of an operational canine injured in
336		-	4 the line of duty must specify which services described under subsection
337		-	5 (b) will be covered under the agreement.
338		-	6 SECTION 10. IC 27-1-2.3 IS ADDED TO THE INDIANA CODE
339		-	7 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
340		-	8 JULY 1, 2022]:
341		-	9 Chapter 2.3. Payment for Ambulance Services
342		-	10 Sec. 1. As used in this chapter, "ambulance" refers only to a
343		-	11 vehicle that is used to provide ambulance service on land.
344		-	12 Sec. 2. As used in this chapter, "ambulance fee dispute" means
345		-	13 a dispute as to the compensation to be paid to an ambulance service
346		-	14 provider for ambulance service.
347		-	15 Sec. 3. As used in this chapter, "ambulance service provider"
348		-	16 means a person that:
349		-	17 (1) provides ambulance service; and
350		-	18 (2) holds a valid certificate issued by the commission under
351		-	19 IC 16-31-3 authorizing the person to provide ambulance
352		-	20 service.
353		-	21 Sec. 4. As used in this chapter, "cost sharing" means the total
354		-	22 amount paid:
355		-	23 (1) by a covered individual; or
356		-	24 (2) on behalf of a covered individual by any person other than
357		-	25 the health plan under which the individual is covered;
358		-	26 in the form of a deductible, copayment, or coinsurance, for
359		-	27 ambulance service provided to the covered individual.
360		-	28 Sec. 5. As used in this chapter, "covered individual" means an
361		-	29 individual who is entitled to coverage under a health plan.
362		-	30 Sec. 6. As used in this chapter, "health plan" means any of the
363		-	31 following:
364		-	32 (1) A self-insurance program established under IC 5-10-8-7(b)
365		-	33 to provide group coverage.
366		-	34 (2) A prepaid health care delivery plan through which health
367		-	35 services are provided under IC 5-10-8-7(c).
368		-	36 (3) A policy of accident and sickness insurance as defined in
369		-	37 IC 27-8-5-1, but not including any insurance, plan, or policy
370		-	38 set forth in IC 27-8-5-2.5(a).
371		-	39 (4) An individual contract (as defined in IC 27-13-1-21) or a
372		-	40 group contract (as defined in IC 27-13-1-16) with a health
373		-	41 maintenance organization that provides coverage for basic
374		-	42 health care services (as defined in IC 27-13-1-4).
375		-	HB 1373—LS 7176/DI 55 9
376		-	1 Sec. 7. As used in this chapter, "health plan operator" means
377		-	2 the following:
378		-	3 (1) In the case of a health plan described in section 6(1) or 6(2)
379		-	4 of this chapter, the state of Indiana.
380		-	5 (2) In the case of a health plan described in section 6(3) of this
381		-	6 chapter, the insurer that issued the policy.
382		-	7 (3) In the case of a health plan described in section 6(4) of this
383		-	8 chapter, the health maintenance organization that entered
384		-	9 into the contract.
385		-	10 Sec. 8. For purposes of this chapter:
386		-	11 (1) an ambulance service provider that provides ambulance
387		-	12 service to an individual covered by a health plan is
388		-	13 "nonparticipating" with respect to the health plan if the
389		-	14 ambulance service provider has not, by contract, affiliation,
390		-	15 agreement, or any other means, agreed to be compensated by
391		-	16 the health plan at no more than a certain amount or rate for
392		-	17 the ambulance service; and
393		-	18 (2) an ambulance service provider that provides ambulance
394		-	19 service to an individual covered by a health plan is
395		-	20 "participating" with respect to the health plan if the
396		-	21 ambulance service provider has agreed to be compensated by
397		-	22 the health plan at no more than a certain amount or rate for
398		-	23 the ambulance service.
399		-	24 Sec. 9. As used in this chapter, "person" means an individual, a
400		-	25 corporation, a limited liability company, a partnership, or another
401		-	26 legal entity.
402		-	27 Sec. 10. (a) A health plan operator shall fairly negotiate rates
403		-	28 and terms with any ambulance service provider willing to become
404		-	29 a participating provider with respect to the health plan.
405		-	30 (b) In negotiations under subsection (a), a health plan must
406		-	31 consider all of the following:
407		-	32 (1) The ambulance service provider's usual and customary
408		-	33 rates.
409		-	34 (2) The ambulance service provider's resources, and whether
410		-	35 the ambulance service provider's staff is available twenty-four
411		-	36 (24) hours per day every day.
412		-	37 (3) The average wages and fuel costs in the geographical area
413		-	38 in which the ambulance service provider operates.
414		-	39 (4) The number of times in which individuals covered by the
415		-	40 health plan have sought ambulance service from the
416		-	41 ambulance service provider but the ambulance service
417		-	42 provider's response was canceled or did not result in a
418		-	HB 1373—LS 7176/DI 55 10
419		-	1 transport.
420		-	2 (5) The local ordinances and state rules concerning staffing,
421		-	3 response times, and equipment under which the ambulance
422		-	4 service provider must operate.
423		-	5 (6) The types of requests for ambulance service for individuals
424		-	6 covered by the health plan that the ambulance service
425		-	7 provider generally receives, and the requesting party or
426		-	8 agency by which those requests are generally made.
427		-	9 (7) The average reimbursement rate per level of service that
428		-	10 the ambulance service provider generally receives as a
429		-	11 nonparticipating provider.
430		-	12 (8) The specific:
431		-	13 (A) clinical and staff capabilities; and
432		-	14 (B) equipment resources;
433		-	15 that an ambulance service provider must have to adequately
434		-	16 meet the needs of individuals covered by the health plan, such
435		-	17 as for the transportation of covered individuals from one (1)
436		-	18 hospital to another after traumatic injury.
437		-	19 (9) The average transport cost data reported to the office of
438		-	20 the secretary of family and social services by governmental
439		-	21 ambulance service providers located within the counties, and
440		-	22 contiguous counties, that the nonparticipating ambulance
441		-	23 service provider serves.
442		-	24 (10) Final arbitration decisions made under section 14 of this
443		-	25 chapter.
444		-	26 (c) If negotiations between an ambulance service provider and
445		-	27 a health plan operator under this section do not result in the
446		-	28 ambulance service provider becoming a participating provider
447		-	29 with respect to the health plan, each party shall provide to the
448		-	30 department:
449		-	31 (1) notice that no agreement has been met; and
450		-	32 (2) a summary of the areas of negotiation that were not
451		-	33 agreed upon.
452		-	34 Sec. 11. If:
453		-	35 (1) an individual covered by a health plan is provided
454		-	36 ambulance service by a nonparticipating ambulance service
455		-	37 provider; and
456		-	38 (2) the covered individual executes a written assignment to the
457		-	39 nonparticipating ambulance service provider of the benefits
458		-	40 the covered individual is entitled to under the health plan with
459		-	41 respect to the ambulance service;
460		-	42 the health plan shall pay the benefits referred to in subdivision (2)
461		-	HB 1373—LS 7176/DI 55 11
462		-	1 directly to the nonparticipating ambulance service provider.
463		-	2 Sec. 12. (a) If an individual covered by a health plan is provided
464		-	3 ambulance service by a nonparticipating ambulance service
465		-	4 provider, the nonparticipating ambulance service provider may
466		-	5 bill the health plan for the ambulance service.
467		-	6 (b) A health plan operator that receives a bill from a
468		-	7 nonparticipating ambulance service provider for ambulance
469		-	8 service provided to a covered individual:
470		-	9 (1) shall provide to the nonparticipating ambulance service
471		-	10 provider a written explanation of:
472		-	11 (A) the health plan's benefits for ambulance service; and
473		-	12 (B) the cost sharing that applies to the health plan's
474		-	13 coverage of the ambulance service provided to the covered
475		-	14 individual; and
476		-	15 (2) may:
477		-	16 (A) pay the amount billed by the nonparticipating
478		-	17 ambulance service provider;
479		-	18 (B) negotiate with the nonparticipating ambulance service
480		-	19 provider for the payment of an amount different from the
481		-	20 billed amount; or
482		-	21 (C) pay to the nonparticipating ambulance service
483		-	22 provider an amount different from the billed amount.
