Introduced Version
HOUSE BILL No. 1385
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 27-1-2.3.
Synopsis: Payment for ambulance services. Requires a health plan
operator to provide payment to a nonparticipating ambulance service
provider for ambulance service provided to a covered individual: (1)
at a rate not to exceed the rates set or approved, by contract or
ordinance, by the county or municipality in which the ambulance
service originated; or (2) if there are no rates set or approved by the
county or municipality in which the ambulance service originated: (A)
at the rate of 500% of the published rate for ambulance services
established under the Medicare law for the same ambulance service
provided in the same geographic area; or (B) according to the
nonparticipating ambulance provider's billed charges; whichever is
less. Provides that if a health plan makes payment to a nonparticipating
ambulance service provider in compliance with these requirements: (1)
the payment shall be considered payment in full, except for any
copayment, coinsurance, deductible, and other cost sharing amounts
that the health plan requires the covered individual to pay; and (2) the
nonparticipating ambulance service provider is prohibited from billing
the covered individual for any additional amount. Provides that the
copayment, coinsurance, deductible, and other cost sharing amounts
that a covered individual is required to pay in connection with
ambulance service provided by a nonparticipating ambulance service
provider shall not exceed the copayment, coinsurance, deductible, and
other cost sharing amounts that the covered individual would be
required to pay if the ambulance service had been provided by a
participating ambulance service provider. Requires a health plan
operator that receives a clean claim from a nonparticipating ambulance
service provider to remit payment to the nonparticipating ambulance
service provider not more than 30 days after receiving the clean claim.
(Continued next page)
Effective: July 1, 2024.
Barrett
January 11, 2024, read first time and referred to Committee on Insurance.
2024 IN 1385—LS 6920/DI 55 Digest Continued
Provides that if a claim received by a health plan operator for
ambulance service provided by a nonparticipating ambulance service
provider is not a clean claim, the health plan operator, not more than 30
days after receiving the claim, shall: (1) remit payment; or (2) send a
written notice that: (A) acknowledges the date of receipt of the claim;
and (B) either explains why the heath plan operator is declining to pay
the claim or states that additional information is needed for a
determination whether to pay the claim. Repeals the requirement that
a health plan operator negotiate rates and terms with any ambulance
service provider willing to become a participating provider and the
requirement that the department of insurance, not later than May 1,
2024, submit a report concerning these negotiations.
2024 IN 1385—LS 6920/DI 552024 IN 1385—LS 6920/DI 55 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. 1385
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 27-1-2.3-2.8 IS ADDED TO THE INDIANA
2 CODE AS A NEW SECTION TO READ AS FOLLOWS
3 [EFFECTIVE JULY 1, 2024]: Sec. 2.8. As used in this chapter,
4 "clean claim" means a claim for payment for ambulance service:
5 (1) that is submitted to a health plan by an ambulance service
6 provider; and
7 (2) about which there is no defect, impropriety, or particular
8 circumstance requiring special treatment that may prevent or
9 delay payment.
10 SECTION 2. IC 27-1-2.3-8 IS REPEALED [EFFECTIVE JULY 1,
11 2024]. Sec. 8. (a) A health plan operator shall fairly negotiate rates and
12 terms with any ambulance service provider willing to become a
13 participating provider with respect to the health plan.
14 (b) In negotiations under subsection (a), a health plan must consider
15 all of the following:
16 (1) The ambulance service provider's usual and customary rates.
17 (2) The ambulance service provider's resources, and whether the
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1 ambulance service provider's staff is available twenty-four (24)
2 hours per day every day.
3 (3) The average wages and fuel costs in the geographical area in
4 which the ambulance service provider operates.
5 (4) The number of times in which individuals covered by the
6 health plan have sought ambulance service from the ambulance
7 service provider but the ambulance service provider's response
8 was canceled or did not result in a transport.
9 (5) The local ordinances and state rules concerning staffing,
10 response times, and equipment under which the ambulance
11 service provider must operate.
12 (6) The types of requests for ambulance service for individuals
13 covered by the health plan that the ambulance service provider
14 generally receives, and the requesting party or agency by which
15 those requests are generally made.
16 (7) The average reimbursement rate per level of service that the
17 ambulance service provider generally receives as a
18 nonparticipating provider.
19 (8) The specific:
20 (A) clinical and staff capabilities; and
21 (B) equipment resources;
22 that an ambulance service provider must have to adequately meet
23 the needs of individuals covered by the health plan, such as for
24 the transportation of covered individuals from one (1) hospital to
25 another after traumatic injury.
26 (9) The average transport cost data reported to the office of the
27 secretary of family and social services by governmental
28 ambulance service providers located within the counties, and
29 contiguous counties, that the nonparticipating ambulance service
30 provider serves.
31 (c) If negotiations between an ambulance service provider and a
32 health plan operator under this section that occur after June 30, 2022,
33 do not result in the ambulance service provider becoming a
34 participating provider with respect to the health plan, each party shall
35 provide to the department a written notice:
36 (1) reporting that negotiations between the ambulance service
37 provider and the health plan operator did not result in the
38 ambulance service provider becoming a participating provider
39 with respect to the health plan; and
40 (2) stating the points on which agreement between the ambulance
41 service provider and the health plan operator was necessary for
42 the ambulance service provider to become a participating
2024 IN 1385—LS 6920/DI 55 3
1 provider with respect to the health plan:
2 (A) that were discussed in the negotiations between the
3 ambulance service provider and the health plan operator; but
4 (B) on which the ambulance service provider and the health
5 plan operator did not reach agreement.
