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Indiana House Bill HB1385

Indiana 2024 Regular Session

Indiana House Bill HB1385 Compare Versions

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1+*EH1385.2*
2+Reprinted
3+February 20, 2024
4+ENGROSSED
5+HOUSE BILL No. 1385
6+_____
7+DIGEST OF HB 1385 (Updated February 19, 2024 3:19 pm - DI 104)
8+Citations Affected: IC 27-1.
9+Synopsis: Payment for ambulance services. Requires a health plan
10+operator to provide payment to a nonparticipating ambulance service
11+provider for ambulance service provided to a covered individual: (1)
12+at a rate not to exceed the rates set or approved, by contract or
13+ordinance, by the county or municipality in which the ambulance
14+(Continued next page)
15+Effective: January 1, 2025.
16+Barrett, Carbaugh, Snow,
17+Shackleford
18+(SENATE SPONSORS — JOHNSON T, CHARBONNEAU, BALDWIN,
19+FREEMAN, WALKER K, RANDOLPH LONNIE M)
20+January 11, 2024, read first time and referred to Committee on Insurance.
21+January 25, 2024, reported — Do Pass.
22+January 29, 2024, read second time, ordered engrossed.
23+January 30, 2024, engrossed. Read third time, passed. Yeas 94, nays 1.
24+SENATE ACTION
25+February 5, 2024, read first time and referred to Committee on Insurance and Financial
26+Institutions.
27+February 15, 2024, amended, reported favorably — Do Pass.
28+February 19, 2024, read second time, amended, ordered engrossed.
29+EH 1385—LS 6920/DI 55 Digest Continued
30+service originated; (2) at the rate of 400% of the published rate for
31+ambulance services established under the Medicare law for the same
32+ambulance service provided in the same geographic area; or (3)
33+according to the nonparticipating ambulance provider's billed charges;
34+whichever is less. Provides that certain payments for ambulance
35+services do not apply to state employee health plans. Provides that if a
36+health plan makes payment to a nonparticipating ambulance service
37+provider in compliance with these requirements: (1) the payment shall
38+be considered payment in full, except for any copayment, coinsurance,
39+deductible, and other cost sharing amounts that the health plan requires
40+the covered individual to pay; and (2) the nonparticipating ambulance
41+service provider is prohibited from billing the covered individual for
42+any additional amount. Provides that the copayment, coinsurance,
43+deductible, and other cost sharing amounts that a covered individual is
44+required to pay in connection with ambulance service provided by a
45+nonparticipating ambulance service provider shall not exceed the
46+copayment, coinsurance, deductible, and other cost sharing amounts
47+that the covered individual would be required to pay if the ambulance
48+service had been provided by a participating ambulance service
49+provider. Requires a health plan operator that receives a clean claim
50+from a nonparticipating ambulance service provider to remit payment
51+to the nonparticipating ambulance service provider not more than 30
52+days after receiving the clean claim. Provides that if a claim received
53+by a health plan operator for ambulance service provided by a
54+nonparticipating ambulance service provider is not a clean claim, the
55+health plan operator, not more than 30 days after receiving the claim,
56+shall: (1) remit payment; or (2) send a written notice that: (A)
57+acknowledges the date of receipt of the claim; and (B) either explains
58+why the heath plan operator is declining to pay the claim or states that
59+additional information is needed for a determination whether to pay the
60+claim. Repeals the requirement that a health plan operator negotiate
61+rates and terms with any ambulance service provider willing to become
62+a participating provider, but retains the requirement that the state
63+negotiate rates and terms with any ambulance service provider willing
64+to become a participating provider. Repeals the requirement that the
65+department of insurance, not later than May 1, 2024, submit a report
66+concerning these negotiations.
67+EH 1385—LS 6920/DI 55EH 1385—LS 6920/DI 55 Reprinted
68+February 20, 2024
169 Second Regular Session of the 123rd General Assembly (2024)
270 PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
371 Constitution) is being amended, the text of the existing provision will appear in this style type,
472 additions will appear in this style type, and deletions will appear in this style type.