484		-	23 (c) If the amount paid by the health plan to the nonparticipating
485		-	24 ambulance service provider under subsection (b)(2)(C) is less than
486		-	25 the amount billed by the nonparticipating ambulance service
487		-	26 provider, the nonparticipating ambulance service provider may
488		-	27 bill the covered individual for the difference between the billed
489		-	28 amount and the amount paid by the health plan.
490		-	29 (d) If a covered individual receives a bill from a
491		-	30 nonparticipating ambulance service provider under subsection (c),
492		-	31 the covered individual may appeal to the health plan operator for
493		-	32 assistance. In response to an appeal under this subsection, the
494		-	33 health plan operator shall:
495		-	34 (1) consider whether to pay all or part of the amount billed to
496		-	35 the covered individual under subsection (c); and
497		-	36 (2) disclose to the covered individual information about the
498		-	37 efforts made by the health plan to negotiate with the
499		-	38 nonparticipating ambulance service provider, including:
500		-	39 (A) the date of the most recent negotiations; and
501		-	40 (B) the amount most recently offered by the health plan in
502		-	41 payment for the ambulance service provided to the covered
503		-	42 individual.
504		-	HB 1373—LS 7176/DI 55 12
505		-	1 (e) Information about a covered individual's right to appeal to
506		-	2 the health plan operator under subsection (d) shall be provided to
507		-	3 a covered individual:
508		-	4 (1) by the health plan operator when the health plan, under
509		-	5 subsection (b)(2)(C), pays to a nonparticipating ambulance
510		-	6 service provider an amount different from the amount billed
511		-	7 by the nonparticipating ambulance service provider; and
512		-	8 (2) by the nonparticipating ambulance service provider when
513		-	9 the nonparticipating ambulance service provider bills the
514		-	10 covered individual under subsection (c).
515		-	11 Sec. 13. (a) If negotiations under this chapter do not result in a
516		-	12 resolution of the ambulance fee dispute within thirty (30) days
517		-	13 after the nonparticipating ambulance service provider receives the
518		-	14 written explanation of benefits and cost sharing under section
519		-	15 12(b)(1) of this chapter:
520		-	16 (1) the health plan operator; or
521		-	17 (2) the nonparticipating ambulance service provider;
522		-	18 may initiate binding arbitration to resolve the ambulance fee
523		-	19 dispute by filing a request for binding arbitration with the
524		-	20 department.
525		-	21 (b) The party initiating binding arbitration under subsection (a)
526		-	22 shall provide to the other party:
527		-	23 (1) notification that arbitration has been initiated through the
528		-	24 filing of a request with the department; and
529		-	25 (2) a final offer to resolve the ambulance fee dispute through
530		-	26 the payment of a certain amount for the ambulance service.
531		-	27 (c) In response to the notification and final offer it receives
532		-	28 under subsection (b), the party not initiating binding arbitration
533		-	29 shall provide to the opposite party its own final offer to resolve the
534		-	30 ambulance fee dispute through the payment of a certain amount
535		-	31 for the ambulance service.
536		-	32 (d) An offer to resolve an ambulance fee dispute that is provided
537		-	33 under subsection (b) or (c) may propose payment for ambulance
538		-	34 services on a per billing basis or a bundled claim basis.
539		-	35 Sec. 14. (a) After arbitration is initiated under section 13 of this
540		-	36 chapter, an arbitrator must be selected according to the following
541		-	37 procedure:
542		-	38 (1) The health plan operator and the nonparticipating
543		-	39 ambulance service provider may select an arbitrator from the
544		-	40 list published by the department under section 15 of this
545		-	41 chapter.
546		-	42 (2) If the health plan operator and the nonparticipating
547		-	HB 1373—LS 7176/DI 55 13
548		-	1 ambulance service provider cannot agree on the selection of
549		-	2 an arbitrator under subdivision (1), the department shall
550		-	3 provide a list of five (5) potential arbitrators randomly taken
551		-	4 from the list published under section 15 of this chapter.
552		-	5 (3) From the list provided under subdivision (2), the health
553		-	6 plan operator and the nonparticipating ambulance service
554		-	7 provider may each veto two (2) potential arbitrators, and the
555		-	8 remaining arbitrator is the arbitrator for the ambulance fee
556		-	9 dispute.
557		-	10 (b) The health plan operator and the nonparticipating
558		-	11 ambulance service provider may submit facts and arguments in
559		-	12 writing to the arbitrator in support of their positions. The
560		-	13 arbitrator, after considering all submissions by the parties, shall
561		-	14 decide on the amount of compensation to be paid to the
562		-	15 nonparticipating ambulance service provider for the ambulance
563		-	16 service provided to the covered individual.
564		-	17 (c) The arbitrator shall issue a decision under subsection (b) not
565		-	18 more than forty-five (45) days after the request for arbitration is
566		-	19 filed with the department under section 13(a) of this chapter. The
567		-	20 decision of the arbitrator:
568		-	21 (1) is binding on the health plan operator and the
569		-	22 nonparticipating ambulance service provider; and
570		-	23 (2) is admissible in any court proceeding between the health
571		-	24 plan operator and the nonparticipating ambulance service
572		-	25 provider.
573		-	26 (d) The arbitrator's expenses and fees and other expenses (not
574		-	27 including the parties' attorney's fees) that are incurred in
575		-	28 conducting the arbitration shall be paid as provided in the
576		-	29 arbitrator's decision.
577		-	30 Sec. 15. For the purposes of this chapter, the department shall
578		-	31 compile and publish a list of individuals or entities that:
579		-	32 (1) are listed in:
580		-	33 (A) the National Roster of Arbitrators of the American
581		-	34 Arbitration Association; or
582		-	35 (B) the roster of arbitrators of the American Health Law
583		-	36 Association; and
584		-	37 (2) are willing to arbitrate ambulance fee disputes under this
585		-	38 chapter.
586		-	39 Sec. 16. The department shall adopt rules under IC 4-22-2 to
587		-	40 implement this chapter.
588		-	41 SECTION 11. IC 27-8-6-8, AS ADDED BY P.L.115-2020,
589		-	42 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
590		-	HB 1373—LS 7176/DI 55 14
591		-	1 JULY 1, 2022]: Sec. 8. (a) As used in this section, "emergency medical
592		-	2 services" has the meaning set forth in IC 16-18-2-110.
593		-	3 (b) As used in this section, "emergency medical services provider
594		-	4 organization" means a provider of emergency medical services that is
595		-	5 certified by the Indiana emergency medical services commission as an
596		-	6 advanced life support provider organization under rules adopted under
597		-	7 IC 16-31-3.
598		-	8 (c) As used in this section, "policy of accident and sickness
599		-	9 insurance" has the meaning set forth in IC 27-8-5-1. However, for
600		-	10 purposes of this section, the term does not include the following:
601		-	11 (1) Accident only, credit, dental, vision, Medicare supplement,
602		-	12 long term care, or disability income insurance.
603		-	13 (2) Coverage issued as a supplement to liability insurance.
604		-	14 (3) Automobile medical payment insurance.
605		-	15 (4) A specified disease policy.
606		-	16 (5) A policy that provides a stipulated daily, weekly, or monthly
607		-	17 payment to an insured without regard to the actual expense of the
608		-	18 confinement.
609		-	19 (6) A short term insurance plan (as defined in IC 27-8-5.9-3).
