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.
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between statutes enacted by the 2023 Regular Session of the General Assembly.
HOUSE ENROLLED ACT No. 1385
AN ACT to amend the Indiana Code concerning health and to make
an appropriation.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 12-7-2-131.4, AS ADDED BY P.L.207-2021,
SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2024]: Sec. 131.4. "Mobile crisis team", for purposes of
IC 12-21-8 and IC 12-29-5, has the meaning set forth in IC 12-21-8-3.
SECTION 2. IC 12-7-2-131.6 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2024]: Sec. 131.6. "Mobile integrated
healthcare", for purposes of IC 12-29-5, has the meaning set forth
in IC 16-31-12-1.
SECTION 3. IC 12-29-5 IS ADDED TO THE INDIANA CODE AS
A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2024]:
Chapter 5. Community Cares Initiative Grant Pilot Program
Sec. 1. As used in this chapter, "mobile crisis team" has the
meaning set forth in IC 12-21-8-3.
Sec. 2. As used in this chapter, "mobile integrated healthcare"
has the meaning set forth in IC 16-31-12-1.
Sec. 3. (a) The community cares initiative grant pilot program
is established for the purpose of assisting in the cost of starting or
expanding mobile integrated healthcare programs and mobile
crisis teams in Indiana.
(b) The division of mental health and addiction shall administer
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the pilot program. A county, city, or town that operates a mobile
integrated healthcare program or mobile crisis team is eligible to
participate in the pilot program.
(c) The division may award a grant to an eligible entity
described in subsection (b) for not more than a three (3) year
period.
(d) The division may issue a request for funds for the pilot
program.
Sec. 4. (a) The community cares initiative fund is established for
the purpose of funding the community cares initiative grant pilot
program. The fund shall be administered by the division of mental
health and addiction.
(b) The expenses of administering the fund shall be paid from
money in the fund.
(c) The fund shall consist of:
(1) money received from state or federal grants or programs;
and
(2) gifts, money, and donations received from any other
source, including transfers from other funds or accounts.
(d) Money in the fund is continuously appropriated for purposes
of this section.
(e) The treasurer of state shall invest the money in the fund not
currently needed to meet the obligations of the fund in the same
manner as other public money may be invested.
(f) Money in the fund at the end of a state fiscal year does not
revert to the state general fund.
Sec. 5. Before December 1 of each year, the division of mental
health and addiction shall report to the legislative council in an
electronic format under IC 5-14-6 the information concerning the
community cares initiative grant pilot program and the grants
offered to eligible entities.
SECTION 4. IC 27-1-2.3-0.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2025]: Sec. 0.5. This chapter does not
apply to the following:
(1) The Medicaid program.
(2) Ambulance services owned or operated by a health system
(as defined in IC 16-18-2-168.5) that bill for ambulance
services under the health system.
SECTION 5. IC 27-1-2.3-2.8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2025]: Sec. 2.8. As used in this chapter,
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"clean claim" means a claim for payment for ambulance service:
(1) that is submitted to a health plan by an ambulance service
provider; and
(2) about which there is no defect, impropriety, or particular
circumstance requiring special treatment that may prevent or
delay payment.
SECTION 6. IC 27-1-2.3-4, AS ADDED BY P.L.170-2022,
SECTION 36, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2025]: Sec. 4. (a) As used in this chapter, "health plan"
means any either of the following:
(1) A self-insurance program established under IC 5-10-8-7(b) to
provide group coverage.
(2) A prepaid health care delivery plan through which health
services are provided under IC 5-10-8-7(c).
(3) (1) A policy of accident and sickness insurance as defined in
IC 27-8-5-1, but not including any insurance, plan, or policy set
forth in IC 27-8-5-2.5(a).
(4) (2) An individual contract (as defined in IC 27-13-1-21) or a
group contract (as defined in IC 27-13-1-16) with a health
maintenance organization that provides coverage for basic health
care services (as defined in IC 27-13-1-4).
(b) The term does not include the state employee health plan.
SECTION 7. IC 27-1-2.3-5, AS ADDED BY P.L.170-2022,
SECTION 36, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2025]: Sec. 5. As used in this chapter, "health plan
operator" means the following:
(1) In the case of a health plan described in section 4(1) or 4(2) of
this chapter, the state of Indiana.
(2) (1) In the case of a health plan described in section 4(3)
4(a)(1) of this chapter, the insurer that issued the policy.
(3) (2) In the case of a health plan described in section 4(4)
4(a)(2) of this chapter, the health maintenance organization that
entered into the contract.
SECTION 8. IC 27-1-2.3-7.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2025]: Sec. 7.5. As used in this chapter,
"state employee health plan" means either of the following:
(1) A self-insurance program established under IC 5-10-8-7(b)
to provide group coverage.
(2) A prepaid health care delivery plan through which health
services are provided under IC 5-10-8-7(c).