573 Additions: Whenever a new statutory provision is being enacted (or a new constitutional
674 provision adopted), the text of the new provision will appear in this style type. Also, the
775 word NEW will appear in that style type in the introductory clause of each SECTION that adds
876 a new provision to the Indiana Code or the Indiana Constitution.
977 Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
1078 between statutes enacted by the 2023 Regular Session of the General Assembly.
11-HOUSE ENROLLED ACT No. 1385
12-AN ACT to amend the Indiana Code concerning health and to make
13-an appropriation.
79+ENGROSSED
80+HOUSE BILL No. 1385
81+A BILL FOR AN ACT to amend the Indiana Code concerning
82+insurance.
1483 Be it enacted by the General Assembly of the State of Indiana:
15-SECTION 1. IC 12-7-2-131.4, AS ADDED BY P.L.207-2021,
16-SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
17-JULY 1, 2024]: Sec. 131.4. "Mobile crisis team", for purposes of
18-IC 12-21-8 and IC 12-29-5, has the meaning set forth in IC 12-21-8-3.
19-SECTION 2. IC 12-7-2-131.6 IS ADDED TO THE INDIANA
20-CODE AS A NEW SECTION TO READ AS FOLLOWS
21-[EFFECTIVE JULY 1, 2024]: Sec. 131.6. "Mobile integrated
22-healthcare", for purposes of IC 12-29-5, has the meaning set forth
23-in IC 16-31-12-1.
24-SECTION 3. IC 12-29-5 IS ADDED TO THE INDIANA CODE AS
25-A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
26-1, 2024]:
27-Chapter 5. Community Cares Initiative Grant Pilot Program
28-Sec. 1. As used in this chapter, "mobile crisis team" has the
29-meaning set forth in IC 12-21-8-3.
30-Sec. 2. As used in this chapter, "mobile integrated healthcare"
31-has the meaning set forth in IC 16-31-12-1.
32-Sec. 3. (a) The community cares initiative grant pilot program
33-is established for the purpose of assisting in the cost of starting or
34-expanding mobile integrated healthcare programs and mobile
35-crisis teams in Indiana.
36-(b) The division of mental health and addiction shall administer
37-HEA 1385 — CC 1 2
38-the pilot program. A county, city, or town that operates a mobile
39-integrated healthcare program or mobile crisis team is eligible to
40-participate in the pilot program.
41-(c) The division may award a grant to an eligible entity
42-described in subsection (b) for not more than a three (3) year
43-period.
44-(d) The division may issue a request for funds for the pilot
45-program.
46-Sec. 4. (a) The community cares initiative fund is established for
47-the purpose of funding the community cares initiative grant pilot
48-program. The fund shall be administered by the division of mental
49-health and addiction.
50-(b) The expenses of administering the fund shall be paid from
51-money in the fund.
52-(c) The fund shall consist of:
53-(1) money received from state or federal grants or programs;
54-and
55-(2) gifts, money, and donations received from any other
56-source, including transfers from other funds or accounts.
57-(d) Money in the fund is continuously appropriated for purposes
58-of this section.
59-(e) The treasurer of state shall invest the money in the fund not
60-currently needed to meet the obligations of the fund in the same
61-manner as other public money may be invested.
62-(f) Money in the fund at the end of a state fiscal year does not
63-revert to the state general fund.
64-Sec. 5. Before December 1 of each year, the division of mental
65-health and addiction shall report to the legislative council in an
66-electronic format under IC 5-14-6 the information concerning the
67-community cares initiative grant pilot program and the grants
68-offered to eligible entities.
