*HB1373.1*
January 20, 2022
HOUSE BILL No. 1373
_____
DIGEST OF HB 1373 (Updated January 19, 2022 3:26 pm - DI 77)
Citations Affected: IC 16-18; IC 16-21; IC 16-28; IC 16-31; IC 27-1;
IC 27-8; IC 27-13.
Synopsis: Ambulance services. Provides for the attending physician,
or the physician's designee, of a patient needing transportation by
ambulance to sign an order that states the level of ambulance service
needed for the patient and the condition or diagnosis of the patient that
makes the transportation of the patient by ambulance necessary.
Amends the law on emergency medical services to make that law apply
to nonemergency ambulance services as well as emergency ambulance
services. Requires a health plan to fairly negotiate rates and terms with
any ambulance service provider willing to become a participating
provider with respect to the health plan. Requires a health plan to pay
ambulance service benefits directly to a nonparticipating ambulance
service provider (nonparticipating provider) that provides ambulance
service to a covered individual if the covered individual executes a
written assignment of benefits in favor of the nonparticipating provider.
Provides that a nonparticipating provider that provides ambulance
service to a covered individual and that is paid less for the service by
the health plan than the amount it billed may bill the covered individual
for the balance. Provides that if the dispute concerning the amount to
be paid to the nonparticipating provider for the ambulance service is
not resolved through negotiation, the health plan operator or the
nonparticipating provider may initiate binding arbitration to resolve the
dispute. Provides that an accident and sickness insurance policy or
HMO contract that provides coverage for emergency medical services
(Continued next page)
Effective: July 1, 2022.
Barrett, Zent, Vermilion, Fleming
January 11, 2022, read first time and referred to Committee on Public Health.
January 20, 2022, amended, reported — Do Pass.
HB 1373—LS 7176/DI 55 Digest Continued
must also provide reimbursement for: (1) emergency ambulance
services; and (2) specialty care transport; provided by an emergency
medical services provider organization. Provides that reimbursement
provided for basic and 0advanced life support services through an
accident and sickness insurance policy or HMO contract must be
provided on an equal basis regardless of whether the services involve
transportation of the patient by ambulance.
HB 1373—LS 7176/DI 55HB 1373—LS 7176/DI 55 January 20, 2022
Second Regular Session of the 122nd General Assembly (2022)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2021 Regular Session of the General Assembly.
HOUSE BILL No. 1373
A BILL FOR AN ACT to amend the Indiana Code concerning
health.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 16-18-2-13.4 IS ADDED TO THE INDIANA
2 CODE AS A NEW SECTION TO READ AS FOLLOWS
3 [EFFECTIVE JULY 1, 2022]: Sec. 13.4. (a) "Ambulance service" or
4 "ambulance services", for purposes of IC 16-31, means:
5 (1) the transportation of patients by ambulance; and
6 (2) any basic life support administered to patients before or
7 during the transportation.
8 (b) The term includes:
9 (1) emergency ambulance services; and
10 (2) ambulance services that are not emergency ambulance
11 services.
12 SECTION 2. IC 16-21-2-5 IS AMENDED TO READ AS
13 FOLLOWS [EFFECTIVE JULY 1, 2022]: Sec. 5. (a) The governing
14 board of the hospital is the supreme authority in the hospital and is
15 responsible for the following:
HB 1373—LS 7176/DI 55 2
1 (1) The management, operation, and control of the hospital.
2 (2) The appointment, reappointment, and assignment of privileges
3 to members of the medical staff, with the advice and
4 recommendations of the medical staff, consistent with the
5 individual training, experience, and other qualifications of the
6 medical staff.
7 (3) Establishing requirements for appointments to and continued
8 service on the hospital's medical staff, consistent with the
9 appointee's individual training, experience, and other
10 qualifications, including the following requirements:
11 (A) Proof that a medical staff member has qualified as a health
12 care provider under IC 16-18-2-163(a).
13 (B) The performance of patient care and related duties in a
14 manner that is not disruptive to the delivery of quality medical
15 care in the hospital setting.
16 (C) Standards of quality medical care that recognize the
17 efficient and effective utilization of hospital resources,
18 developed by the medical staff.
19 (4) Upon recommendation of the medical staff, establishing
20 protocols within the requirements of this chapter and 410
21 IAC 15-1.2-1 for the admission, treatment, and care of patients
22 with extended lengths of stay.
