Introduced Version
SENATE BILL No. 142
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 5-10-8-23; IC 27-8-6-8; IC 27-13-7-27.
Synopsis: Coverage for mobile integrated healthcare services.
Provides that a state employee health plan that provides coverage for
emergency medical services must provide reimbursement, subject to
applicable deductible and coinsurance, for a covered individual for
emergency medical services that are performed or provided during a
response initiated as part of a mobile integrated healthcare program.
Provides that a policy of accident and sickness insurance that provides
coverage for emergency medical services must provide reimbursement
for emergency medical services that are performed or provided during
a response initiated as part of a mobile integrated healthcare program.
Provides that an individual contract and a group contract that provide
coverage for emergency medical services must provide reimbursement
for emergency medical services that are performed or provided during
a response initiated as part of a mobile integrated healthcare program.
Effective: July 1, 2024.
Buchanan
January 8, 2024, read first time and referred to Committee on Health and Provider
Services.
2024 IN 142—LS 6486/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.
SENATE BILL No. 142
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 142—LS 6486/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, regardless of whether the
13 patient was transported.
14 (e) If multiple emergency medical services provider organizations
15 qualify and submit a claim for reimbursement under this section for an
16 encounter, the state employee health plan:
17 (1) may only reimburse, subject to applicable deductible and
18 coinsurance, under this section for one (1) claim per patient
19 encounter; and
20 (2) shall reimburse, subject to applicable deductible and
21 coinsurance, the claim submitted by the emergency medical
22 services provider organization that performed or provided the
23 majority of advanced life support services for the patient.
24 (f) The state personnel department may adopt rules under IC 4-22-2,
25 including emergency rules under IC 4-22-2-37.1, to implement this
26 section.
27 (g) This section does not restrict the state employee health plan from
28 providing coverage beyond the requirements in this section.
29 SECTION 2. IC 27-8-6-8, AS AMENDED BY P.L.170-2022,
30 SECTION 37, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
31 JULY 1, 2024]: Sec. 8. (a) As used in this section, "emergency medical
32 services" has the meaning set forth in IC 16-18-2-110.
33 (b) As used in this section, "emergency medical services provider
34 organization" means a provider of emergency medical services that is
35 certified by the Indiana emergency medical services commission as an
36 advanced life support provider organization under rules adopted under
37 IC 16-31-3.
38 (c) As used in this section, "policy of accident and sickness
39 insurance" has the meaning set forth in IC 27-8-5-1. However, for
40 purposes of this section, the term does not include the following:
41 (1) Accident only, credit, dental, vision, Medicare supplement,
42 long term care, or disability income insurance.
2024 IN 142—LS 6486/DI 154 3
1 (2) Coverage issued as a supplement to liability insurance.
2 (3) Automobile medical payment insurance.
3 (4) A specified disease policy.
4 (5) A policy that provides a stipulated daily, weekly, or monthly
5 payment to an insured without regard to the actual expense of the
6 confinement.
7 (6) A short term insurance plan (as defined in IC 27-8-5.9-3).
8 (d) A policy of accident and sickness insurance that provides
9 coverage for emergency medical services must provide reimbursement
10 for emergency medical services that are:
11 (1) rendered by an emergency medical services provider
12 organization;
13 (2) within the emergency medical services provider organization's
14 scope of practice;
15 (3) performed or provided as advanced life support services; and
16 (4) performed or provided during a response initiated through the
17 911 system or as part of a mobile integrated healthcare
18 program described in IC 16-31-12, regardless of whether the
19 patient is transported.
20 (e) Reimbursement for basic and advanced life support services
21 through a policy to which this section applies must be provided on an
22 equal basis regardless of whether the services involve transportation of
23 the patient by ambulance.
24 (f) If multiple emergency medical services provider organizations
25 qualify and submit a claim for reimbursement under this section for an
26 encounter, the insurer:
27 (1) may reimburse under this section only for one (1) claim per
28 patient encounter; and
29 (2) shall reimburse the claim submitted by the emergency medical
30 services provider organization that performed or provided the
31 majority of advanced life support services for the patient.
32 (g) The department may adopt rules under IC 4-22-2, including
33 emergency rules under IC 4-22-2-37.1, to implement this section.
34 (h) This section does not require a policy of accident and sickness
35 insurance to provide coverage for emergency medical services.
36 SECTION 3. IC 27-13-7-27, AS AMENDED BY P.L.170-2022,
37 SECTION 39, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
38 JULY 1, 2024]: Sec. 27. (a) This section applies to each of the
39 following:
40 (1) An individual contract.
41 (2) A group contract.
42 (b) As used in this section, "emergency medical services" has the
2024 IN 142—LS 6486/DI 154 4
1 meaning set forth in IC 16-18-2-110.
2 (c) As used in this section, "emergency medical services provider
3 organization" means a provider of emergency medical services that is
4 certified by the Indiana emergency medical services commission as an
5 advanced life support provider organization under rules adopted under
6 IC 16-31-3.
7 (d) An individual contract and a group contract that provide
8 coverage for emergency medical services must provide reimbursement
9 for emergency medical services that are:
10 (1) rendered by an emergency medical services provider
11 organization;
12 (2) within the emergency medical services provider organization's
13 scope of practice;
14 (3) performed or provided as advanced life support services; and
15 (4) performed or provided during a response initiated through the
16 911 system or as part of a mobile integrated healthcare
17 program described in IC 16-31-12, regardless of whether the
18 patient is transported.
19 (e) Reimbursement for basic and advanced life support services
20 through a contract to which this section applies must be provided on an
21 equal basis regardless of whether the services involve transportation of
22 the patient by ambulance.
23 (f) If multiple emergency medical services provider organizations
24 qualify and submit a claim for reimbursement under this section, the
25 health maintenance organization:
26 (1) may reimburse under this section only for one (1) claim per
27 patient encounter; and
28 (2) shall reimburse the claim submitted by the emergency medical
29 services provider organization that performed or provided the
30 majority of advanced life support services.
31 (g) The department may adopt rules under IC 4-22-2, including
32 emergency rules under IC 4-22-2-37.1, to implement this section.
33 (h) This section does not require an individual contract or a group
34 contract to provide coverage for emergency medical services.
2024 IN 142—LS 6486/DI 154