Introduced Version
HOUSE BILL No. 1378
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 5-10-8; IC 27-8-6; IC 27-13-7.
Synopsis: Coverage for mobile integrated healthcare services.
Requires health plans, subject to applicable deductible and coinsurance
for a state employee health plan, to provide reimbursement for
emergency medical services that are performed or provided during a
response initiated as part of a mobile integrated healthcare program
currently established in Delaware, White, and Montgomery counties.
Provides that the reimbursement for emergency medical services that
are performed or provided as part of a mobile integrated healthcare
program in Delaware, White, and Montgomery counties shall be in
effect from July 1, 2024, through June 30, 2027. Requires the
department of insurance (department) to compile a report detailing any
cost changes based on claims data, as a result of the reimbursement for
emergency medical services that are performed or provided as part of
a mobile integrated healthcare program in Delaware, White, and
Montgomery counties. Requires the department to compile the report
not later than July 1, 2026.
Effective: July 1, 2024.
Baird, Barrett
January 10, 2024, read first time and referred to Committee on Insurance.
2024 IN 1378—LS 6992/DI 154 Introduced
Second Regular Session of the 123rd General Assembly (2024)
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 2023 Regular Session of the General Assembly.
HOUSE BILL No. 1378
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 5-10-8-23, AS ADDED BY P.L.115-2020,
2 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 JULY 1, 2024]: Sec. 23. (a) As used in this section, "covered
4 individual" means an individual who is entitled to coverage under a
5 state employee health plan.
6 (b) As used in this section, "emergency medical services provider
7 organization" means a provider of emergency medical services that is
8 certified by the Indiana emergency medical services commission as an
9 advanced life support provider organization under rules adopted under
10 IC 16-31-3.
11 (c) As used in this section, "state employee health plan" means
12 either of the following that provides coverage for emergency medical
13 services:
14 (1) A self-insurance program established under section 7(b) of
15 this chapter to provide group health coverage.
16 (2) A contract with a prepaid health care delivery plan that is
17 entered into or renewed under section 7(c) of this chapter.
2024 IN 1378—LS 6992/DI 154 2
1 (d) A state employee health plan that provides coverage for
2 emergency medical services must at least provide reimbursement,
3 subject to applicable deductible and coinsurance, for a covered
4 individual for emergency medical services that are:
5 (1) rendered by an emergency medical services provider
6 organization;
7 (2) within the emergency medical services provider organization's
8 scope of practice;
9 (3) performed or provided as advanced life support services; and
10 (4) performed or provided during a response initiated through the
11 911 system or as part of a mobile integrated healthcare
12 program described in IC 16-31-12 currently established in
13 Delaware, White, and Montgomery counties, regardless of
14 whether the patient was transported.
15 (e) If multiple emergency medical services provider organizations
16 qualify and submit a claim for reimbursement under this section for an
17 encounter, the state employee health plan:
18 (1) may only reimburse, subject to applicable deductible and
19 coinsurance, under this section for one (1) claim per patient
20 encounter; and
21 (2) shall reimburse, subject to applicable deductible and
22 coinsurance, the claim submitted by the emergency medical
23 services provider organization that performed or provided the
24 majority of advanced life support services for the patient.
25 (f) The state personnel department may adopt rules under IC 4-22-2,
26 including emergency rules under IC 4-22-2-37.1, to implement this
27 section.
28 (g) This section does not restrict the state employee health plan from
29 providing coverage beyond the requirements in this section.
30 SECTION 2. IC 5-10-8-23.5 IS ADDED TO THE INDIANA CODE
31 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
32 1, 2024]: Sec. 23.5. (a) The reimbursement for emergency medical
33 services that are performed or provided as part of a mobile
34 integrated healthcare program described in section 23(d)(4) of this
35 chapter shall be in effect from July 1, 2024, through June 30, 2027.
36 (b) The department of insurance shall compile:
37 (1) a report detailing any cost changes based on claims data,
38 as a result of the reimbursement for emergency medical
39 services that are performed or provided as part of a mobile
40 integrated healthcare program described in section 23(d)(4)
41 of this chapter; and
42 (2) the report described in subdivision (1) not later than July
2024 IN 1378—LS 6992/DI 154 3
1 1, 2026.
2 SECTION 3. IC 27-8-6-8, AS AMENDED BY P.L.170-2022,
3 SECTION 37, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
4 JULY 1, 2024]: Sec. 8. (a) As used in this section, "emergency medical
5 services" has the meaning set forth in IC 16-18-2-110.
6 (b) As used in this section, "emergency medical services provider
7 organization" means a provider of emergency medical services that is
8 certified by the Indiana emergency medical services commission as an
9 advanced life support provider organization under rules adopted under
10 IC 16-31-3.
11 (c) As used in this section, "policy of accident and sickness
12 insurance" has the meaning set forth in IC 27-8-5-1. However, for
13 purposes of this section, the term does not include the following:
14 (1) Accident only, credit, dental, vision, Medicare supplement,
15 long term care, or disability income insurance.
16 (2) Coverage issued as a supplement to liability insurance.
17 (3) Automobile medical payment insurance.
18 (4) A specified disease policy.