23 (b) The protocols established under subsection (a)(4) must
24 provide that:
25 (1) a patient's attending physician or the physician's designee
26 must sign an order when the patient needs ambulance services
27 other than emergency ambulance services; and
28 (2) the order signed by a patient's physician or the physician's
29 designee under subdivision (1) must state:
30 (A) the level of ambulance service needed for the patient;
31 and
32 (B) the condition or diagnosis of the patient that makes the
33 transportation of the patient by ambulance necessary.
34 SECTION 3. IC 16-28-8-8 IS ADDED TO THE INDIANA CODE
35 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
36 1, 2022]: Sec. 8. When a patient receiving care at a health facility,
37 due to the patient's condition or diagnosis, needs ambulance
38 services other than emergency ambulance services, the patient's
39 attending physician or the physician's designee must sign an order
40 that states:
41 (1) the level of ambulance service needed for the patient; and
42 (2) the condition or diagnosis of the patient that makes the
HB 1373—LS 7176/DI 55 3
1 transportation of the patient by ambulance necessary.
2 SECTION 4. IC 16-31-2-2, AS AMENDED BY P.L.187-2021,
3 SECTION 57, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
4 JULY 1, 2022]: Sec. 2. (a) The commission is composed of fourteen
5 (14) members. The governor shall appoint the members for four (4)
6 year terms as follows:
7 (1) One (1) must be appointed from a volunteer fire department
8 that provides emergency medical service.
9 (2) One (1) must be appointed from a full-time municipal fire or
10 police department that provides emergency medical service.
11 (3) One (1) must be a nonprofit provider of emergency ambulance
12 services organized on a volunteer basis other than a volunteer fire
13 department.
14 (4) One (1) must be a provider of private ambulance services.
15 (5) One (1) must be a state licensed paramedic.
16 (6) One (1) must be a licensed physician who:
17 (A) has a primary interest, training, and experience in
18 emergency medical services; and
19 (B) is currently practicing in an emergency medical services
20 facility.
21 (7) One (1) must be a chief executive officer of a hospital that
22 provides emergency ambulance services.
23 (8) One (1) must be a registered nurse who has supervisory or
24 administrative responsibility in a hospital emergency department.
25 (9) One (1) must be a licensed physician who:
26 (A) has a primary interest, training, and experience in trauma
27 care; and
28 (B) is practicing in a trauma facility.
29 (10) One (1) must be a state certified emergency medical service
30 technician.
31 (11) One (1) must be an individual who:
32 (A) represents the public at large; and
33 (B) is not in any way related to providing emergency medical
34 services.
35 (12) One (1) must be a program director (as defined in 836
36 IAC 4-2-2(12)(B)(iii)) for a commission certified advanced life
37 support training institution.
38 (13) One (1) must be the executive director of the department of
39 homeland security appointed under IC 10-19-3-1 or the designee
40 of the executive director.
41 (14) One (1) must be a representative of an entity that provides air
42 ambulance services.
HB 1373—LS 7176/DI 55 4
1 (b) The chief executive officer of a hospital appointed under
2 subsection (a)(7) may designate another administrator of the hospital
3 to serve for the chief executive officer on the commission.
4 (c) Not more than eight (8) members may be from the same political
5 party.
6 SECTION 5. IC 16-31-2-7, AS AMENDED BY P.L.185-2015,
7 SECTION 16, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
8 JULY 1, 2022]: Sec. 7. (a) The commission shall do the following:
9 (1) Develop and promote, in cooperation with state, regional, and
10 local public and private organizations, agencies, and persons, a
11 statewide program for the provision of emergency medical
12 services that must include the following:
13 (A) Preparation of state, regional, and local emergency
14 ambulance service plans.
15 (B) Provision of consultative services to state, regional, and
16 local organizations and agencies in developing and
17 implementing emergency ambulance service programs.
18 (C) Promotion of a statewide system of emergency medical
19 service facilities by developing minimum standards,
20 procedures, and guidelines in regard to personnel, equipment,
21 supplies, communications, facilities, and location of such
22 centers.
23 (D) Promotion of programs for the training of personnel
24 providing emergency medical services and programs for the
25 education of the general public in first aid techniques and
26 procedures. The training shall be held in various local
27 communities of the state and shall be conducted by agreement
28 with publicly and privately supported educational institutions
29 or hospitals licensed under IC 16-21, wherever appropriate.
30 (E) Promotion of coordination of emergency communications,
31 resources, and procedures throughout Indiana and, in
32 cooperation with interested state, regional, and local public
33 and private agencies, organizations, and persons, the
34 development of an effective state, regional, and local
35 emergency communications system.
36 (F) Organizing and sponsoring a statewide emergency medical
37 services conference to provide continuing education for
38 persons providing emergency medical services.