69-SECTION 4. IC 27-1-2.3-0.5 IS ADDED TO THE INDIANA
84+1 SECTION 1. IC 27-1-2.3-0.5 IS ADDED TO THE INDIANA
85+2 CODE AS A NEW SECTION TO READ AS FOLLOWS
86+3 [EFFECTIVE JANUARY 1, 2025]: Sec. 0.5. This chapter does not
87+4 apply to the following:
88+5 (1) The Medicaid program.
89+6 (2) Ambulance services owned or operated by a health system
90+7 (as defined in IC 16-18-2-168.5) that bill for ambulance
91+8 services under the health system.
92+9 SECTION 2. IC 27-1-2.3-2.8 IS ADDED TO THE INDIANA
93+10 CODE AS A NEW SECTION TO READ AS FOLLOWS
94+11 [EFFECTIVE JANUARY 1, 2025]: Sec. 2.8. As used in this chapter,
95+12 "clean claim" means a claim for payment for ambulance service:
96+13 (1) that is submitted to a health plan by an ambulance service
97+14 provider; and
98+15 (2) about which there is no defect, impropriety, or particular
99+16 circumstance requiring special treatment that may prevent or
100+17 delay payment.
101+EH 1385—LS 6920/DI 55 2
102+1 SECTION 3. IC 27-1-2.3-4, AS ADDED BY P.L.170-2022,
103+2 SECTION 36, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
104+3 JANUARY 1, 2025]: Sec. 4. (a) As used in this chapter, "health plan"
105+4 means any either of the following:
106+5 (1) A self-insurance program established under IC 5-10-8-7(b) to
107+6 provide group coverage.
108+7 (2) A prepaid health care delivery plan through which health
109+8 services are provided under IC 5-10-8-7(c).
110+9 (3) (1) A policy of accident and sickness insurance as defined in
111+10 IC 27-8-5-1, but not including any insurance, plan, or policy set
112+11 forth in IC 27-8-5-2.5(a).
113+12 (4) (2) An individual contract (as defined in IC 27-13-1-21) or a
114+13 group contract (as defined in IC 27-13-1-16) with a health
115+14 maintenance organization that provides coverage for basic health
116+15 care services (as defined in IC 27-13-1-4).
117+16 (b) The term does not include the state employee health plan.
118+17 SECTION 4. IC 27-1-2.3-5, AS ADDED BY P.L.170-2022,
119+18 SECTION 36, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
120+19 JANUARY 1, 2025]: Sec. 5. As used in this chapter, "health plan
121+20 operator" means the following:
122+21 (1) In the case of a health plan described in section 4(1) or 4(2) of
123+22 this chapter, the state of Indiana.
124+23 (2) (1) In the case of a health plan described in section 4(3)
125+24 4(a)(1) of this chapter, the insurer that issued the policy.
126+25 (3) (2) In the case of a health plan described in section 4(4)
127+26 4(a)(2) of this chapter, the health maintenance organization that
128+27 entered into the contract.
129+28 SECTION 5. IC 27-1-2.3-7.5 IS ADDED TO THE INDIANA
130+29 CODE AS A NEW SECTION TO READ AS FOLLOWS
131+30 [EFFECTIVE JANUARY 1, 2025]: Sec. 7.5. As used in this chapter,
132+31 "state employee health plan" means either of the following:
133+32 (1) A self-insurance program established under IC 5-10-8-7(b)
134+33 to provide group coverage.
135+34 (2) A prepaid health care delivery plan through which health
136+35 services are provided under IC 5-10-8-7(c).
137+36 SECTION 6. IC 27-1-2.3-8, AS AMENDED BY P.L.92-2023,
138+37 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
139+38 JANUARY 1, 2025]: Sec. 8. (a) A health plan operator The state shall
140+39 fairly negotiate rates and terms with any ambulance service provider
141+40 willing to become a participating provider with respect to the state
142+41 employee health plan.
143+42 (b) In negotiations under subsection (a), a the state employee
144+EH 1385—LS 6920/DI 55 3
145+1 health plan must consider all of the following:
146+2 (1) The ambulance service provider's usual and customary rates.