19 (5) A policy that provides a stipulated daily, weekly, or monthly
20 payment to an insured without regard to the actual expense of the
21 confinement.
22 (6) A short term insurance plan (as defined in IC 27-8-5.9-3).
23 (d) A policy of accident and sickness insurance that provides
24 coverage for emergency medical services must provide reimbursement
25 for emergency medical services that are:
26 (1) rendered by an emergency medical services provider
27 organization;
28 (2) within the emergency medical services provider organization's
29 scope of practice;
30 (3) performed or provided as advanced life support services; and
31 (4) performed or provided during a response initiated through the
32 911 system or as part of a mobile integrated healthcare
33 program described in IC 16-31-12 currently established in
34 Delaware, White, and Montgomery counties, regardless of
35 whether the patient is transported.
36 (e) Reimbursement for basic and advanced life support services
37 through a policy to which this section applies must be provided on an
38 equal basis regardless of whether the services involve transportation of
39 the patient by ambulance.
40 (f) If multiple emergency medical services provider organizations
41 qualify and submit a claim for reimbursement under this section for an
42 encounter, the insurer:
2024 IN 1378—LS 6992/DI 154 4
1 (1) may reimburse under this section only for one (1) claim per
2 patient encounter; and
3 (2) shall reimburse the claim submitted by the emergency medical
4 services provider organization that performed or provided the
5 majority of advanced life support services for the patient.
6 (g) The department may adopt rules under IC 4-22-2, including
7 emergency rules under IC 4-22-2-37.1, to implement this section.
8 (h) This section does not require a policy of accident and sickness
9 insurance to provide coverage for emergency medical services.
10 SECTION 4. IC 27-8-6-8.5 IS ADDED TO THE INDIANA CODE
11 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
12 1, 2024]: Sec. 8.5. (a) The reimbursement for emergency medical
13 services that are performed or provided as part of a mobile
14 integrated healthcare program described in section 8(d)(4) of this
15 chapter shall be in effect from July 1, 2024, through June 30, 2027.
16 (b) The department of insurance shall compile:
17 (1) a report detailing any cost changes based on claims data,
18 as a result of the reimbursement for emergency medical
19 services that are performed or provided as part of a mobile
20 integrated healthcare program described in section 8(d)(4) of
21 this chapter; and
22 (2) the report described in subdivision (1) not later than July
23 1, 2026.
24 SECTION 5. IC 27-13-7-27, AS AMENDED BY P.L.170-2022,
25 SECTION 39, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
26 JULY 1, 2024]: Sec. 27. (a) This section applies to each of the
27 following:
28 (1) An individual contract.
29 (2) A group contract.
30 (b) As used in this section, "emergency medical services" has the
31 meaning set forth in IC 16-18-2-110.
32 (c) As used in this section, "emergency medical services provider
33 organization" means a provider of emergency medical services that is
34 certified by the Indiana emergency medical services commission as an
35 advanced life support provider organization under rules adopted under
36 IC 16-31-3.
37 (d) An individual contract and a group contract that provide
38 coverage for emergency medical services must provide reimbursement
39 for emergency medical services that are:
40 (1) rendered by an emergency medical services provider
41 organization;
42 (2) within the emergency medical services provider organization's
2024 IN 1378—LS 6992/DI 154 5
1 scope of practice;
2 (3) performed or provided as advanced life support services; and
3 (4) performed or provided during a response initiated through the
4 911 system or as part of a mobile integrated healthcare
5 program described in IC 16-31-12 currently established in
6 Delaware, White, and Montgomery counties, regardless of
7 whether the patient is transported.
8 (e) Reimbursement for basic and advanced life support services
9 through a contract to which this section applies must be provided on an
10 equal basis regardless of whether the services involve transportation of
11 the patient by ambulance.
12 (f) If multiple emergency medical services provider organizations
13 qualify and submit a claim for reimbursement under this section, the
14 health maintenance organization:
15 (1) may reimburse under this section only for one (1) claim per
16 patient encounter; and
17 (2) shall reimburse the claim submitted by the emergency medical
18 services provider organization that performed or provided the
19 majority of advanced life support services.
20 (g) The department may adopt rules under IC 4-22-2, including
21 emergency rules under IC 4-22-2-37.1, to implement this section.
22 (h) This section does not require an individual contract or a group
23 contract to provide coverage for emergency medical services.
24 SECTION 6. IC 27-13-7-27.5 IS ADDED TO THE INDIANA
25 CODE AS A NEW SECTION TO READ AS FOLLOWS
26 [EFFECTIVE JULY 1, 2024]: Sec. 27.5. (a) The reimbursement for
27 emergency medical services that are performed or provided as
28 part of a mobile integrated healthcare program described in
29 section 27(d)(4) of this chapter shall be in effect from July 1, 2024,
30 through June 30, 2027.
31 (b) The department shall compile:
32 (1) a report detailing any cost changes based on claims data,
33 as a result of the reimbursement for emergency medical
34 services that are performed or provided as part of a mobile
35 integrated healthcare program described in section 27(d)(4)
36 of this chapter; and
37 (2) the report described in subdivision (1) not later than July
38 1, 2026.
2024 IN 1378—LS 6992/DI 154