39 (2) Regulate, inspect, and certify or license services, facilities,
40 and personnel engaged in providing emergency medical services
41 as provided in this article.
42 (3) Adopt rules required to implement an approved system of
HB 1373—LS 7176/DI 55 5
1 emergency medical services.
2 (4) Adopt rules concerning triage and transportation protocols for
3 the transportation of trauma patients consistent with the field
4 triage decision scheme of the American College of Surgeons
5 Committee on Trauma.
6 (5) Apply for, receive, and accept gifts, bequests, grants-in-aid,
7 state, federal, and local aid, and other forms of financial
8 assistance for the support of emergency medical services.
9 (6) Employ necessary administrative staff.
10 (b) The commission shall include the provision of the mental health
11 first aid training program developed under IC 12-21-5-4 in the
12 promotion of continuing education programs under subsection
13 (a)(1)(D).
14 SECTION 6. IC 16-31-3-5, AS AMENDED BY P.L.249-2019,
15 SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
16 JULY 1, 2022]: Sec. 5. (a) The department of homeland security shall
17 waive any rule adopted by the commission under this article for:
18 (1) a person who provides emergency ambulance service;
19 (2) an emergency medical technician;
20 (3) an advanced emergency medical technician;
21 (4) a paramedic; or
22 (5) an ambulance;
23 when operating from a location in an adjoining state by contract with
24 an Indiana unit of government to provide emergency ambulance or
25 medical services to patients who are picked up or treated in Indiana.
26 (b) The department of homeland security may waive any rule,
27 including a rule establishing a fee adopted by the commission under
28 this article, for a person who submits facts demonstrating that:
29 (1) compliance with the rule will impose an undue hardship on
30 the person; and
31 (2) either:
32 (A) noncompliance with the rule; or
33 (B) compliance with an alternative requirement approved by
34 the department of homeland security;
35 will not jeopardize the quality of patient care. However, the
36 department of homeland security may not waive a rule that sets
37 forth educational requirements for a person regulated under this
38 article.
39 (c) A waiver granted under subsection (b)(2)(B) is conditioned upon
40 compliance with the alternative requirement approved under subsection
41 (b).
42 (d) The department of homeland security shall establish an
HB 1373—LS 7176/DI 55 6
1 expiration date for any waiver that is granted.
2 (e) The department of homeland security may renew a waiver if the
3 person makes the same demonstration required for the original waiver.
4 (f) The commission is the ultimate authority for orders issued under
5 this section.
6 SECTION 7. IC 16-31-5-1, AS AMENDED BY P.L.197-2016,
7 SECTION 116, IS AMENDED TO READ AS FOLLOWS
8 [EFFECTIVE JULY 1, 2022]: Sec. 1. The governing body of a city,
9 town, township, or county by the governing body's action or in any
10 combination may do the following:
11 (1) Establish, operate, and maintain emergency medical services.
12 (2) Levy taxes under and limited by IC 6-3.6 and expend
13 appropriated funds of the political subdivision to pay the costs
14 and expenses of establishing, operating, maintaining, or
15 contracting for emergency medical services.
16 (3) Except as provided in section 2 of this chapter, authorize,
17 franchise, or contract for emergency medical services. However:
18 (A) a county may not provide, authorize, or contract for
19 emergency medical services within the limits of any city
20 without the consent of the city; and
21 (B) a city or town may not provide, authorize, franchise, or
22 contract for emergency medical services outside the limits of
23 the city or town without the approval of the governing body of
24 the area to be served.
25 (4) Apply for, receive, and accept gifts, bequests, grants-in-aid,
26 state, federal, and local aid, and other forms of financial
27 assistance for the support of emergency medical services.
28 (5) Establish and provide for the collection of reasonable fees for
29 emergency ambulance services the governing body provides
30 under this chapter.
31 (6) Pay the fees or dues for individual or group membership in
32 any regularly organized volunteer emergency medical services
33 association on their own behalf or on behalf of the emergency
34 medical services personnel serving that unit of government.
35 SECTION 8. IC 16-31-5-2 IS AMENDED TO READ AS
36 FOLLOWS [EFFECTIVE JULY 1, 2022]: Sec. 2. A city, town, or
37 county may not adopt an ordinance that restricts a person from
38 providing emergency ambulance services in the city, town, township,
39 or county if:
40 (1) the person is authorized to provide emergency ambulance
41 services in any part of another county; and
42 (2) the person has been requested to provide emergency
HB 1373—LS 7176/DI 55 7
1 ambulance services:
2 (A) to the county in which the person is authorized to provide
3 emergency ambulance services, and those services will
4 originate in another county; or
5 (B) from the county in which the person is authorized to
6 provide emergency ambulance services, and those services
7 will terminate in another county.