147+3 (2) The ambulance service provider's resources, and whether the
148+4 ambulance service provider's staff is available twenty-four (24)
149+5 hours per day every day.
150+6 (3) The average wages and fuel costs in the geographical area in
151+7 which the ambulance service provider operates.
152+8 (4) The number of times in which individuals covered by the state
153+9 employee health plan have sought ambulance service from the
154+10 ambulance service provider but the ambulance service provider's
155+11 response was canceled or did not result in a transport.
156+12 (5) The local ordinances and state rules concerning staffing,
157+13 response times, and equipment under which the ambulance
158+14 service provider must operate.
159+15 (6) The types of requests for ambulance service for individuals
160+16 covered by the state employee health plan that the ambulance
161+17 service provider generally receives, and the requesting party or
162+18 agency by which those requests are generally made.
163+19 (7) The average reimbursement rate per level of service that the
164+20 ambulance service provider generally receives as a
165+21 nonparticipating provider.
166+22 (8) The specific:
167+23 (A) clinical and staff capabilities; and
168+24 (B) equipment resources;
169+25 that an ambulance service provider must have to adequately meet
170+26 the needs of individuals covered by the state employee health
171+27 plan, such as for the transportation of covered individuals
172+28 covered by the state employee health plan from one (1) hospital
173+29 to another after traumatic injury.
174+30 (9) The average transport cost data reported to the office of the
175+31 secretary of family and social services by governmental
176+32 ambulance service providers located within the counties, and
177+33 contiguous counties, that the nonparticipating ambulance service
178+34 provider serves.
179+35 (c) If negotiations between an ambulance service provider and a
180+36 health plan operator under this section that occur after June 30, 2022,
181+37 do not result in the ambulance service provider becoming a
182+38 participating provider with respect to the health plan, each party shall
183+39 provide to the department a written notice:
184+40 (1) reporting that negotiations between the ambulance service
185+41 provider and the health plan operator did not result in the
186+42 ambulance service provider becoming a participating provider
187+EH 1385—LS 6920/DI 55 4
188+1 with respect to the health plan; and
189+2 (2) stating the points on which agreement between the ambulance
190+3 service provider and the health plan operator was necessary for
191+4 the ambulance service provider to become a participating
192+5 provider with respect to the health plan:
193+6 (A) that were discussed in the negotiations between the
194+7 ambulance service provider and the health plan operator; but
195+8 (B) on which the ambulance service provider and the health
196+9 plan operator did not reach agreement.
197+10 SECTION 7. IC 27-1-2.3-8.1 IS ADDED TO THE INDIANA
198+11 CODE AS A NEW SECTION TO READ AS FOLLOWS
199+12 [EFFECTIVE JANUARY 1, 2025]: Sec. 8.1. A health plan operator
200+13 shall provide payment to a nonparticipating ambulance service
201+14 provider for ambulance service provided to a covered individual:
202+15 (1) at a rate set or approved, by contract or ordinance, by the
203+16 county or municipality in which the ambulance service
204+17 originated;
205+18 (2) at the rate of four hundred percent (400%) of the current
206+19 published rate for ambulance service as established by the
207+20 Centers for Medicare and Medicaid Services under Title
208+21 XVIII of the federal Social Security Act (42 U.S.C. 1395 et
209+22 seq.) for the same ambulance service provided in the same
210+23 geographic area; or
211+24 (3) according to the nonparticipating ambulance service
212+25 provider's billed charges;
213+26 whichever is less.
