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Indiana House Bill HB1378

Indiana 2024 Regular Session

Indiana House Bill HB1378 Compare Versions

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22 Introduced Version
33 HOUSE BILL No. 1378
44 _____
55 DIGEST OF INTRODUCED BILL
66 Citations Affected: IC 5-10-8; IC 27-8-6; IC 27-13-7.
77 Synopsis: Coverage for mobile integrated healthcare services.
88 Requires health plans, subject to applicable deductible and coinsurance
99 for a state employee health plan, to provide reimbursement for
1010 emergency medical services that are performed or provided during a
1111 response initiated as part of a mobile integrated healthcare program
1212 currently established in Delaware, White, and Montgomery counties.
1313 Provides that the reimbursement for emergency medical services that
1414 are performed or provided as part of a mobile integrated healthcare
1515 program in Delaware, White, and Montgomery counties shall be in
1616 effect from July 1, 2024, through June 30, 2027. Requires the
1717 department of insurance (department) to compile a report detailing any
1818 cost changes based on claims data, as a result of the reimbursement for
1919 emergency medical services that are performed or provided as part of
2020 a mobile integrated healthcare program in Delaware, White, and
2121 Montgomery counties. Requires the department to compile the report
2222 not later than July 1, 2026.
2323 Effective: July 1, 2024.
2424 Baird, Barrett
2525 January 10, 2024, read first time and referred to Committee on Insurance.
2626 2024 IN 1378—LS 6992/DI 154 Introduced
2727 Second Regular Session of the 123rd General Assembly (2024)
2828 PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
2929 Constitution) is being amended, the text of the existing provision will appear in this style type,
3030 additions will appear in this style type, and deletions will appear in this style type.
3131 Additions: Whenever a new statutory provision is being enacted (or a new constitutional
3232 provision adopted), the text of the new provision will appear in this style type. Also, the
3333 word NEW will appear in that style type in the introductory clause of each SECTION that adds
3434 a new provision to the Indiana Code or the Indiana Constitution.
3535 Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
3636 between statutes enacted by the 2023 Regular Session of the General Assembly.
3737 HOUSE BILL No. 1378
3838 A BILL FOR AN ACT to amend the Indiana Code concerning
3939 insurance.
4040 Be it enacted by the General Assembly of the State of Indiana:
4141 1 SECTION 1. IC 5-10-8-23, AS ADDED BY P.L.115-2020,
4242 2 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
4343 3 JULY 1, 2024]: Sec. 23. (a) As used in this section, "covered
4444 4 individual" means an individual who is entitled to coverage under a
4545 5 state employee health plan.
4646 6 (b) As used in this section, "emergency medical services provider
4747 7 organization" means a provider of emergency medical services that is
4848 8 certified by the Indiana emergency medical services commission as an
4949 9 advanced life support provider organization under rules adopted under
5050 10 IC 16-31-3.
5151 11 (c) As used in this section, "state employee health plan" means
5252 12 either of the following that provides coverage for emergency medical
5353 13 services:
5454 14 (1) A self-insurance program established under section 7(b) of
5555 15 this chapter to provide group health coverage.
5656 16 (2) A contract with a prepaid health care delivery plan that is
5757 17 entered into or renewed under section 7(c) of this chapter.
5858 2024 IN 1378—LS 6992/DI 154 2
5959 1 (d) A state employee health plan that provides coverage for
6060 2 emergency medical services must at least provide reimbursement,
6161 3 subject to applicable deductible and coinsurance, for a covered
6262 4 individual for emergency medical services that are:
6363 5 (1) rendered by an emergency medical services provider
6464 6 organization;
6565 7 (2) within the emergency medical services provider organization's
6666 8 scope of practice;
6767 9 (3) performed or provided as advanced life support services; and
6868 10 (4) performed or provided during a response initiated through the
6969 11 911 system or as part of a mobile integrated healthcare
7070 12 program described in IC 16-31-12 currently established in
7171 13 Delaware, White, and Montgomery counties, regardless of
7272 14 whether the patient was transported.