SECTION 9. IC 27-1-2.3-8, AS AMENDED BY P.L.92-2023,
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SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2025]: Sec. 8. (a) A health plan operator The state shall
fairly negotiate rates and terms with any ambulance service provider
willing to become a participating provider with respect to the state
employee health plan.
(b) In negotiations under subsection (a), a the state employee
health plan must consider all of the following:
(1) The ambulance service provider's usual and customary rates.
(2) The ambulance service provider's resources, and whether the
ambulance service provider's staff is available twenty-four (24)
hours per day every day.
(3) The average wages and fuel costs in the geographical area in
which the ambulance service provider operates.
(4) The number of times in which individuals covered by the state
employee health plan have sought ambulance service from the
ambulance service provider but the ambulance service provider's
response was canceled or did not result in a transport.
(5) The local ordinances and state rules concerning staffing,
response times, and equipment under which the ambulance
service provider must operate.
(6) The types of requests for ambulance service for individuals
covered by the state employee health plan that the ambulance
service provider generally receives, and the requesting party or
agency by which those requests are generally made.
(7) The average reimbursement rate per level of service that the
ambulance service provider generally receives as a
nonparticipating provider.
(8) The specific:
(A) clinical and staff capabilities; and
(B) equipment resources;
that an ambulance service provider must have to adequately meet
the needs of individuals covered by the state employee health
plan, such as for the transportation of covered individuals
covered by the state employee health plan from one (1) hospital
to another after traumatic injury.
(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.
(c) If negotiations between an ambulance service provider and a
health plan operator under this section that occur after June 30, 2022,
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do not result in the ambulance service provider becoming a
participating provider with respect to the health plan, each party shall
provide to the department a written notice:
(1) reporting that negotiations between the ambulance service
provider and the health plan operator did not result in the
ambulance service provider becoming a participating provider
with respect to the health plan; and
(2) stating the points on which agreement between the ambulance
service provider and the health plan operator was necessary for
the ambulance service provider to become a participating
provider with respect to the health plan:
(A) that were discussed in the negotiations between the
ambulance service provider and the health plan operator; but
(B) on which the ambulance service provider and the health
plan operator did not reach agreement.
SECTION 10. IC 27-1-2.3-8.1 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2025]: Sec. 8.1. A health plan operator
shall provide payment to a nonparticipating ambulance service
provider for ambulance service provided to a covered individual:
(1) at a rate set or approved, by contract or ordinance, by the
county or municipality in which the ambulance service
originated;
(2) at the rate of four hundred percent (400%) of the current
published rate for ambulance service as established by the
Centers for Medicare and Medicaid Services under Title
XVIII of the federal Social Security Act (42 U.S.C. 1395 et
seq.) for the same ambulance service provided in the same
geographic area; or
(3) according to the nonparticipating ambulance service
provider's billed charges;
whichever is less.
SECTION 11. IC 27-1-2.3-8.2 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2025]: Sec. 8.2. (a) If a health plan
operator makes payment to a nonparticipating ambulance service
provider according to section 8.1 of this chapter for ambulance
service provided to a covered individual:
(1) the payment shall be considered payment in full for the
ambulance service provided, except for any copayment,
coinsurance, deductible, and other cost sharing amounts that
the health plan requires the covered individual to pay; and
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(2) the nonparticipating ambulance service provider is
prohibited from billing the covered individual for any
additional amount for the ambulance service provided.
(b) The copayment, coinsurance, deductible, and other cost
sharing amounts that a health plan requires a covered individual
to pay in connection with ambulance service provided to the
covered individual 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 to
the covered individual by a participating ambulance service
provider.
SECTION 12. IC 27-1-2.3-8.3 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2025]: Sec. 8.3. (a) A health plan
operator that receives a clean claim for ambulance service
provided to a covered individual by a nonparticipating ambulance
service provider:
(1) shall remit payment for the ambulance service directly to
the nonparticipating ambulance service provider not more
than thirty (30) days after receiving the clean claim; and
(2) shall not send payment to the covered individual.
(b) If a claim that a health plan operator receives for ambulance
service provided to a covered individual by a nonparticipating
ambulance service provider is not a clean claim, the health plan
operator, not more than thirty (30) days after receiving the claim,
shall:
(1) remit payment for the ambulance service directly to the
nonparticipating ambulance service provider; or
(2) send to the nonparticipating ambulance service provider
a written notice that:
(A) acknowledges the date of the receipt of the claim; and
(B) either:
(i) states that the health plan operator is declining to pay
all or part of the claim and sets forth the specific reason
or reasons for declining to pay the claim in full; or
(ii) states that additional information is needed to
determine whether all or part of the claim is payable and
specifically describes the additional information that is
needed.
HEA 1385 — CC 1 Speaker of the House of Representatives
President of the Senate
President Pro Tempore
Governor of the State of Indiana
Date: Time:
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