214+27 SECTION 8. IC 27-1-2.3-8.2 IS ADDED TO THE INDIANA
215+28 CODE AS A NEW SECTION TO READ AS FOLLOWS
216+29 [EFFECTIVE JANUARY 1, 2025]: Sec. 8.2. (a) If a health plan
217+30 makes payment to a nonparticipating ambulance service provider
218+31 according to section 8.1 of this chapter for ambulance service
219+32 provided to a covered individual:
220+33 (1) the payment shall be considered payment in full for the
221+34 ambulance service provided, except for any copayment,
222+35 coinsurance, deductible, and other cost sharing amounts that
223+36 the health plan requires the covered individual to pay; and
224+37 (2) the nonparticipating ambulance service provider is
225+38 prohibited from billing the covered individual for any
226+39 additional amount for the ambulance service provided.
227+40 (b) The copayment, coinsurance, deductible, and other cost
228+41 sharing amounts that a health plan requires a covered individual
229+42 to pay in connection with ambulance service provided to the
230+EH 1385—LS 6920/DI 55 5
231+1 covered individual by a nonparticipating ambulance service
232+2 provider shall not exceed the copayment, coinsurance, deductible,
233+3 and other cost sharing amounts that the covered individual would
234+4 be required to pay if the ambulance service had been provided to
235+5 the covered individual by a participating ambulance service
236+6 provider.
237+7 SECTION 9. IC 27-1-2.3-8.3 IS ADDED TO THE INDIANA
238+8 CODE AS A NEW SECTION TO READ AS FOLLOWS
239+9 [EFFECTIVE JANUARY 1, 2025]: Sec. 8.3. (a) A health plan
240+10 operator that receives a clean claim for ambulance service
241+11 provided to a covered individual by a nonparticipating ambulance
242+12 service provider:
243+13 (1) shall remit payment for the ambulance service directly to
244+14 the nonparticipating ambulance service provider not more
245+15 than thirty (30) days after receiving the clean claim; and
246+16 (2) shall not send payment to the covered individual.
247+17 (b) If a claim that a health plan operator receives for ambulance
248+18 service provided to a covered individual by a nonparticipating
249+19 ambulance service provider is not a clean claim, the health plan
250+20 operator, not more than thirty (30) days after receiving the claim,
251+21 shall:
252+22 (1) remit payment for the ambulance service directly to the
253+23 nonparticipating ambulance service provider; or
254+24 (2) send to the nonparticipating ambulance service provider
255+25 a written notice that:
256+26 (A) acknowledges the date of the receipt of the claim; and
257+27 (B) either:
258+28 (i) states that the heath plan operator is declining to pay
259+29 all or part of the claim and sets forth the specific reason
260+30 or reasons for declining to pay the claim in full; or
261+31 (ii) states that additional information is needed to
262+32 determine whether all or part of the claim is payable and
263+33 specifically describes the additional information that is
264+34 needed.
265+EH 1385—LS 6920/DI 55 6
266+COMMITTEE REPORT
267+Mr. Speaker: Your Committee on Insurance, to which was referred
268+House Bill 1385, has had the same under consideration and begs leave
269+to report the same back to the House with the recommendation that said
270+bill do pass.
271+(Reference is to HB 1385 as introduced.)
272+CARBAUGH
273+Committee Vote: Yeas 11, Nays 1
274+_____
275+COMMITTEE REPORT
276+Madam President: The Senate Committee on Insurance and
277+Financial Institutions, to which was referred House Bill No. 1385, has
278+had the same under consideration and begs leave to report the same
279+back to the Senate with the recommendation that said bill be
280+AMENDED as follows:
281+Replace the effective date in SECTION 1 with "[EFFECTIVE
282+JANUARY 1, 2025]".
283+Replace the effective dates in SECTIONS 4 through 5 with
284+"[EFFECTIVE JANUARY 1, 2025]".
285+Page 1, between the enacting clause and line 1, begin a new
286+paragraph and insert:
287+"SECTION 1. IC 27-1-2.3-0.5 IS ADDED TO THE INDIANA
70288 CODE AS A NEW SECTION TO READ AS FOLLOWS
71289 [EFFECTIVE JANUARY 1, 2025]: Sec. 0.5. This chapter does not
72-apply to the following:
73-(1) The Medicaid program.