7373 15 (e) If multiple emergency medical services provider organizations
7474 16 qualify and submit a claim for reimbursement under this section for an
7575 17 encounter, the state employee health plan:
7676 18 (1) may only reimburse, subject to applicable deductible and
7777 19 coinsurance, under this section for one (1) claim per patient
7878 20 encounter; and
7979 21 (2) shall reimburse, subject to applicable deductible and
8080 22 coinsurance, the claim submitted by the emergency medical
8181 23 services provider organization that performed or provided the
8282 24 majority of advanced life support services for the patient.
8383 25 (f) The state personnel department may adopt rules under IC 4-22-2,
8484 26 including emergency rules under IC 4-22-2-37.1, to implement this
8585 27 section.
8686 28 (g) This section does not restrict the state employee health plan from
8787 29 providing coverage beyond the requirements in this section.
8888 30 SECTION 2. IC 5-10-8-23.5 IS ADDED TO THE INDIANA CODE
8989 31 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
9090 32 1, 2024]: Sec. 23.5. (a) The reimbursement for emergency medical
9191 33 services that are performed or provided as part of a mobile
9292 34 integrated healthcare program described in section 23(d)(4) of this
9393 35 chapter shall be in effect from July 1, 2024, through June 30, 2027.
9494 36 (b) The department of insurance shall compile:
9595 37 (1) a report detailing any cost changes based on claims data,
9696 38 as a result of the reimbursement for emergency medical
9797 39 services that are performed or provided as part of a mobile
9898 40 integrated healthcare program described in section 23(d)(4)
9999 41 of this chapter; and
100100 42 (2) the report described in subdivision (1) not later than July
101101 2024 IN 1378—LS 6992/DI 154 3
102102 1 1, 2026.
103103 2 SECTION 3. IC 27-8-6-8, AS AMENDED BY P.L.170-2022,
104104 3 SECTION 37, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
105105 4 JULY 1, 2024]: Sec. 8. (a) As used in this section, "emergency medical
106106 5 services" has the meaning set forth in IC 16-18-2-110.
107107 6 (b) As used in this section, "emergency medical services provider
108108 7 organization" means a provider of emergency medical services that is
109109 8 certified by the Indiana emergency medical services commission as an
110110 9 advanced life support provider organization under rules adopted under
111111 10 IC 16-31-3.
112112 11 (c) As used in this section, "policy of accident and sickness
113113 12 insurance" has the meaning set forth in IC 27-8-5-1. However, for
114114 13 purposes of this section, the term does not include the following:
115115 14 (1) Accident only, credit, dental, vision, Medicare supplement,
116116 15 long term care, or disability income insurance.
117117 16 (2) Coverage issued as a supplement to liability insurance.
118118 17 (3) Automobile medical payment insurance.
119119 18 (4) A specified disease policy.
120120 19 (5) A policy that provides a stipulated daily, weekly, or monthly
121121 20 payment to an insured without regard to the actual expense of the
122122 21 confinement.
123123 22 (6) A short term insurance plan (as defined in IC 27-8-5.9-3).
124124 23 (d) A policy of accident and sickness insurance that provides
125125 24 coverage for emergency medical services must provide reimbursement
126126 25 for emergency medical services that are:
127127 26 (1) rendered by an emergency medical services provider
128128 27 organization;
129129 28 (2) within the emergency medical services provider organization's
130130 29 scope of practice;
131131 30 (3) performed or provided as advanced life support services; and
132132 31 (4) performed or provided during a response initiated through the
133133 32 911 system or as part of a mobile integrated healthcare
134134 33 program described in IC 16-31-12 currently established in
135135 34 Delaware, White, and Montgomery counties, regardless of
136136 35 whether the patient is transported.
137137 36 (e) Reimbursement for basic and advanced life support services
138138 37 through a policy to which this section applies must be provided on an
139139 38 equal basis regardless of whether the services involve transportation of
140140 39 the patient by ambulance.
141141 40 (f) If multiple emergency medical services provider organizations
142142 41 qualify and submit a claim for reimbursement under this section for an
143143 42 encounter, the insurer:
144144 2024 IN 1378—LS 6992/DI 154 4
145145 1 (1) may reimburse under this section only for one (1) claim per
146146 2 patient encounter; and
147147 3 (2) shall reimburse the claim submitted by the emergency medical
148148 4 services provider organization that performed or provided the
149149 5 majority of advanced life support services for the patient.
150150 6 (g) The department may adopt rules under IC 4-22-2, including
151151 7 emergency rules under IC 4-22-2-37.1, to implement this section.