6 SECTION 3. IC 27-1-2.3-8.1 IS ADDED TO THE INDIANA
7 CODE AS A NEW SECTION TO READ AS FOLLOWS
8 [EFFECTIVE JULY 1, 2024]: Sec. 8.1. (a) Except as provided in
9 subsection (b), a health plan operator shall provide payment to a
10 nonparticipating ambulance service provider for ambulance
11 service provided to a covered individual at a rate not to exceed the
12 rates set or approved, by contract or ordinance, by the county or
13 municipality in which the ambulance service originated.
14 (b) If there are no rates set or approved for ambulance service
15 by contract or ordinance by the county or municipality in which
16 the ambulance service originated, the health plan operator shall
17 provide payment to the ambulance service provider:
18 (1) at the rate of five hundred percent (500%) of the current
19 published rate for ambulance service as established by the
20 Centers for Medicare and Medicaid Services under Title
21 XVIII of the federal Social Security Act (42 U.S.C. 1395 et
22 seq.) for the same ambulance service provided in the same
23 geographic area; or
24 (2) according to the nonparticipating ambulance provider's
25 billed charges;
26 whichever is less.
27 SECTION 4. IC 27-1-2.3-8.2 IS ADDED TO THE INDIANA
28 CODE AS A NEW SECTION TO READ AS FOLLOWS
29 [EFFECTIVE JULY 1, 2024]: Sec. 8.2. (a) If a health plan makes
30 payment to a nonparticipating ambulance service provider
31 according to section 8.1(a) or 8.1(b) of this chapter for ambulance
32 service provided to a covered individual:
33 (1) the payment shall be considered payment in full for the
34 ambulance service provided, except for any copayment,
35 coinsurance, deductible, and other cost sharing amounts that
36 the health plan requires the covered individual to pay; and
37 (2) the nonparticipating ambulance service provider is
38 prohibited from billing the covered individual for any
39 additional amount for the ambulance service provided.
40 (b) The copayment, coinsurance, deductible, and other cost
41 sharing amounts that a health plan requires a covered individual
42 to pay in connection with ambulance service provided to the
2024 IN 1385—LS 6920/DI 55 4
1 covered individual by a nonparticipating ambulance service
2 provider shall not exceed the copayment, coinsurance, deductible,
3 and other cost sharing amounts that the covered individual would
4 be required to pay if the ambulance service had been provided to
5 the covered individual by a participating ambulance service
6 provider.
7 SECTION 5. IC 27-1-2.3-8.3 IS ADDED TO THE INDIANA
8 CODE AS A NEW SECTION TO READ AS FOLLOWS
9 [EFFECTIVE JULY 1, 2024]: Sec. 8.3. (a) A health plan operator
10 that receives a clean claim for ambulance service provided to a
11 covered individual by a nonparticipating ambulance service
12 provider:
13 (1) shall remit payment for the ambulance service directly to
14 the nonparticipating ambulance service provider not more
15 than thirty (30) days after receiving the clean claim; and
16 (2) shall not send payment to the covered individual.
17 (b) If a claim that a health plan operator receives for ambulance
18 service provided to a covered individual by a nonparticipating
19 ambulance service provider is not a clean claim, the health plan
20 operator, not more than thirty (30) days after receiving the claim,
21 shall:
22 (1) remit payment for the ambulance service directly to the
23 nonparticipating ambulance service provider; or
24 (2) send to the nonparticipating ambulance service provider
25 a written notice that:
26 (A) acknowledges the date of the receipt of the claim; and
27 (B) either:
28 (i) states that the heath plan operator is declining to pay
29 all or part of the claim and sets forth the specific reason
30 or reasons for declining to pay the claim in full; or
31 (ii) states that additional information is needed to
32 determine whether all or part of the claim is payable and
33 specifically describes the additional information that is
34 needed.
35 SECTION 6. IC 27-1-2.3-9 IS REPEALED [EFFECTIVE JULY 1,
36 2024]. Sec. 9. (a) Not later than May 1, 2024, the department shall
37 submit, in an electronic format under IC 5-14-6, to:
38 (1) the interim study committee on public health, behavioral
39 health, and human services established by IC 2-5-1.3-4(14); and
40 (2) the legislative council;
41 a report summarizing the notices that the department has received from
42 ambulance service providers and health plan operators under section
2024 IN 1385—LS 6920/DI 55 5
1 8(c) of this chapter.
2 (b) The report submitted under subsection (a) must:
3 (1) indicate the number of notices received by the department
4 under section 8(c) of this chapter reporting that negotiations
5 between an ambulance service provider and a health plan operator
6 did not result in the ambulance service provider becoming a
7 participating provider with respect to the health plan; and
8 (2) include:
9 (A) a summary of the points described in section 8(c)(2) of
10 this chapter that were stated in reports provided by ambulance
11 service providers under section 8(c) of this chapter; and
12 (B) a summary of the points described in section 8(c)(2) of this
13 chapter that were stated in reports provided by health plan
14 operators under section 8(c) of this chapter.
15 (c) This section expires January 1, 2025.
2024 IN 1385—LS 6920/DI 55