74-(2) Ambulance services owned or operated by a health system
75-(as defined in IC 16-18-2-168.5) that bill for ambulance
76-services under the health system.
77-SECTION 5. IC 27-1-2.3-2.8 IS ADDED TO THE INDIANA
78-CODE AS A NEW SECTION TO READ AS FOLLOWS
79-[EFFECTIVE JANUARY 1, 2025]: Sec. 2.8. As used in this chapter,
80-HEA 1385 — CC 1 3
81-"clean claim" means a claim for payment for ambulance service:
82-(1) that is submitted to a health plan by an ambulance service
83-provider; and
84-(2) about which there is no defect, impropriety, or particular
85-circumstance requiring special treatment that may prevent or
86-delay payment.
87-SECTION 6. IC 27-1-2.3-4, AS ADDED BY P.L.170-2022,
290+apply to ambulance services owned or operated by a health system
291+(as defined in IC 16-18-2-168.5).".
292+Page 1, delete lines 10 through 17, begin a new paragraph and
293+insert:
294+"SECTION 3. IC 27-1-2.3-4, AS ADDED BY P.L.170-2022,
88295 SECTION 36, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
89296 JANUARY 1, 2025]: Sec. 4. (a) As used in this chapter, "health plan"
90297 means any either of the following:
91298 (1) A self-insurance program established under IC 5-10-8-7(b) to
92299 provide group coverage.
93300 (2) A prepaid health care delivery plan through which health
94301 services are provided under IC 5-10-8-7(c).
95302 (3) (1) A policy of accident and sickness insurance as defined in
96303 IC 27-8-5-1, but not including any insurance, plan, or policy set
304+EH 1385—LS 6920/DI 55 7
97305 forth in IC 27-8-5-2.5(a).
98306 (4) (2) An individual contract (as defined in IC 27-13-1-21) or a
99307 group contract (as defined in IC 27-13-1-16) with a health
100308 maintenance organization that provides coverage for basic health
101309 care services (as defined in IC 27-13-1-4).
102310 (b) The term does not include the state employee health plan.
103-SECTION 7. IC 27-1-2.3-5, AS ADDED BY P.L.170-2022,
311+SECTION 4. IC 27-1-2.3-5, AS ADDED BY P.L.170-2022,
104312 SECTION 36, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
105313 JANUARY 1, 2025]: Sec. 5. As used in this chapter, "health plan
106314 operator" means the following:
107315 (1) In the case of a health plan described in section 4(1) or 4(2) of
108316 this chapter, the state of Indiana.
109317 (2) (1) In the case of a health plan described in section 4(3)
110318 4(a)(1) of this chapter, the insurer that issued the policy.
111319 (3) (2) In the case of a health plan described in section 4(4)
112320 4(a)(2) of this chapter, the health maintenance organization that
113321 entered into the contract.
114-SECTION 8. IC 27-1-2.3-7.5 IS ADDED TO THE INDIANA
322+SECTION 5. IC 27-1-2.3-7.5 IS ADDED TO THE INDIANA
115323 CODE AS A NEW SECTION TO READ AS FOLLOWS
116324 [EFFECTIVE JANUARY 1, 2025]: Sec. 7.5. As used in this chapter,
117325 "state employee health plan" means either of the following:
118326 (1) A self-insurance program established under IC 5-10-8-7(b)
119327 to provide group coverage.
120328 (2) A prepaid health care delivery plan through which health
121329 services are provided under IC 5-10-8-7(c).
122-SECTION 9. IC 27-1-2.3-8, AS AMENDED BY P.L.92-2023,
123-HEA 1385 — CC 1 4
330+SECTION 6. IC 27-1-2.3-8, AS AMENDED BY P.L.92-2023,
124331 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
125332 JANUARY 1, 2025]: Sec. 8. (a) A health plan operator The state shall
126333 fairly negotiate rates and terms with any ambulance service provider
127334 willing to become a participating provider with respect to the state
128335 employee health plan.