610		-	20 (d) A policy of accident and sickness insurance that provides
611		-	21 coverage for emergency medical services must provide reimbursement
612		-	22 for emergency medical services that are:
613		-	23 (1) rendered by an emergency medical services provider
614		-	24 organization;
615		-	25 (2) within the emergency medical services provider organization's
616		-	26 scope of practice;
617		-	27 (3) performed or provided as advanced life support services; and
618		-	28 (4) performed or provided during a response initiated through the
619		-	29 911 system regardless of whether the patient is transported.
620		-	30 (e) Reimbursement for basic and advanced life support services
621		-	31 through a policy to which this section applies must be provided on
622		-	32 an equal basis regardless of whether the services involve
623		-	33 transportation of the patient by ambulance.
624		-	34 (e) (f) If multiple emergency medical services provider
625		-	35 organizations qualify and submit a claim for reimbursement under this
626		-	36 section for an encounter, the insurer:
627		-	37 (1) may reimburse under this section only for one (1) claim per
628		-	38 patient encounter; and
629		-	39 (2) shall reimburse the claim submitted by the emergency medical
630		-	40 services provider organization that performed or provided the
631		-	41 majority of advanced life support services for the patient.
632		-	42 (f) (g) The department may adopt rules under IC 4-22-2, including
633		-	HB 1373—LS 7176/DI 55 15
634		-	1 emergency rules under IC 4-22-2-37.1, to implement this section.
635		-	2 (g) (h) This section does not require a policy of accident and
636		-	3 sickness insurance to provide coverage for emergency medical
637		-	4 services.
638		-	5 SECTION 12. IC 27-8-38 IS ADDED TO THE INDIANA CODE
	112	+	39 attending physician must sign an order that states:
	113	+	40 (1) the level of ambulance service needed for the patient; and
	114	+	41 (2) the condition or diagnosis of the patient that makes the
	115	+	42 transportation of the patient by ambulance necessary.
	116	+	2022 IN 1373—LS 7176/DI 55 3
	117	+	1 SECTION 4. IC 16-31-2-2, AS AMENDED BY P.L.187-2021,
	118	+	2 SECTION 57, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	119	+	3 JULY 1, 2022]: Sec. 2. (a) The commission is composed of fourteen
	120	+	4 (14) members. The governor shall appoint the members for four (4)
	121	+	5 year terms as follows:
	122	+	6 (1) One (1) must be appointed from a volunteer fire department
	123	+	7 that provides emergency medical service.
	124	+	8 (2) One (1) must be appointed from a full-time municipal fire or
	125	+	9 police department that provides emergency medical service.
	126	+	10 (3) One (1) must be a nonprofit provider of emergency ambulance
	127	+	11 services organized on a volunteer basis other than a volunteer fire
	128	+	12 department.
	129	+	13 (4) One (1) must be a provider of private ambulance services.
	130	+	14 (5) One (1) must be a state licensed paramedic.
	131	+	15 (6) One (1) must be a licensed physician who:
	132	+	16 (A) has a primary interest, training, and experience in
	133	+	17 emergency medical services; and
	134	+	18 (B) is currently practicing in an emergency medical services
	135	+	19 facility.
	136	+	20 (7) One (1) must be a chief executive officer of a hospital that
	137	+	21 provides emergency ambulance services.
	138	+	22 (8) One (1) must be a registered nurse who has supervisory or
	139	+	23 administrative responsibility in a hospital emergency department.
	140	+	24 (9) One (1) must be a licensed physician who:
	141	+	25 (A) has a primary interest, training, and experience in trauma
	142	+	26 care; and
	143	+	27 (B) is practicing in a trauma facility.
	144	+	28 (10) One (1) must be a state certified emergency medical service
	145	+	29 technician.
	146	+	30 (11) One (1) must be an individual who:
	147	+	31 (A) represents the public at large; and
	148	+	32 (B) is not in any way related to providing emergency medical
	149	+	33 services.
	150	+	34 (12) One (1) must be a program director (as defined in 836
	151	+	35 IAC 4-2-2(12)(B)(iii)) for a commission certified advanced life
	152	+	36 support training institution.
	153	+	37 (13) One (1) must be the executive director of the department of
	154	+	38 homeland security appointed under IC 10-19-3-1 or the designee
	155	+	39 of the executive director.
	156	+	40 (14) One (1) must be a representative of an entity that provides air
	157	+	41 ambulance services.
	158	+	42 (b) The chief executive officer of a hospital appointed under
	159	+	2022 IN 1373—LS 7176/DI 55 4
	160	+	1 subsection (a)(7) may designate another administrator of the hospital
	161	+	2 to serve for the chief executive officer on the commission.
	162	+	3 (c) Not more than eight (8) members may be from the same political
	163	+	4 party.
	164	+	5 SECTION 5. IC 16-31-2-7, AS AMENDED BY P.L.185-2015,
	165	+	6 SECTION 16, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	166	+	7 JULY 1, 2022]: Sec. 7. (a) The commission shall do the following:
	167	+	8 (1) Develop and promote, in cooperation with state, regional, and
	168	+	9 local public and private organizations, agencies, and persons, a
	169	+	10 statewide program for the provision of emergency medical
	170	+	11 services that must include the following:
	171	+	12 (A) Preparation of state, regional, and local emergency
	172	+	13 ambulance service plans.
	173	+	14 (B) Provision of consultative services to state, regional, and
	174	+	15 local organizations and agencies in developing and
	175	+	16 implementing emergency ambulance service programs.
	176	+	17 (C) Promotion of a statewide system of emergency medical
	177	+	18 service facilities by developing minimum standards,
	178	+	19 procedures, and guidelines in regard to personnel, equipment,
	179	+	20 supplies, communications, facilities, and location of such
	180	+	21 centers.
	181	+	22 (D) Promotion of programs for the training of personnel
	182	+	23 providing emergency medical services and programs for the
	183	+	24 education of the general public in first aid techniques and
	184	+	25 procedures. The training shall be held in various local
	185	+	26 communities of the state and shall be conducted by agreement
	186	+	27 with publicly and privately supported educational institutions
	187	+	28 or hospitals licensed under IC 16-21, wherever appropriate.
	188	+	29 (E) Promotion of coordination of emergency communications,
	189	+	30 resources, and procedures throughout Indiana and, in
	190	+	31 cooperation with interested state, regional, and local public
	191	+	32 and private agencies, organizations, and persons, the
	192	+	33 development of an effective state, regional, and local
	193	+	34 emergency communications system.
	194	+	35 (F) Organizing and sponsoring a statewide emergency medical
	195	+	36 services conference to provide continuing education for
	196	+	37 persons providing emergency medical services.
	197	+	38 (2) Regulate, inspect, and certify or license services, facilities,
	198	+	39 and personnel engaged in providing emergency medical services
	199	+	40 as provided in this article.
	200	+	41 (3) Adopt rules required to implement an approved system of
	201	+	42 emergency medical services.
	202	+	2022 IN 1373—LS 7176/DI 55 5
	203	+	1 (4) Adopt rules concerning triage and transportation protocols for
	204	+	2 the transportation of trauma patients consistent with the field
	205	+	3 triage decision scheme of the American College of Surgeons
	206	+	4 Committee on Trauma.
	207	+	5 (5) Apply for, receive, and accept gifts, bequests, grants-in-aid,
	208	+	6 state, federal, and local aid, and other forms of financial
	209	+	7 assistance for the support of emergency medical services.
	210	+	8 (6) Employ necessary administrative staff.
	211	+	9 (b) The commission shall include the provision of the mental health
	212	+	10 first aid training program developed under IC 12-21-5-4 in the
	213	+	11 promotion of continuing education programs under subsection
	214	+	12 (a)(1)(D).