8 SECTION 9. IC 16-31-13-2, AS ADDED BY P.L.37-2021,
9 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
10 JULY 1, 2022]: Sec. 2. (a) If there is not an individual requiring
11 medical attention or transport, a paramedic, advanced emergency
12 medical technician, or emergency medical technician may use
13 emergency ambulance services to transport an operational canine
14 injured in the line of duty to a veterinary hospital or clinic.
15 (b) During transport, a paramedic, advanced emergency medical
16 technician, or emergency medical technician may provide the following
17 care to an injured operational canine:
18 (1) Opening and manually maintaining an airway.
19 (2) Performing cardiopulmonary resuscitation.
20 (3) Administering oxygen.
21 (4) Managing ventilation by mask.
22 (5) Controlling hemorrhage with direct pressure.
23 (6) Immobilizing fractures.
24 (7) Bandaging.
25 (8) Procedures authorized under a written protocol established
26 and provided by the state veterinarian.
27 (9) Procedures authorized by the Indiana emergency medical
28 services commission.
29 (10) If the paramedic, advanced emergency medical technician,
30 or emergency medical technician is trained in canine tactical
31 combat casualty care (K9TCCC), the individual may provide care
32 within the scope and protocols of the K9TCCC training.
33 (c) A paramedic, advanced emergency medical technician, or
34 emergency medical technician may require a member of the law
35 enforcement department or agency to accompany the injured
36 operational canine during transport.
37 (d) Unless there is a written agreement that specifies the party that
38 is financially responsible for the transportation and treatment cost for
39 an injured operational canine, the law enforcement agency or other
40 governmental agency that owns or requested the use of the operational
41 canine is responsible for the transportation and treatment cost for the
42 operational canine.
HB 1373—LS 7176/DI 55 8
1 (e) A written agreement between a law enforcement agency or other
2 governmental agency and a provider of emergency ambulance services
3 that concerns the transport and care of an operational canine injured in
4 the line of duty must specify which services described under subsection
5 (b) will be covered under the agreement.
6 SECTION 10. IC 27-1-2.3 IS ADDED TO THE INDIANA CODE
7 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
8 JULY 1, 2022]:
9 Chapter 2.3. Payment for Ambulance Services
10 Sec. 1. As used in this chapter, "ambulance" refers only to a
11 vehicle that is used to provide ambulance service on land.
12 Sec. 2. As used in this chapter, "ambulance fee dispute" means
13 a dispute as to the compensation to be paid to an ambulance service
14 provider for ambulance service.
15 Sec. 3. As used in this chapter, "ambulance service provider"
16 means a person that:
17 (1) provides ambulance service; and
18 (2) holds a valid certificate issued by the commission under
19 IC 16-31-3 authorizing the person to provide ambulance
20 service.
21 Sec. 4. As used in this chapter, "cost sharing" means the total
22 amount paid:
23 (1) by a covered individual; or
24 (2) on behalf of a covered individual by any person other than
25 the health plan under which the individual is covered;
26 in the form of a deductible, copayment, or coinsurance, for
27 ambulance service provided to the covered individual.
28 Sec. 5. As used in this chapter, "covered individual" means an
29 individual who is entitled to coverage under a health plan.
30 Sec. 6. As used in this chapter, "health plan" means any of the
31 following:
32 (1) A self-insurance program established under IC 5-10-8-7(b)
33 to provide group coverage.
34 (2) A prepaid health care delivery plan through which health
35 services are provided under IC 5-10-8-7(c).
36 (3) A policy of accident and sickness insurance as defined in
37 IC 27-8-5-1, but not including any insurance, plan, or policy
38 set forth in IC 27-8-5-2.5(a).
39 (4) An individual contract (as defined in IC 27-13-1-21) or a
40 group contract (as defined in IC 27-13-1-16) with a health
41 maintenance organization that provides coverage for basic
42 health care services (as defined in IC 27-13-1-4).
HB 1373—LS 7176/DI 55 9
1 Sec. 7. As used in this chapter, "health plan operator" means
2 the following:
3 (1) In the case of a health plan described in section 6(1) or 6(2)
4 of this chapter, the state of Indiana.
5 (2) In the case of a health plan described in section 6(3) of this
6 chapter, the insurer that issued the policy.
7 (3) In the case of a health plan described in section 6(4) of this
8 chapter, the health maintenance organization that entered
9 into the contract.
