*SB0142.1*
January 26, 2024
SENATE BILL No. 142
_____
DIGEST OF SB 142 (Updated January 24, 2024 12:45 pm - DI 104)
Citations Affected: IC 5-10; IC 27-8; IC 27-13.
Synopsis: Coverage for mobile integrated healthcare services.
Provides that: (1) a state employee health plan; (2) a policy of accident
and sickness policy; and (3) an individual or group contract; must
provide reimbursement beginning July 1, 2024, and ending June 30,
2027, for emergency medical services that are performed or provided
in specified counties by a mobile integrated healthcare program.
Effective: July 1, 2024.
Buchanan, Charbonneau
January 8, 2024, read first time and referred to Committee on Health and Provider
Services.
January 25, 2024, amended, reported favorably — Do Pass.
SB 142—LS 6486/DI 154 January 26, 2024
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, "mobile integrated healthcare
12 program" refers to a program developed under IC 16-31-12 and
13 operating in the following counties before July 1, 2024:
14 (1) Delaware.
15 (2) White.
16 (3) Montgomery.
17 (d) As used in this section, "state employee health plan" means
SB 142—LS 6486/DI 154 2
1 either of the following that provides coverage for emergency medical
2 services:
3 (1) A self-insurance program established under section 7(b) of
4 this chapter to provide group health coverage.
5 (2) A contract with a prepaid health care delivery plan that is
6 entered into or renewed under section 7(c) of this chapter.
7 (d) (e) A state employee health plan that provides coverage for
8 emergency medical services must at least provide reimbursement,
9 subject to applicable deductible and coinsurance, for a covered
10 individual 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:
17 (A) during a response initiated through the 911 system; or
18 (B) beginning July 1, 2024, and ending June 30, 2027, as
19 part of a mobile integrated healthcare program;
20 regardless of whether the patient was transported.
21 (e) (f) If multiple emergency medical services provider
22 organizations qualify and submit a claim for reimbursement under this
23 section for an encounter, the state employee health plan:
24 (1) may only reimburse, subject to applicable deductible and
25 coinsurance, under this section for one (1) claim per patient
26 encounter; and
27 (2) shall reimburse, subject to applicable deductible and
28 coinsurance, the claim submitted by the emergency medical
29 services provider organization that performed or provided the
30 majority of advanced life support services for the patient.
31 (f) (g) The state personnel department may adopt rules under
32 IC 4-22-2, including emergency rules under IC 4-22-2-37.1, to
33 implement this section.
34 (g) (h) This section does not restrict the state employee health plan
35 from providing coverage beyond the requirements in this section.
36 (i) Not later than July 1, 2026, the state personnel department
37 shall prepare and submit a report concerning the reimbursement
38 for emergency medical services as part of a mobile integrated
39 healthcare program under this section. The report must include the
40 following:
41 (1) The number of claims submitted by a mobile integrated
42 healthcare program for emergency medical services.
SB 142—LS 6486/DI 154 3
1 (2) The total reimbursement amount paid for the claims
2 described in subdivision (1).
3 The state personnel department shall submit the report in an
4 electronic format under IC 5-14-6 to the legislative council. This
5 subsection expires December 31, 2026.
6 SECTION 2. IC 27-8-6-8, AS AMENDED BY P.L.170-2022,
7 SECTION 37, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
8 JULY 1, 2024]: Sec. 8. (a) As used in this section, "emergency medical
9 services" has the meaning set forth in IC 16-18-2-110.
10 (b) As used in this section, "emergency medical services provider
11 organization" means a provider of emergency medical services that is
12 certified by the Indiana emergency medical services commission as an
13 advanced life support provider organization under rules adopted under
14 IC 16-31-3.
15 (c) As used in this section, "mobile integrated healthcare
16 program" refers to a program developed under IC 16-31-12 and
17 operating in the following counties before July 1, 2024:
18 (1) Delaware.
19 (2) White.
20 (3) Montgomery.
21 (d) As used in this section, "policy of accident and sickness
22 insurance" has the meaning set forth in IC 27-8-5-1. However, for
23 purposes of this section, the term does not include the following:
24 (1) Accident only, credit, dental, vision, Medicare supplement,
25 long term care, or disability income insurance.
26 (2) Coverage issued as a supplement to liability insurance.
27 (3) Automobile medical payment insurance.
28 (4) A specified disease policy.
29 (5) A policy that provides a stipulated daily, weekly, or monthly
30 payment to an insured without regard to the actual expense of the
31 confinement.
32 (6) A short term insurance plan (as defined in IC 27-8-5.9-3).