	215	+	13 SECTION 6. IC 16-31-3-5, AS AMENDED BY P.L.249-2019,
	216	+	14 SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	217	+	15 JULY 1, 2022]: Sec. 5. (a) The department of homeland security shall
	218	+	16 waive any rule adopted by the commission under this article for:
	219	+	17 (1) a person who provides emergency ambulance service;
	220	+	18 (2) an emergency medical technician;
	221	+	19 (3) an advanced emergency medical technician;
	222	+	20 (4) a paramedic; or
	223	+	21 (5) an ambulance;
	224	+	22 when operating from a location in an adjoining state by contract with
	225	+	23 an Indiana unit of government to provide emergency ambulance or
	226	+	24 medical services to patients who are picked up or treated in Indiana.
	227	+	25 (b) The department of homeland security may waive any rule,
	228	+	26 including a rule establishing a fee adopted by the commission under
	229	+	27 this article, for a person who submits facts demonstrating that:
	230	+	28 (1) compliance with the rule will impose an undue hardship on
	231	+	29 the person; and
	232	+	30 (2) either:
	233	+	31 (A) noncompliance with the rule; or
	234	+	32 (B) compliance with an alternative requirement approved by
	235	+	33 the department of homeland security;
	236	+	34 will not jeopardize the quality of patient care. However, the
	237	+	35 department of homeland security may not waive a rule that sets
	238	+	36 forth educational requirements for a person regulated under this
	239	+	37 article.
	240	+	38 (c) A waiver granted under subsection (b)(2)(B) is conditioned upon
	241	+	39 compliance with the alternative requirement approved under subsection
	242	+	40 (b).
	243	+	41 (d) The department of homeland security shall establish an
	244	+	42 expiration date for any waiver that is granted.
	245	+	2022 IN 1373—LS 7176/DI 55 6
	246	+	1 (e) The department of homeland security may renew a waiver if the
	247	+	2 person makes the same demonstration required for the original waiver.
	248	+	3 (f) The commission is the ultimate authority for orders issued under
	249	+	4 this section.
	250	+	5 SECTION 7. IC 16-31-5-1, AS AMENDED BY P.L.197-2016,
	251	+	6 SECTION 116, IS AMENDED TO READ AS FOLLOWS
	252	+	7 [EFFECTIVE JULY 1, 2022]: Sec. 1. The governing body of a city,
	253	+	8 town, township, or county by the governing body's action or in any
	254	+	9 combination may do the following:
	255	+	10 (1) Establish, operate, and maintain emergency medical services.
	256	+	11 (2) Levy taxes under and limited by IC 6-3.6 and expend
	257	+	12 appropriated funds of the political subdivision to pay the costs
	258	+	13 and expenses of establishing, operating, maintaining, or
	259	+	14 contracting for emergency medical services.
	260	+	15 (3) Except as provided in section 2 of this chapter, authorize,
	261	+	16 franchise, or contract for emergency medical services. However:
	262	+	17 (A) a county may not provide, authorize, or contract for
	263	+	18 emergency medical services within the limits of any city
	264	+	19 without the consent of the city; and
	265	+	20 (B) a city or town may not provide, authorize, franchise, or
	266	+	21 contract for emergency medical services outside the limits of
	267	+	22 the city or town without the approval of the governing body of
	268	+	23 the area to be served.
	269	+	24 (4) Apply for, receive, and accept gifts, bequests, grants-in-aid,
	270	+	25 state, federal, and local aid, and other forms of financial
	271	+	26 assistance for the support of emergency medical services.
	272	+	27 (5) Establish and provide for the collection of reasonable fees for
	273	+	28 emergency ambulance services the governing body provides
	274	+	29 under this chapter.
	275	+	30 (6) Pay the fees or dues for individual or group membership in
	276	+	31 any regularly organized volunteer emergency medical services
	277	+	32 association on their own behalf or on behalf of the emergency
	278	+	33 medical services personnel serving that unit of government.
	279	+	34 SECTION 8. IC 16-31-5-2 IS AMENDED TO READ AS
	280	+	35 FOLLOWS [EFFECTIVE JULY 1, 2022]: Sec. 2. A city, town, or
	281	+	36 county may not adopt an ordinance that restricts a person from
	282	+	37 providing emergency ambulance services in the city, town, township,
	283	+	38 or county if:
	284	+	39 (1) the person is authorized to provide emergency ambulance
	285	+	40 services in any part of another county; and
	286	+	41 (2) the person has been requested to provide emergency
	287	+	42 ambulance services:
	288	+	2022 IN 1373—LS 7176/DI 55 7
	289	+	1 (A) to the county in which the person is authorized to provide
	290	+	2 emergency ambulance services, and those services will
	291	+	3 originate in another county; or
	292	+	4 (B) from the county in which the person is authorized to
	293	+	5 provide emergency ambulance services, and those services
	294	+	6 will terminate in another county.
	295	+	7 SECTION 9. IC 16-31-13-2, AS ADDED BY P.L.37-2021,
	296	+	8 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	297	+	9 JULY 1, 2022]: Sec. 2. (a) If there is not an individual requiring
	298	+	10 medical attention or transport, a paramedic, advanced emergency
	299	+	11 medical technician, or emergency medical technician may use
	300	+	12 emergency ambulance services to transport an operational canine
	301	+	13 injured in the line of duty to a veterinary hospital or clinic.
	302	+	14 (b) During transport, a paramedic, advanced emergency medical
	303	+	15 technician, or emergency medical technician may provide the following
	304	+	16 care to an injured operational canine:
	305	+	17 (1) Opening and manually maintaining an airway.
	306	+	18 (2) Performing cardiopulmonary resuscitation.
	307	+	19 (3) Administering oxygen.
	308	+	20 (4) Managing ventilation by mask.
	309	+	21 (5) Controlling hemorrhage with direct pressure.
	310	+	22 (6) Immobilizing fractures.
	311	+	23 (7) Bandaging.
	312	+	24 (8) Procedures authorized under a written protocol established
	313	+	25 and provided by the state veterinarian.
	314	+	26 (9) Procedures authorized by the Indiana emergency medical
	315	+	27 services commission.
	316	+	28 (10) If the paramedic, advanced emergency medical technician,
	317	+	29 or emergency medical technician is trained in canine tactical
	318	+	30 combat casualty care (K9TCCC), the individual may provide care
	319	+	31 within the scope and protocols of the K9TCCC training.
	320	+	32 (c) A paramedic, advanced emergency medical technician, or
	321	+	33 emergency medical technician may require a member of the law
	322	+	34 enforcement department or agency to accompany the injured
	323	+	35 operational canine during transport.
	324	+	36 (d) Unless there is a written agreement that specifies the party that
	325	+	37 is financially responsible for the transportation and treatment cost for
	326	+	38 an injured operational canine, the law enforcement agency or other
	327	+	39 governmental agency that owns or requested the use of the operational
	328	+	40 canine is responsible for the transportation and treatment cost for the
	329	+	41 operational canine.
	330	+	42 (e) A written agreement between a law enforcement agency or other
	331	+	2022 IN 1373—LS 7176/DI 55 8
	332	+	1 governmental agency and a provider of emergency ambulance services
	333	+	2 that concerns the transport and care of an operational canine injured in
	334	+	3 the line of duty must specify which services described under subsection
	335	+	4 (b) will be covered under the agreement.
	336	+	5 SECTION 10. IC 27-1-2.3 IS ADDED TO THE INDIANA CODE
639	337		6 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
640	338		7 JULY 1, 2022]:
641		-	8 Chapter 38. Coverage for Emergency Ambulance Services and
642		-	9 Specialty Care Transport
643		-	10 Sec. 1. This chapter applies to:
644		-	11 (1) accident and sickness insurance policies issued, delivered,
645		-	12 or renewed after June 30, 2022; and
646		-	13 (2) HMO contracts entered into or renewed after June 30,
647		-	14 2022.