10 Sec. 8. For purposes of this chapter:
11 (1) an ambulance service provider that provides ambulance
12 service to an individual covered by a health plan is
13 "nonparticipating" with respect to the health plan if the
14 ambulance service provider has not, by contract, affiliation,
15 agreement, or any other means, agreed to be compensated by
16 the health plan at no more than a certain amount or rate for
17 the ambulance service; and
18 (2) an ambulance service provider that provides ambulance
19 service to an individual covered by a health plan is
20 "participating" with respect to the health plan if the
21 ambulance service provider has agreed to be compensated by
22 the health plan at no more than a certain amount or rate for
23 the ambulance service.
24 Sec. 9. As used in this chapter, "person" means an individual, a
25 corporation, a limited liability company, a partnership, or another
26 legal entity.
27 Sec. 10. (a) A health plan operator shall fairly negotiate rates
28 and terms with any ambulance service provider willing to become
29 a participating provider with respect to the health plan.
30 (b) In negotiations under subsection (a), a health plan must
31 consider all of the following:
32 (1) The ambulance service provider's usual and customary
33 rates.
34 (2) The ambulance service provider's resources, and whether
35 the ambulance service provider's staff is available twenty-four
36 (24) hours per day every day.
37 (3) The average wages and fuel costs in the geographical area
38 in which the ambulance service provider operates.
39 (4) The number of times in which individuals covered by the
40 health plan have sought ambulance service from the
41 ambulance service provider but the ambulance service
42 provider's response was canceled or did not result in a
HB 1373—LS 7176/DI 55 10
1 transport.
2 (5) The local ordinances and state rules concerning staffing,
3 response times, and equipment under which the ambulance
4 service provider must operate.
5 (6) The types of requests for ambulance service for individuals
6 covered by the health plan that the ambulance service
7 provider generally receives, and the requesting party or
8 agency by which those requests are generally made.
9 (7) The average reimbursement rate per level of service that
10 the ambulance service provider generally receives as a
11 nonparticipating provider.
12 (8) The specific:
13 (A) clinical and staff capabilities; and
14 (B) equipment resources;
15 that an ambulance service provider must have to adequately
16 meet the needs of individuals covered by the health plan, such
17 as for the transportation of covered individuals from one (1)
18 hospital to another after traumatic injury.
19 (9) The average transport cost data reported to the office of
20 the secretary of family and social services by governmental
21 ambulance service providers located within the counties, and
22 contiguous counties, that the nonparticipating ambulance
23 service provider serves.
24 (10) Final arbitration decisions made under section 14 of this
25 chapter.
26 (c) If negotiations between an ambulance service provider and
27 a health plan operator under this section do not result in the
28 ambulance service provider becoming a participating provider
29 with respect to the health plan, each party shall provide to the
30 department:
31 (1) notice that no agreement has been met; and
32 (2) a summary of the areas of negotiation that were not
33 agreed upon.
34 Sec. 11. If:
35 (1) an individual covered by a health plan is provided
36 ambulance service by a nonparticipating ambulance service
37 provider; and
38 (2) the covered individual executes a written assignment to the
39 nonparticipating ambulance service provider of the benefits
40 the covered individual is entitled to under the health plan with
41 respect to the ambulance service;
42 the health plan shall pay the benefits referred to in subdivision (2)
HB 1373—LS 7176/DI 55 11
1 directly to the nonparticipating ambulance service provider.
2 Sec. 12. (a) If an individual covered by a health plan is provided
3 ambulance service by a nonparticipating ambulance service
4 provider, the nonparticipating ambulance service provider may
5 bill the health plan for the ambulance service.
6 (b) A health plan operator that receives a bill from a
7 nonparticipating ambulance service provider for ambulance
8 service provided to a covered individual:
9 (1) shall provide to the nonparticipating ambulance service
10 provider a written explanation of:
11 (A) the health plan's benefits for ambulance service; and
12 (B) the cost sharing that applies to the health plan's
13 coverage of the ambulance service provided to the covered
14 individual; and
15 (2) may:
16 (A) pay the amount billed by the nonparticipating
17 ambulance service provider;
18 (B) negotiate with the nonparticipating ambulance service
19 provider for the payment of an amount different from the
20 billed amount; or
21 (C) pay to the nonparticipating ambulance service
22 provider an amount different from the billed amount.
23 (c) If the amount paid by the health plan to the nonparticipating
24 ambulance service provider under subsection (b)(2)(C) is less than
25 the amount billed by the nonparticipating ambulance service
26 provider, the nonparticipating ambulance service provider may
27 bill the covered individual for the difference between the billed
28 amount and the amount paid by the health plan.