152152 8 (h) This section does not require a policy of accident and sickness
153153 9 insurance to provide coverage for emergency medical services.
154154 10 SECTION 4. IC 27-8-6-8.5 IS ADDED TO THE INDIANA CODE
155155 11 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
156156 12 1, 2024]: Sec. 8.5. (a) The reimbursement for emergency medical
157157 13 services that are performed or provided as part of a mobile
158158 14 integrated healthcare program described in section 8(d)(4) of this
159159 15 chapter shall be in effect from July 1, 2024, through June 30, 2027.
160160 16 (b) The department of insurance shall compile:
161161 17 (1) a report detailing any cost changes based on claims data,
162162 18 as a result of the reimbursement for emergency medical
163163 19 services that are performed or provided as part of a mobile
164164 20 integrated healthcare program described in section 8(d)(4) of
165165 21 this chapter; and
166166 22 (2) the report described in subdivision (1) not later than July
167167 23 1, 2026.
168168 24 SECTION 5. IC 27-13-7-27, AS AMENDED BY P.L.170-2022,
169169 25 SECTION 39, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
170170 26 JULY 1, 2024]: Sec. 27. (a) This section applies to each of the
171171 27 following:
172172 28 (1) An individual contract.
173173 29 (2) A group contract.
174174 30 (b) As used in this section, "emergency medical services" has the
175175 31 meaning set forth in IC 16-18-2-110.
176176 32 (c) As used in this section, "emergency medical services provider
177177 33 organization" means a provider of emergency medical services that is
178178 34 certified by the Indiana emergency medical services commission as an
179179 35 advanced life support provider organization under rules adopted under
180180 36 IC 16-31-3.
181181 37 (d) An individual contract and a group contract that provide
182182 38 coverage for emergency medical services must provide reimbursement
183183 39 for emergency medical services that are:
184184 40 (1) rendered by an emergency medical services provider
185185 41 organization;
186186 42 (2) within the emergency medical services provider organization's
187187 2024 IN 1378—LS 6992/DI 154 5
188188 1 scope of practice;
189189 2 (3) performed or provided as advanced life support services; and
190190 3 (4) performed or provided during a response initiated through the
191191 4 911 system or as part of a mobile integrated healthcare
192192 5 program described in IC 16-31-12 currently established in
193193 6 Delaware, White, and Montgomery counties, regardless of
194194 7 whether the patient is transported.
195195 8 (e) Reimbursement for basic and advanced life support services
196196 9 through a contract to which this section applies must be provided on an
197197 10 equal basis regardless of whether the services involve transportation of
198198 11 the patient by ambulance.
199199 12 (f) If multiple emergency medical services provider organizations
200200 13 qualify and submit a claim for reimbursement under this section, the
201201 14 health maintenance organization:
202202 15 (1) may reimburse under this section only for one (1) claim per
203203 16 patient encounter; and
204204 17 (2) shall reimburse the claim submitted by the emergency medical
205205 18 services provider organization that performed or provided the
206206 19 majority of advanced life support services.
207207 20 (g) The department may adopt rules under IC 4-22-2, including
208208 21 emergency rules under IC 4-22-2-37.1, to implement this section.
209209 22 (h) This section does not require an individual contract or a group
210210 23 contract to provide coverage for emergency medical services.
211211 24 SECTION 6. IC 27-13-7-27.5 IS ADDED TO THE INDIANA
212212 25 CODE AS A NEW SECTION TO READ AS FOLLOWS
213213 26 [EFFECTIVE JULY 1, 2024]: Sec. 27.5. (a) The reimbursement for
214214 27 emergency medical services that are performed or provided as
215215 28 part of a mobile integrated healthcare program described in
216216 29 section 27(d)(4) of this chapter shall be in effect from July 1, 2024,
217217 30 through June 30, 2027.
218218 31 (b) The department shall compile:
219219 32 (1) a report detailing any cost changes based on claims data,
220220 33 as a result of the reimbursement for emergency medical
221221 34 services that are performed or provided as part of a mobile
222222 35 integrated healthcare program described in section 27(d)(4)
223223 36 of this chapter; and
224224 37 (2) the report described in subdivision (1) not later than July
225225 38 1, 2026.
226226 2024 IN 1378—LS 6992/DI 154