648		-	15 Sec. 2. (a) As used in this chapter, "accident and sickness
649		-	16 insurance policy" means an insurance policy that:
650		-	17 (1) provides at least one (1) of the types of insurance described
651		-	18 in IC 27-1-5-1, Classes 1(b) and 2(a); and
652		-	19 (2) is issued on:
653		-	20 (A) an individual basis; or
654		-	21 (B) a group basis.
655		-	22 (b) "Accident and sickness insurance policy" does not include
656		-	23 the following:
657		-	24 (1) Accident only, credit, dental, vision, Medicare supplement,
658		-	25 long term care, or disability income insurance.
659		-	26 (2) Coverage issued as a supplement to liability insurance.
660		-	27 (3) Worker's compensation or similar insurance.
661		-	28 (4) Automobile medical payment insurance.
662		-	29 (5) A specified disease policy.
663		-	30 (6) A short term insurance plan that:
664		-	31 (A) may be renewed for the greater of:
665		-	32 (i) thirty-six (36) months; or
666		-	33 (ii) the maximum period permitted under federal law;
667		-	34 (B) has a term of not more than three hundred sixty-four
668		-	35 (364) days; and
669		-	36 (C) has an annual limit of at least two million dollars
670		-	37 ($2,000,000).
671		-	38 (7) A policy that provides indemnity benefits not based on any
672		-	39 expense incurred requirement, including a plan that provides
673		-	40 coverage for:
674		-	41 (A) hospital confinement, critical illness, or intensive care;
675		-	42 or
676		-	HB 1373—LS 7176/DI 55 16
677		-	1 (B) gaps for deductibles or copayments.
678		-	2 (8) A supplemental plan that always pays in addition to other
679		-	3 coverage.
680		-	4 (9) A student health plan.
681		-	5 (10) An employer sponsored health benefit plan that is:
682		-	6 (A) provided to individuals who are eligible for Medicare;
683		-	7 and
684		-	8 (B) not marketed as, or held out to be, a Medicare
685		-	9 supplement policy.
686		-	10 Sec. 3. As used in this chapter, "emergency ambulance services"
687		-	11 has the meaning set forth in IC 16-18-2-107.
688		-	12 Sec. 4. As used in this chapter, "emergency medical services"
689		-	13 has the meaning set forth in IC 16-18-2-110.
690		-	14 Sec. 5. As used in this chapter, "emergency medical services
691		-	15 provider organization" means a provider of emergency medical
692		-	16 services that is certified by the Indiana emergency medical services
693		-	17 commission under the rules adopted under IC 16-31-3 to provide
694		-	18 advanced life support.
695		-	19 Sec. 6. (a) As used in this chapter, "HMO contract" means a
696		-	20 contract under which a health maintenance organization (as
697		-	21 defined in IC 27-13-1-19) undertakes to provide or arrange for the
698		-	22 delivery of health care services to enrollees on a prepaid basis,
699		-	23 except for enrollee responsibility for copayments or deductibles.
700		-	24 (b) The term includes:
701		-	25 (1) an individual contract (as defined in IC 27-13-1-21); and
702		-	26 (2) a group contract (as defined in IC 27-13-1-16).
703		-	27 Sec. 7. As used in this chapter, "specialty care transport" means
704		-	28 transport in which the level of service or procedures required is as
705		-	29 set forth in 836 IAC 2-2-3(k) as in effect on January 1, 2022.
706		-	30 Sec. 8. An accident and sickness insurance policy or HMO
707		-	31 contract that provides coverage for emergency medical services
708		-	32 must also provide reimbursement for the following:
709		-	33 (1) Emergency ambulance services provided by an emergency
710		-	34 medical services provider organization.
711		-	35 (2) Specialty care transport provided by an emergency
712		-	36 medical services provider organization.
713		-	37 SECTION 13. IC 27-13-7-27, AS ADDED BY P.L.115-2020,
714		-	38 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
715		-	39 JULY 1, 2022]: Sec. 27. (a) This section applies to each of the
716		-	40 following:
717		-	41 (1) An individual contract.
718		-	42 (2) A group contract.
719		-	HB 1373—LS 7176/DI 55 17
720		-	1 (b) As used in this section, "emergency medical services" has the
721		-	2 meaning set forth in IC 16-18-2-110.
722		-	3 (c) As used in this section, "emergency medical services provider
723		-	4 organization" means a provider of emergency medical services that is
724		-	5 certified by the Indiana emergency medical services commission as an
725		-	6 advanced life support provider organization under rules adopted under
726		-	7 IC 16-31-3.
727		-	8 (d) An individual contract and a group contract that provide
728		-	9 coverage for emergency medical services must provide reimbursement
729		-	10 for emergency medical services that are:
730		-	11 (1) rendered by an emergency medical services provider
731		-	12 organization;
732		-	13 (2) within the emergency medical services provider organization's
733		-	14 scope of practice;
734		-	15 (3) performed or provided as advanced life support services; and
735		-	16 (4) performed or provided during a response initiated through the
736		-	17 911 system regardless of whether the patient is transported.
737		-	18 (e) Reimbursement for basic and advanced life support services
738		-	19 through a contract to which this section applies must be provided
739		-	20 on an equal basis regardless of whether the services involve
740		-	21 transportation of the patient by ambulance.
741		-	22 (e) (f) If multiple emergency medical services provider
742		-	23 organizations qualify and submit a claim for reimbursement under this
743		-	24 section, the health maintenance organization:
744		-	25 (1) may reimburse under this section only for one (1) claim per
745		-	26 patient encounter; and
746		-	27 (2) shall reimburse the claim submitted by the emergency medical
747		-	28 services provider organization that performed or provided the
748		-	29 majority of advanced life support services.
749		-	30 (f) (g) The department may adopt rules under IC 4-22-2, including
750		-	31 emergency rules under IC 4-22-2-37.1, to implement this section.
751		-	32 (g) (h) This section does not require an individual contract or a
752		-	33 group contract to provide coverage for emergency medical services.
753		-	HB 1373—LS 7176/DI 55 18
754		-	COMMITTEE REPORT
755		-	Mr. Speaker: Your Committee on Public Health, to which was
756		-	referred House Bill 1373, has had the same under consideration and
757		-	begs leave to report the same back to the House with the
758		-	recommendation that said bill be amended as follows:
759		-	Page 2, line 25, after "physician" insert "or the physician's
760		-	designee".
761		-	Page 2, line 28, after "physician" insert "or the physician's
762		-	designee".
763		-	Page 2, line 39, after "physician" insert "or the physician's
764		-	designee".
765		-	Page 9, line 41, delete "canceled." and insert "canceled or did not
766		-	result in a transport.".
767		-	Page 10, between lines 16 and 17, begin a new line block indented
768		-	and insert:
769		-	"(9) The average transport cost data reported to the office of
770		-	the secretary of family and social services by governmental
771		-	ambulance service providers located within the counties, and
772		-	contiguous counties, that the nonparticipating ambulance
773		-	service provider serves.
774		-	(10) Final arbitration decisions made under section 14 of this
775		-	chapter.".
776		-	Page 14, line 21, after "for" insert "basic and".
777		-	Page 17, line 9, after "for" insert "basic and".
778		-	and when so amended that said bill do pass.
779		-	(Reference is to HB 1373 as introduced.)
780		-	BARRETT
781		-	Committee Vote: yeas 12, nays 0.
782		-	HB 1373—LS 7176/DI 55
	339	+	8 Chapter 2.3. Payment for Ambulance Services
	340	+	9 Sec. 1. As used in this chapter, "ambulance" refers only to a
	341	+	10 vehicle that is used to provide ambulance service on land.
	342	+	11 Sec. 2. As used in this chapter, "ambulance fee dispute" means
	343	+	12 a dispute as to the compensation to be paid to an ambulance service
	344	+	13 provider for ambulance service.