29 (d) If a covered individual receives a bill from a
30 nonparticipating ambulance service provider under subsection (c),
31 the covered individual may appeal to the health plan operator for
32 assistance. In response to an appeal under this subsection, the
33 health plan operator shall:
34 (1) consider whether to pay all or part of the amount billed to
35 the covered individual under subsection (c); and
36 (2) disclose to the covered individual information about the
37 efforts made by the health plan to negotiate with the
38 nonparticipating ambulance service provider, including:
39 (A) the date of the most recent negotiations; and
40 (B) the amount most recently offered by the health plan in
41 payment for the ambulance service provided to the covered
42 individual.
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1 (e) Information about a covered individual's right to appeal to
2 the health plan operator under subsection (d) shall be provided to
3 a covered individual:
4 (1) by the health plan operator when the health plan, under
5 subsection (b)(2)(C), pays to a nonparticipating ambulance
6 service provider an amount different from the amount billed
7 by the nonparticipating ambulance service provider; and
8 (2) by the nonparticipating ambulance service provider when
9 the nonparticipating ambulance service provider bills the
10 covered individual under subsection (c).
11 Sec. 13. (a) If negotiations under this chapter do not result in a
12 resolution of the ambulance fee dispute within thirty (30) days
13 after the nonparticipating ambulance service provider receives the
14 written explanation of benefits and cost sharing under section
15 12(b)(1) of this chapter:
16 (1) the health plan operator; or
17 (2) the nonparticipating ambulance service provider;
18 may initiate binding arbitration to resolve the ambulance fee
19 dispute by filing a request for binding arbitration with the
20 department.
21 (b) The party initiating binding arbitration under subsection (a)
22 shall provide to the other party:
23 (1) notification that arbitration has been initiated through the
24 filing of a request with the department; and
25 (2) a final offer to resolve the ambulance fee dispute through
26 the payment of a certain amount for the ambulance service.
27 (c) In response to the notification and final offer it receives
28 under subsection (b), the party not initiating binding arbitration
29 shall provide to the opposite party its own final offer to resolve the
30 ambulance fee dispute through the payment of a certain amount
31 for the ambulance service.
32 (d) An offer to resolve an ambulance fee dispute that is provided
33 under subsection (b) or (c) may propose payment for ambulance
34 services on a per billing basis or a bundled claim basis.
35 Sec. 14. (a) After arbitration is initiated under section 13 of this
36 chapter, an arbitrator must be selected according to the following
37 procedure:
38 (1) The health plan operator and the nonparticipating
39 ambulance service provider may select an arbitrator from the
40 list published by the department under section 15 of this
41 chapter.
42 (2) If the health plan operator and the nonparticipating
HB 1373—LS 7176/DI 55 13
1 ambulance service provider cannot agree on the selection of
2 an arbitrator under subdivision (1), the department shall
3 provide a list of five (5) potential arbitrators randomly taken
4 from the list published under section 15 of this chapter.
5 (3) From the list provided under subdivision (2), the health
6 plan operator and the nonparticipating ambulance service
7 provider may each veto two (2) potential arbitrators, and the
8 remaining arbitrator is the arbitrator for the ambulance fee
9 dispute.
10 (b) The health plan operator and the nonparticipating
11 ambulance service provider may submit facts and arguments in
12 writing to the arbitrator in support of their positions. The
13 arbitrator, after considering all submissions by the parties, shall
14 decide on the amount of compensation to be paid to the
15 nonparticipating ambulance service provider for the ambulance
16 service provided to the covered individual.
17 (c) The arbitrator shall issue a decision under subsection (b) not
18 more than forty-five (45) days after the request for arbitration is
19 filed with the department under section 13(a) of this chapter. The
20 decision of the arbitrator:
21 (1) is binding on the health plan operator and the
22 nonparticipating ambulance service provider; and
23 (2) is admissible in any court proceeding between the health
24 plan operator and the nonparticipating ambulance service
25 provider.
26 (d) The arbitrator's expenses and fees and other expenses (not
27 including the parties' attorney's fees) that are incurred in
28 conducting the arbitration shall be paid as provided in the
29 arbitrator's decision.
30 Sec. 15. For the purposes of this chapter, the department shall
31 compile and publish a list of individuals or entities that:
32 (1) are listed in:
33 (A) the National Roster of Arbitrators of the American
34 Arbitration Association; or
35 (B) the roster of arbitrators of the American Health Law
36 Association; and
37 (2) are willing to arbitrate ambulance fee disputes under this
38 chapter.