129336 (b) In negotiations under subsection (a), a the state employee
130337 health plan must consider all of the following:
131338 (1) The ambulance service provider's usual and customary rates.
132339 (2) The ambulance service provider's resources, and whether the
133340 ambulance service provider's staff is available twenty-four (24)
134341 hours per day every day.
135342 (3) The average wages and fuel costs in the geographical area in
136343 which the ambulance service provider operates.
137344 (4) The number of times in which individuals covered by the state
138345 employee health plan have sought ambulance service from the
139346 ambulance service provider but the ambulance service provider's
347+EH 1385—LS 6920/DI 55 8
140348 response was canceled or did not result in a transport.
141349 (5) The local ordinances and state rules concerning staffing,
142350 response times, and equipment under which the ambulance
143351 service provider must operate.
144352 (6) The types of requests for ambulance service for individuals
145353 covered by the state employee health plan that the ambulance
146354 service provider generally receives, and the requesting party or
147355 agency by which those requests are generally made.
148356 (7) The average reimbursement rate per level of service that the
149357 ambulance service provider generally receives as a
150358 nonparticipating provider.
151359 (8) The specific:
152360 (A) clinical and staff capabilities; and
153361 (B) equipment resources;
154362 that an ambulance service provider must have to adequately meet
155363 the needs of individuals covered by the state employee health
156364 plan, such as for the transportation of covered individuals
157365 covered by the state employee health plan from one (1) hospital
158366 to another after traumatic injury.
159367 (9) The average transport cost data reported to the office of the
160368 secretary of family and social services by governmental
161369 ambulance service providers located within the counties, and
162370 contiguous counties, that the nonparticipating ambulance service
163371 provider serves.
164372 (c) If negotiations between an ambulance service provider and a
165373 health plan operator under this section that occur after June 30, 2022,
166-HEA 1385 — CC 1 5
167374 do not result in the ambulance service provider becoming a
168375 participating provider with respect to the health plan, each party shall
169376 provide to the department a written notice:
170377 (1) reporting that negotiations between the ambulance service
171378 provider and the health plan operator did not result in the
172379 ambulance service provider becoming a participating provider
173380 with respect to the health plan; and
174381 (2) stating the points on which agreement between the ambulance
175382 service provider and the health plan operator was necessary for
176383 the ambulance service provider to become a participating
177384 provider with respect to the health plan:
178385 (A) that were discussed in the negotiations between the
179386 ambulance service provider and the health plan operator; but
180387 (B) on which the ambulance service provider and the health
181-plan operator did not reach agreement.
182-SECTION 10. IC 27-1-2.3-8.1 IS ADDED TO THE INDIANA
388+plan operator did not reach agreement.".
389+Delete page 2.
390+EH 1385—LS 6920/DI 55 9
391+Page 3, delete lines 1 through 26, begin a new paragraph and insert:
392+"SECTION 7. IC 27-1-2.3-8.1 IS ADDED TO THE INDIANA
183393 CODE AS A NEW SECTION TO READ AS FOLLOWS
184394 [EFFECTIVE JANUARY 1, 2025]: Sec. 8.1. A health plan operator
185395 shall provide payment to a nonparticipating ambulance service
186396 provider for ambulance service provided to a covered individual:
187397 (1) at a rate set or approved, by contract or ordinance, by the
188398 county or municipality in which the ambulance service
189399 originated;
190400 (2) at the rate of four hundred percent (400%) of the current
191401 published rate for ambulance service as established by the
192402 Centers for Medicare and Medicaid Services under Title
193403 XVIII of the federal Social Security Act (42 U.S.C. 1395 et
194404 seq.) for the same ambulance service provided in the same
195405 geographic area; or
196406 (3) according to the nonparticipating ambulance service
197407 provider's billed charges;
198-whichever is less.