	345	+	14 Sec. 3. As used in this chapter, "ambulance service provider"
	346	+	15 means a person that:
	347	+	16 (1) provides ambulance service; and
	348	+	17 (2) holds a valid certificate issued by the commission under
	349	+	18 IC 16-31-3 authorizing the person to provide ambulance
	350	+	19 service.
	351	+	20 Sec. 4. As used in this chapter, "cost sharing" means the total
	352	+	21 amount paid:
	353	+	22 (1) by a covered individual; or
	354	+	23 (2) on behalf of a covered individual by any person other than
	355	+	24 the health plan under which the individual is covered;
	356	+	25 in the form of a deductible, copayment, or coinsurance, for
	357	+	26 ambulance service provided to the covered individual.
	358	+	27 Sec. 5. As used in this chapter, "covered individual" means an
	359	+	28 individual who is entitled to coverage under a health plan.
	360	+	29 Sec. 6. As used in this chapter, "health plan" means any of the
	361	+	30 following:
	362	+	31 (1) A self-insurance program established under IC 5-10-8-7(b)
	363	+	32 to provide group coverage.
	364	+	33 (2) A prepaid health care delivery plan through which health
	365	+	34 services are provided under IC 5-10-8-7(c).
	366	+	35 (3) A policy of accident and sickness insurance as defined in
	367	+	36 IC 27-8-5-1, but not including any insurance, plan, or policy
	368	+	37 set forth in IC 27-8-5-2.5(a).
	369	+	38 (4) An individual contract (as defined in IC 27-13-1-21) or a
	370	+	39 group contract (as defined in IC 27-13-1-16) with a health
	371	+	40 maintenance organization that provides coverage for basic
	372	+	41 health care services (as defined in IC 27-13-1-4).
	373	+	42 Sec. 7. As used in this chapter, "health plan operator" means
	374	+	2022 IN 1373—LS 7176/DI 55 9
	375	+	1 the following:
	376	+	2 (1) In the case of a health plan described in section 6(1) or 6(2)
	377	+	3 of this chapter, the state of Indiana.
	378	+	4 (2) In the case of a health plan described in section 6(3) of this
	379	+	5 chapter, the insurer that issued the policy.
	380	+	6 (3) In the case of a health plan described in section 6(4) of this
	381	+	7 chapter, the health maintenance organization that entered
	382	+	8 into the contract.
	383	+	9 Sec. 8. For purposes of this chapter:
	384	+	10 (1) an ambulance service provider that provides ambulance
	385	+	11 service to an individual covered by a health plan is
	386	+	12 "nonparticipating" with respect to the health plan if the
	387	+	13 ambulance service provider has not, by contract, affiliation,
	388	+	14 agreement, or any other means, agreed to be compensated by
	389	+	15 the health plan at no more than a certain amount or rate for
	390	+	16 the ambulance service; and
	391	+	17 (2) an ambulance service provider that provides ambulance
	392	+	18 service to an individual covered by a health plan is
	393	+	19 "participating" with respect to the health plan if the
	394	+	20 ambulance service provider has agreed to be compensated by
	395	+	21 the health plan at no more than a certain amount or rate for
	396	+	22 the ambulance service.
	397	+	23 Sec. 9. As used in this chapter, "person" means an individual, a
	398	+	24 corporation, a limited liability company, a partnership, or another
	399	+	25 legal entity.
	400	+	26 Sec. 10. (a) A health plan operator shall fairly negotiate rates
	401	+	27 and terms with any ambulance service provider willing to become
	402	+	28 a participating provider with respect to the health plan.
	403	+	29 (b) In negotiations under subsection (a), a health plan must
	404	+	30 consider all of the following:
	405	+	31 (1) The ambulance service provider's usual and customary
	406	+	32 rates.
	407	+	33 (2) The ambulance service provider's resources, and whether
	408	+	34 the ambulance service provider's staff is available twenty-four
	409	+	35 (24) hours per day every day.
	410	+	36 (3) The average wages and fuel costs in the geographical area
	411	+	37 in which the ambulance service provider operates.
	412	+	38 (4) The number of times in which individuals covered by the
	413	+	39 health plan have sought ambulance service from the
	414	+	40 ambulance service provider but the ambulance service
	415	+	41 provider's response was canceled.
	416	+	42 (5) The local ordinances and state rules concerning staffing,
	417	+	2022 IN 1373—LS 7176/DI 55 10
	418	+	1 response times, and equipment under which the ambulance
	419	+	2 service provider must operate.
	420	+	3 (6) The types of requests for ambulance service for individuals
	421	+	4 covered by the health plan that the ambulance service
	422	+	5 provider generally receives, and the requesting party or
	423	+	6 agency by which those requests are generally made.
	424	+	7 (7) The average reimbursement rate per level of service that
	425	+	8 the ambulance service provider generally receives as a
	426	+	9 nonparticipating provider.
	427	+	10 (8) The specific:
	428	+	11 (A) clinical and staff capabilities; and
	429	+	12 (B) equipment resources;
	430	+	13 that an ambulance service provider must have to adequately
	431	+	14 meet the needs of individuals covered by the health plan, such
	432	+	15 as for the transportation of covered individuals from one (1)
	433	+	16 hospital to another after traumatic injury.
	434	+	17 (c) If negotiations between an ambulance service provider and
	435	+	18 a health plan operator under this section do not result in the
	436	+	19 ambulance service provider becoming a participating provider
	437	+	20 with respect to the health plan, each party shall provide to the
	438	+	21 department:
	439	+	22 (1) notice that no agreement has been met; and
	440	+	23 (2) a summary of the areas of negotiation that were not
	441	+	24 agreed upon.
	442	+	25 Sec. 11. If:
	443	+	26 (1) an individual covered by a health plan is provided
	444	+	27 ambulance service by a nonparticipating ambulance service
	445	+	28 provider; and
	446	+	29 (2) the covered individual executes a written assignment to the
	447	+	30 nonparticipating ambulance service provider of the benefits
	448	+	31 the covered individual is entitled to under the health plan with
	449	+	32 respect to the ambulance service;
	450	+	33 the health plan shall pay the benefits referred to in subdivision (2)
	451	+	34 directly to the nonparticipating ambulance service provider.
	452	+	35 Sec. 12. (a) If an individual covered by a health plan is provided
	453	+	36 ambulance service by a nonparticipating ambulance service
	454	+	37 provider, the nonparticipating ambulance service provider may
	455	+	38 bill the health plan for the ambulance service.
	456	+	39 (b) A health plan operator that receives a bill from a
	457	+	40 nonparticipating ambulance service provider for ambulance
	458	+	41 service provided to a covered individual:
	459	+	42 (1) shall provide to the nonparticipating ambulance service
	460	+	2022 IN 1373—LS 7176/DI 55 11
	461	+	1 provider a written explanation of:
	462	+	2 (A) the health plan's benefits for ambulance service; and
	463	+	3 (B) the cost sharing that applies to the health plan's
	464	+	4 coverage of the ambulance service provided to the covered
	465	+	5 individual; and
	466	+	6 (2) may:
	467	+	7 (A) pay the amount billed by the nonparticipating
	468	+	8 ambulance service provider;
	469	+	9 (B) negotiate with the nonparticipating ambulance service
	470	+	10 provider for the payment of an amount different from the
	471	+	11 billed amount; or
	472	+	12 (C) pay to the nonparticipating ambulance service
	473	+	13 provider an amount different from the billed amount.
	474	+	14 (c) If the amount paid by the health plan to the nonparticipating
	475	+	15 ambulance service provider under subsection (b)(2)(C) is less than
	476	+	16 the amount billed by the nonparticipating ambulance service
	477	+	17 provider, the nonparticipating ambulance service provider may
	478	+	18 bill the covered individual for the difference between the billed
	479	+	19 amount and the amount paid by the health plan.