39 Sec. 16. The department shall adopt rules under IC 4-22-2 to
40 implement this chapter.
41 SECTION 11. IC 27-8-6-8, AS ADDED BY P.L.115-2020,
42 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
HB 1373—LS 7176/DI 55 14
1 JULY 1, 2022]: Sec. 8. (a) As used in this section, "emergency medical
2 services" has the meaning set forth in IC 16-18-2-110.
3 (b) As used in this section, "emergency medical services provider
4 organization" means a provider of emergency medical services that is
5 certified by the Indiana emergency medical services commission as an
6 advanced life support provider organization under rules adopted under
7 IC 16-31-3.
8 (c) As used in this section, "policy of accident and sickness
9 insurance" has the meaning set forth in IC 27-8-5-1. However, for
10 purposes of this section, the term does not include the following:
11 (1) Accident only, credit, dental, vision, Medicare supplement,
12 long term care, or disability income insurance.
13 (2) Coverage issued as a supplement to liability insurance.
14 (3) Automobile medical payment insurance.
15 (4) A specified disease policy.
16 (5) A policy that provides a stipulated daily, weekly, or monthly
17 payment to an insured without regard to the actual expense of the
18 confinement.
19 (6) A short term insurance plan (as defined in IC 27-8-5.9-3).
20 (d) A policy of accident and sickness insurance that provides
21 coverage for emergency medical services must provide reimbursement
22 for emergency medical services that are:
23 (1) rendered by an emergency medical services provider
24 organization;
25 (2) within the emergency medical services provider organization's
26 scope of practice;
27 (3) performed or provided as advanced life support services; and
28 (4) performed or provided during a response initiated through the
29 911 system regardless of whether the patient is transported.
30 (e) Reimbursement for basic and advanced life support services
31 through a policy to which this section applies must be provided on
32 an equal basis regardless of whether the services involve
33 transportation of the patient by ambulance.
34 (e) (f) If multiple emergency medical services provider
35 organizations qualify and submit a claim for reimbursement under this
36 section for an encounter, the insurer:
37 (1) may reimburse under this section only for one (1) claim per
38 patient encounter; and
39 (2) shall reimburse the claim submitted by the emergency medical
40 services provider organization that performed or provided the
41 majority of advanced life support services for the patient.
42 (f) (g) The department may adopt rules under IC 4-22-2, including
HB 1373—LS 7176/DI 55 15
1 emergency rules under IC 4-22-2-37.1, to implement this section.
2 (g) (h) This section does not require a policy of accident and
3 sickness insurance to provide coverage for emergency medical
4 services.
5 SECTION 12. IC 27-8-38 IS ADDED TO THE INDIANA CODE
6 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
7 JULY 1, 2022]:
8 Chapter 38. Coverage for Emergency Ambulance Services and
9 Specialty Care Transport
10 Sec. 1. This chapter applies to:
11 (1) accident and sickness insurance policies issued, delivered,
12 or renewed after June 30, 2022; and
13 (2) HMO contracts entered into or renewed after June 30,
14 2022.
15 Sec. 2. (a) As used in this chapter, "accident and sickness
16 insurance policy" means an insurance policy that:
17 (1) provides at least one (1) of the types of insurance described
18 in IC 27-1-5-1, Classes 1(b) and 2(a); and
19 (2) is issued on:
20 (A) an individual basis; or
21 (B) a group basis.
22 (b) "Accident and sickness insurance policy" does not include
23 the following:
24 (1) Accident only, credit, dental, vision, Medicare supplement,
25 long term care, or disability income insurance.
26 (2) Coverage issued as a supplement to liability insurance.
27 (3) Worker's compensation or similar insurance.
28 (4) Automobile medical payment insurance.
29 (5) A specified disease policy.
30 (6) A short term insurance plan that:
31 (A) may be renewed for the greater of:
32 (i) thirty-six (36) months; or
33 (ii) the maximum period permitted under federal law;
34 (B) has a term of not more than three hundred sixty-four
35 (364) days; and
36 (C) has an annual limit of at least two million dollars
37 ($2,000,000).
38 (7) A policy that provides indemnity benefits not based on any
39 expense incurred requirement, including a plan that provides
40 coverage for:
41 (A) hospital confinement, critical illness, or intensive care;
42 or
HB 1373—LS 7176/DI 55 16
1 (B) gaps for deductibles or copayments.
2 (8) A supplemental plan that always pays in addition to other
3 coverage.
4 (9) A student health plan.
5 (10) An employer sponsored health benefit plan that is:
6 (A) provided to individuals who are eligible for Medicare;
7 and
8 (B) not marketed as, or held out to be, a Medicare
9 supplement policy.