199-SECTION 11. IC 27-1-2.3-8.2 IS ADDED TO THE INDIANA
200-CODE AS A NEW SECTION TO READ AS FOLLOWS
201-[EFFECTIVE JANUARY 1, 2025]: Sec. 8.2. (a) If a health plan
202-operator makes payment to a nonparticipating ambulance service
203-provider according to section 8.1 of this chapter for ambulance
204-service provided to a covered individual:
205-(1) the payment shall be considered payment in full for the
206-ambulance service provided, except for any copayment,
207-coinsurance, deductible, and other cost sharing amounts that
208-the health plan requires the covered individual to pay; and
209-HEA 1385 — CC 1 6
210-(2) the nonparticipating ambulance service provider is
211-prohibited from billing the covered individual for any
212-additional amount for the ambulance service provided.
213-(b) The copayment, coinsurance, deductible, and other cost
214-sharing amounts that a health plan requires a covered individual
215-to pay in connection with ambulance service provided to the
216-covered individual by a nonparticipating ambulance service
217-provider shall not exceed the copayment, coinsurance, deductible,
218-and other cost sharing amounts that the covered individual would
219-be required to pay if the ambulance service had been provided to
220-the covered individual by a participating ambulance service
221-provider.
222-SECTION 12. IC 27-1-2.3-8.3 IS ADDED TO THE INDIANA
223-CODE AS A NEW SECTION TO READ AS FOLLOWS
224-[EFFECTIVE JANUARY 1, 2025]: Sec. 8.3. (a) A health plan
225-operator that receives a clean claim for ambulance service
226-provided to a covered individual by a nonparticipating ambulance
227-service provider:
228-(1) shall remit payment for the ambulance service directly to
229-the nonparticipating ambulance service provider not more
230-than thirty (30) days after receiving the clean claim; and
231-(2) shall not send payment to the covered individual.
232-(b) If a claim that a health plan operator receives for ambulance
233-service provided to a covered individual by a nonparticipating
234-ambulance service provider is not a clean claim, the health plan
235-operator, not more than thirty (30) days after receiving the claim,
236-shall:
237-(1) remit payment for the ambulance service directly to the
238-nonparticipating ambulance service provider; or
239-(2) send to the nonparticipating ambulance service provider
240-a written notice that:
241-(A) acknowledges the date of the receipt of the claim; and
242-(B) either:
243-(i) states that the health plan operator is declining to pay
244-all or part of the claim and sets forth the specific reason
245-or reasons for declining to pay the claim in full; or
246-(ii) states that additional information is needed to
247-determine whether all or part of the claim is payable and
248-specifically describes the additional information that is
249-needed.
250-HEA 1385 — CC 1 Speaker of the House of Representatives
251-President of the Senate
252-President Pro Tempore
253-Governor of the State of Indiana
254-Date: Time:
255-HEA 1385 — CC 1
408+whichever is less.".
409+Page 4, delete lines 35 through 42.
410+Delete page 5.
411+Renumber all SECTIONS consecutively.
412+and when so amended that said bill do pass.
413+(Reference is to HB 1385 as printed January 25, 2024.)
414+BALDWIN, Chairperson
415+Committee Vote: Yeas 7, Nays 1.
416+_____
417+SENATE MOTION
418+Madam President: I move that Engrossed House Bill 1385 be
419+amended to read as follows:
420+Page 1, line 4, delete "ambulance" and insert "the following:
421+(1) The Medicaid program.
422+(2) Ambulance".
423+Page 1, line 5, delete "IC 16-18-2-168.5)." and insert "IC
424+16-18-2-168.5) that bill for ambulance services under the health
425+system.".
426+EH 1385—LS 6920/DI 55 10
427+Page 4, line 28, delete "section 8.1(a) or 8.1(b)" and insert "section
428+8.1".
429+(Reference is to EHB 1385 as printed February 16, 2024.)
430+JOHNSON T
431+EH 1385—LS 6920/DI 55