	480	+	20 (d) If a covered individual receives a bill from a
	481	+	21 nonparticipating ambulance service provider under subsection (c),
	482	+	22 the covered individual may appeal to the health plan operator for
	483	+	23 assistance. In response to an appeal under this subsection, the
	484	+	24 health plan operator shall:
	485	+	25 (1) consider whether to pay all or part of the amount billed to
	486	+	26 the covered individual under subsection (c); and
	487	+	27 (2) disclose to the covered individual information about the
	488	+	28 efforts made by the health plan to negotiate with the
	489	+	29 nonparticipating ambulance service provider, including:
	490	+	30 (A) the date of the most recent negotiations; and
	491	+	31 (B) the amount most recently offered by the health plan in
	492	+	32 payment for the ambulance service provided to the covered
	493	+	33 individual.
	494	+	34 (e) Information about a covered individual's right to appeal to
	495	+	35 the health plan operator under subsection (d) shall be provided to
	496	+	36 a covered individual:
	497	+	37 (1) by the health plan operator when the health plan, under
	498	+	38 subsection (b)(2)(C), pays to a nonparticipating ambulance
	499	+	39 service provider an amount different from the amount billed
	500	+	40 by the nonparticipating ambulance service provider; and
	501	+	41 (2) by the nonparticipating ambulance service provider when
	502	+	42 the nonparticipating ambulance service provider bills the
	503	+	2022 IN 1373—LS 7176/DI 55 12
	504	+	1 covered individual under subsection (c).
	505	+	2 Sec. 13. (a) If negotiations under this chapter do not result in a
	506	+	3 resolution of the ambulance fee dispute within thirty (30) days
	507	+	4 after the nonparticipating ambulance service provider receives the
	508	+	5 written explanation of benefits and cost sharing under section
	509	+	6 12(b)(1) of this chapter:
	510	+	7 (1) the health plan operator; or
	511	+	8 (2) the nonparticipating ambulance service provider;
	512	+	9 may initiate binding arbitration to resolve the ambulance fee
	513	+	10 dispute by filing a request for binding arbitration with the
	514	+	11 department.
	515	+	12 (b) The party initiating binding arbitration under subsection (a)
	516	+	13 shall provide to the other party:
	517	+	14 (1) notification that arbitration has been initiated through the
	518	+	15 filing of a request with the department; and
	519	+	16 (2) a final offer to resolve the ambulance fee dispute through
	520	+	17 the payment of a certain amount for the ambulance service.
	521	+	18 (c) In response to the notification and final offer it receives
	522	+	19 under subsection (b), the party not initiating binding arbitration
	523	+	20 shall provide to the opposite party its own final offer to resolve the
	524	+	21 ambulance fee dispute through the payment of a certain amount
	525	+	22 for the ambulance service.
	526	+	23 (d) An offer to resolve an ambulance fee dispute that is provided
	527	+	24 under subsection (b) or (c) may propose payment for ambulance
	528	+	25 services on a per billing basis or a bundled claim basis.
	529	+	26 Sec. 14. (a) After arbitration is initiated under section 13 of this
	530	+	27 chapter, an arbitrator must be selected according to the following
	531	+	28 procedure:
	532	+	29 (1) The health plan operator and the nonparticipating
	533	+	30 ambulance service provider may select an arbitrator from the
	534	+	31 list published by the department under section 15 of this
	535	+	32 chapter.
	536	+	33 (2) If the health plan operator and the nonparticipating
	537	+	34 ambulance service provider cannot agree on the selection of
	538	+	35 an arbitrator under subdivision (1), the department shall
	539	+	36 provide a list of five (5) potential arbitrators randomly taken
	540	+	37 from the list published under section 15 of this chapter.
	541	+	38 (3) From the list provided under subdivision (2), the health
	542	+	39 plan operator and the nonparticipating ambulance service
	543	+	40 provider may each veto two (2) potential arbitrators, and the
	544	+	41 remaining arbitrator is the arbitrator for the ambulance fee
	545	+	42 dispute.
	546	+	2022 IN 1373—LS 7176/DI 55 13
	547	+	1 (b) The health plan operator and the nonparticipating
	548	+	2 ambulance service provider may submit facts and arguments in
	549	+	3 writing to the arbitrator in support of their positions. The
	550	+	4 arbitrator, after considering all submissions by the parties, shall
	551	+	5 decide on the amount of compensation to be paid to the
	552	+	6 nonparticipating ambulance service provider for the ambulance
	553	+	7 service provided to the covered individual.
	554	+	8 (c) The arbitrator shall issue a decision under subsection (b) not
	555	+	9 more than forty-five (45) days after the request for arbitration is
	556	+	10 filed with the department under section 13(a) of this chapter. The
	557	+	11 decision of the arbitrator:
	558	+	12 (1) is binding on the health plan operator and the
	559	+	13 nonparticipating ambulance service provider; and
	560	+	14 (2) is admissible in any court proceeding between the health
	561	+	15 plan operator and the nonparticipating ambulance service
	562	+	16 provider.
	563	+	17 (d) The arbitrator's expenses and fees and other expenses (not
	564	+	18 including the parties' attorney's fees) that are incurred in
	565	+	19 conducting the arbitration shall be paid as provided in the
	566	+	20 arbitrator's decision.
	567	+	21 Sec. 15. For the purposes of this chapter, the department shall
	568	+	22 compile and publish a list of individuals or entities that:
	569	+	23 (1) are listed in:
	570	+	24 (A) the National Roster of Arbitrators of the American
	571	+	25 Arbitration Association; or
	572	+	26 (B) the roster of arbitrators of the American Health Law
	573	+	27 Association; and
	574	+	28 (2) are willing to arbitrate ambulance fee disputes under this
	575	+	29 chapter.
	576	+	30 Sec. 16. The department shall adopt rules under IC 4-22-2 to
	577	+	31 implement this chapter.
	578	+	32 SECTION 11. IC 27-8-6-8, AS ADDED BY P.L.115-2020,
	579	+	33 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	580	+	34 JULY 1, 2022]: Sec. 8. (a) As used in this section, "emergency medical
	581	+	35 services" has the meaning set forth in IC 16-18-2-110.
	582	+	36 (b) As used in this section, "emergency medical services provider
	583	+	37 organization" means a provider of emergency medical services that is
	584	+	38 certified by the Indiana emergency medical services commission as an
	585	+	39 advanced life support provider organization under rules adopted under
	586	+	40 IC 16-31-3.
	587	+	41 (c) As used in this section, "policy of accident and sickness
	588	+	42 insurance" has the meaning set forth in IC 27-8-5-1. However, for
	589	+	2022 IN 1373—LS 7176/DI 55 14
	590	+	1 purposes of this section, the term does not include the following:
	591	+	2 (1) Accident only, credit, dental, vision, Medicare supplement,
	592	+	3 long term care, or disability income insurance.
	593	+	4 (2) Coverage issued as a supplement to liability insurance.
	594	+	5 (3) Automobile medical payment insurance.
	595	+	6 (4) A specified disease policy.
	596	+	7 (5) A policy that provides a stipulated daily, weekly, or monthly
	597	+	8 payment to an insured without regard to the actual expense of the
	598	+	9 confinement.
	599	+	10 (6) A short term insurance plan (as defined in IC 27-8-5.9-3).
	600	+	11 (d) A policy of accident and sickness insurance that provides
	601	+	12 coverage for emergency medical services must provide reimbursement
	602	+	13 for emergency medical services that are:
	603	+	14 (1) rendered by an emergency medical services provider
	604	+	15 organization;
	605	+	16 (2) within the emergency medical services provider organization's
	606	+	17 scope of practice;
	607	+	18 (3) performed or provided as advanced life support services; and
	608	+	19 (4) performed or provided during a response initiated through the
	609	+	20 911 system regardless of whether the patient is transported.
	610	+	21 (e) Reimbursement for advanced life support services through
	611	+	22 a policy to which this section applies must be provided on an equal
	612	+	23 basis regardless of whether the services involve transportation of
	613	+	24 the patient by ambulance.