10 Sec. 3. As used in this chapter, "emergency ambulance services"
11 has the meaning set forth in IC 16-18-2-107.
12 Sec. 4. As used in this chapter, "emergency medical services"
13 has the meaning set forth in IC 16-18-2-110.
14 Sec. 5. As used in this chapter, "emergency medical services
15 provider organization" means a provider of emergency medical
16 services that is certified by the Indiana emergency medical services
17 commission under the rules adopted under IC 16-31-3 to provide
18 advanced life support.
19 Sec. 6. (a) As used in this chapter, "HMO contract" means a
20 contract under which a health maintenance organization (as
21 defined in IC 27-13-1-19) undertakes to provide or arrange for the
22 delivery of health care services to enrollees on a prepaid basis,
23 except for enrollee responsibility for copayments or deductibles.
24 (b) The term includes:
25 (1) an individual contract (as defined in IC 27-13-1-21); and
26 (2) a group contract (as defined in IC 27-13-1-16).
27 Sec. 7. As used in this chapter, "specialty care transport" means
28 transport in which the level of service or procedures required is as
29 set forth in 836 IAC 2-2-3(k) as in effect on January 1, 2022.
30 Sec. 8. An accident and sickness insurance policy or HMO
31 contract that provides coverage for emergency medical services
32 must also provide reimbursement for the following:
33 (1) Emergency ambulance services provided by an emergency
34 medical services provider organization.
35 (2) Specialty care transport provided by an emergency
36 medical services provider organization.
37 SECTION 13. IC 27-13-7-27, AS ADDED BY P.L.115-2020,
38 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
39 JULY 1, 2022]: Sec. 27. (a) This section applies to each of the
40 following:
41 (1) An individual contract.
42 (2) A group contract.
HB 1373—LS 7176/DI 55 17
1 (b) As used in this section, "emergency medical services" has the
2 meaning set forth in IC 16-18-2-110.
3 (c) As used in this section, "emergency medical services provider
4 organization" means a provider of emergency medical services that is
5 certified by the Indiana emergency medical services commission as an
6 advanced life support provider organization under rules adopted under
7 IC 16-31-3.
8 (d) An individual contract and a group contract that provide
9 coverage for emergency medical services must provide reimbursement
10 for emergency medical services that are:
11 (1) rendered by an emergency medical services provider
12 organization;
13 (2) within the emergency medical services provider organization's
14 scope of practice;
15 (3) performed or provided as advanced life support services; and
16 (4) performed or provided during a response initiated through the
17 911 system regardless of whether the patient is transported.
18 (e) Reimbursement for basic and advanced life support services
19 through a contract to which this section applies must be provided
20 on an equal basis regardless of whether the services involve
21 transportation of the patient by ambulance.
22 (e) (f) If multiple emergency medical services provider
23 organizations qualify and submit a claim for reimbursement under this
24 section, the health maintenance organization:
25 (1) may reimburse under this section only for one (1) claim per
26 patient encounter; and
27 (2) shall reimburse the claim submitted by the emergency medical
28 services provider organization that performed or provided the
29 majority of advanced life support services.
30 (f) (g) The department may adopt rules under IC 4-22-2, including
31 emergency rules under IC 4-22-2-37.1, to implement this section.
32 (g) (h) This section does not require an individual contract or a
33 group contract to provide coverage for emergency medical services.
HB 1373—LS 7176/DI 55 18
COMMITTEE REPORT
Mr. Speaker: Your Committee on Public Health, to which was
referred House Bill 1373, has had the same under consideration and
begs leave to report the same back to the House with the
recommendation that said bill be amended as follows:
Page 2, line 25, after "physician" insert "or the physician's
designee".
Page 2, line 28, after "physician" insert "or the physician's
designee".
Page 2, line 39, after "physician" insert "or the physician's
designee".
Page 9, line 41, delete "canceled." and insert "canceled or did not
result in a transport.".
Page 10, between lines 16 and 17, begin a new line block indented
and insert:
"(9) The average transport cost data reported to the office of
the secretary of family and social services by governmental
ambulance service providers located within the counties, and
contiguous counties, that the nonparticipating ambulance
service provider serves.
(10) Final arbitration decisions made under section 14 of this
chapter.".
Page 14, line 21, after "for" insert "basic and".
Page 17, line 9, after "for" insert "basic and".
and when so amended that said bill do pass.
(Reference is to HB 1373 as introduced.)
BARRETT
Committee Vote: yeas 12, nays 0.
HB 1373—LS 7176/DI 55