	614	+	25 (e) (f) If multiple emergency medical services provider
	615	+	26 organizations qualify and submit a claim for reimbursement under this
	616	+	27 section for an encounter, the insurer:
	617	+	28 (1) may reimburse under this section only for one (1) claim per
	618	+	29 patient encounter; and
	619	+	30 (2) shall reimburse the claim submitted by the emergency medical
	620	+	31 services provider organization that performed or provided the
	621	+	32 majority of advanced life support services for the patient.
	622	+	33 (f) (g) The department may adopt rules under IC 4-22-2, including
	623	+	34 emergency rules under IC 4-22-2-37.1, to implement this section.
	624	+	35 (g) (h) This section does not require a policy of accident and
	625	+	36 sickness insurance to provide coverage for emergency medical
	626	+	37 services.
	627	+	38 SECTION 12. IC 27-8-38 IS ADDED TO THE INDIANA CODE
	628	+	39 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
	629	+	40 JULY 1, 2022]:
	630	+	41 Chapter 38. Coverage for Emergency Ambulance Services and
	631	+	42 Specialty Care Transport
	632	+	2022 IN 1373—LS 7176/DI 55 15
	633	+	1 Sec. 1. This chapter applies to:
	634	+	2 (1) accident and sickness insurance policies issued, delivered,
	635	+	3 or renewed after June 30, 2022; and
	636	+	4 (2) HMO contracts entered into or renewed after June 30,
	637	+	5 2022.
	638	+	6 Sec. 2. (a) As used in this chapter, "accident and sickness
	639	+	7 insurance policy" means an insurance policy that:
	640	+	8 (1) provides at least one (1) of the types of insurance described
	641	+	9 in IC 27-1-5-1, Classes 1(b) and 2(a); and
	642	+	10 (2) is issued on:
	643	+	11 (A) an individual basis; or
	644	+	12 (B) a group basis.
	645	+	13 (b) "Accident and sickness insurance policy" does not include
	646	+	14 the following:
	647	+	15 (1) Accident only, credit, dental, vision, Medicare supplement,
	648	+	16 long term care, or disability income insurance.
	649	+	17 (2) Coverage issued as a supplement to liability insurance.
	650	+	18 (3) Worker's compensation or similar insurance.
	651	+	19 (4) Automobile medical payment insurance.
	652	+	20 (5) A specified disease policy.
	653	+	21 (6) A short term insurance plan that:
	654	+	22 (A) may be renewed for the greater of:
	655	+	23 (i) thirty-six (36) months; or
	656	+	24 (ii) the maximum period permitted under federal law;
	657	+	25 (B) has a term of not more than three hundred sixty-four
	658	+	26 (364) days; and
	659	+	27 (C) has an annual limit of at least two million dollars
	660	+	28 ($2,000,000).
	661	+	29 (7) A policy that provides indemnity benefits not based on any
	662	+	30 expense incurred requirement, including a plan that provides
	663	+	31 coverage for:
	664	+	32 (A) hospital confinement, critical illness, or intensive care;
	665	+	33 or
	666	+	34 (B) gaps for deductibles or copayments.
	667	+	35 (8) A supplemental plan that always pays in addition to other
	668	+	36 coverage.
	669	+	37 (9) A student health plan.
	670	+	38 (10) An employer sponsored health benefit plan that is:
	671	+	39 (A) provided to individuals who are eligible for Medicare;
	672	+	40 and
	673	+	41 (B) not marketed as, or held out to be, a Medicare
	674	+	42 supplement policy.
	675	+	2022 IN 1373—LS 7176/DI 55 16
	676	+	1 Sec. 3. As used in this chapter, "emergency ambulance services"
	677	+	2 has the meaning set forth in IC 16-18-2-107.
	678	+	3 Sec. 4. As used in this chapter, "emergency medical services"
	679	+	4 has the meaning set forth in IC 16-18-2-110.
	680	+	5 Sec. 5. As used in this chapter, "emergency medical services
	681	+	6 provider organization" means a provider of emergency medical
	682	+	7 services that is certified by the Indiana emergency medical services
	683	+	8 commission under the rules adopted under IC 16-31-3 to provide
	684	+	9 advanced life support.
	685	+	10 Sec. 6. (a) As used in this chapter, "HMO contract" means a
	686	+	11 contract under which a health maintenance organization (as
	687	+	12 defined in IC 27-13-1-19) undertakes to provide or arrange for the
	688	+	13 delivery of health care services to enrollees on a prepaid basis,
	689	+	14 except for enrollee responsibility for copayments or deductibles.
	690	+	15 (b) The term includes:
	691	+	16 (1) an individual contract (as defined in IC 27-13-1-21); and
	692	+	17 (2) a group contract (as defined in IC 27-13-1-16).
	693	+	18 Sec. 7. As used in this chapter, "specialty care transport" means
	694	+	19 transport in which the level of service or procedures required is as
	695	+	20 set forth in 836 IAC 2-2-3(k) as in effect on January 1, 2022.
	696	+	21 Sec. 8. An accident and sickness insurance policy or HMO
	697	+	22 contract that provides coverage for emergency medical services
	698	+	23 must also provide reimbursement for the following:
	699	+	24 (1) Emergency ambulance services provided by an emergency
	700	+	25 medical services provider organization.
	701	+	26 (2) Specialty care transport provided by an emergency
	702	+	27 medical services provider organization.
	703	+	28 SECTION 13. IC 27-13-7-27, AS ADDED BY P.L.115-2020,
	704	+	29 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	705	+	30 JULY 1, 2022]: Sec. 27. (a) This section applies to each of the
	706	+	31 following:
	707	+	32 (1) An individual contract.
	708	+	33 (2) A group contract.
	709	+	34 (b) As used in this section, "emergency medical services" has the
	710	+	35 meaning set forth in IC 16-18-2-110.
	711	+	36 (c) As used in this section, "emergency medical services provider
	712	+	37 organization" means a provider of emergency medical services that is
	713	+	38 certified by the Indiana emergency medical services commission as an
	714	+	39 advanced life support provider organization under rules adopted under
	715	+	40 IC 16-31-3.
	716	+	41 (d) An individual contract and a group contract that provide
	717	+	42 coverage for emergency medical services must provide reimbursement
	718	+	2022 IN 1373—LS 7176/DI 55 17
	719	+	1 for emergency medical services that are:
	720	+	2 (1) rendered by an emergency medical services provider
	721	+	3 organization;
	722	+	4 (2) within the emergency medical services provider organization's
	723	+	5 scope of practice;
	724	+	6 (3) performed or provided as advanced life support services; and
	725	+	7 (4) performed or provided during a response initiated through the
	726	+	8 911 system regardless of whether the patient is transported.
	727	+	9 (e) Reimbursement for advanced life support services through
	728	+	10 a contract to which this section applies must be provided on an
	729	+	11 equal basis regardless of whether the services involve
	730	+	12 transportation of the patient by ambulance.
	731	+	13 (e) (f) If multiple emergency medical services provider
	732	+	14 organizations qualify and submit a claim for reimbursement under this
	733	+	15 section, the health maintenance organization:
	734	+	16 (1) may reimburse under this section only for one (1) claim per
	735	+	17 patient encounter; and
	736	+	18 (2) shall reimburse the claim submitted by the emergency medical
	737	+	19 services provider organization that performed or provided the
	738	+	20 majority of advanced life support services.
	739	+	21 (f) (g) The department may adopt rules under IC 4-22-2, including
	740	+	22 emergency rules under IC 4-22-2-37.1, to implement this section.
	741	+	23 (g) (h) This section does not require an individual contract or a
	742	+	24 group contract to provide coverage for emergency medical services.
	743	+	2022 IN 1373—LS 7176/DI 55