33 (d) (e) A policy of accident and sickness insurance that provides
34 coverage for emergency medical services must provide reimbursement
35 for emergency medical services that are:
36 (1) rendered by an emergency medical services provider
37 organization;
38 (2) within the emergency medical services provider organization's
39 scope of practice;
40 (3) performed or provided as advanced life support services; and
41 (4) performed or provided:
42 (A) during a response initiated through the 911 system; or
SB 142—LS 6486/DI 154 4
1 (B) beginning July 1, 2024, and ending June 30, 2027, as
2 part of a mobile integrated healthcare program;
3 regardless of whether the patient is transported.
4 (e) (f) Reimbursement for basic and advanced life support services
5 through a policy to which this section applies must be provided on an
6 equal basis regardless of whether the services involve transportation of
7 the patient by ambulance.
8 (f) (g) If multiple emergency medical services provider
9 organizations qualify and submit a claim for reimbursement under this
10 section for an encounter, the insurer:
11 (1) may reimburse under this section only for one (1) claim per
12 patient encounter; and
13 (2) shall reimburse the claim submitted by the emergency medical
14 services provider organization that performed or provided the
15 majority of advanced life support services for the patient.
16 (g) (h) The department may adopt rules under IC 4-22-2, including
17 emergency rules under IC 4-22-2-37.1, to implement this section.
18 (h) (i) This section does not require a policy of accident and
19 sickness insurance to provide coverage for emergency medical
20 services.
21 (j) Not later than July 1, 2026, a policy of accident and sickness
22 insurance shall submit to the department claims and
23 reimbursement rate data necessary for the department to prepare
24 the report required by this subsection. Not later than November 1,
25 2026, the department shall compile the data from each policy of
26 accident and sickness insurance and prepare and submit a report
27 concerning the reimbursement for emergency medical services as
28 part of a mobile integrated healthcare program under this section.
29 The report must include the following:
30 (1) The number of claims submitted by a mobile integrated
31 healthcare program for emergency medical services.
32 (2) The total reimbursement amount paid for the claims
33 described in subdivision (1).
34 The department shall submit the report in an electronic format
35 under IC 5-14-6 to the legislative council. This subsection expires
36 December 31, 2026.
37 SECTION 3. IC 27-13-7-27, AS AMENDED BY P.L.170-2022,
38 SECTION 39, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
39 JULY 1, 2024]: Sec. 27. (a) This section applies to each of the
40 following:
41 (1) An individual contract.
42 (2) A group contract.
SB 142—LS 6486/DI 154 5
1 (b) As used in this section, "emergency medical services" has the
2 meaning set forth in IC 16-18-2-110.
3 (c) As used in this section, "emergency medical services provider
4 organization" means a provider of emergency medical services that is
5 certified by the Indiana emergency medical services commission as an
6 advanced life support provider organization under rules adopted under
7 IC 16-31-3.
8 (d) As used in this section, "mobile integrated healthcare
9 program" refers to a program developed under IC 16-31-12 and
10 operating in the following counties before July 1, 2024:
11 (1) Delaware.
12 (2) White.
13 (3) Montgomery.
14 (e) An individual contract and a group contract that provide
15 coverage for emergency medical services must provide reimbursement
16 for emergency medical services that are:
17 (1) rendered by an emergency medical services provider
18 organization;
19 (2) within the emergency medical services provider organization's
20 scope of practice;
21 (3) performed or provided as advanced life support services; and
22 (4) performed or provided:
23 (A) during a response initiated through the 911 system; or
24 (B) beginning July 1, 2024, and ending June 30, 2027, as
25 part of a mobile integrated healthcare program;
26 regardless of whether the patient is transported. Reimbursement
27 for a service performed or provided as part of a mobile
28 integrated healthcare program under this subdivision may not
29 be construed to require coverage for the service under the
30 Medicaid program.
31 (e) (f) Reimbursement for basic and advanced life support services
32 through a contract to which this section applies must be provided on an
33 equal basis regardless of whether the services involve transportation of
34 the patient by ambulance.
35 (f) (g) If multiple emergency medical services provider
36 organizations qualify and submit a claim for reimbursement under this
37 section, the health maintenance organization:
38 (1) may reimburse under this section only for one (1) claim per
39 patient encounter; and
40 (2) shall reimburse the claim submitted by the emergency medical
41 services provider organization that performed or provided the
42 majority of advanced life support services.
SB 142—LS 6486/DI 154 6
1 (g) (h) The department may adopt rules under IC 4-22-2, including
2 emergency rules under IC 4-22-2-37.1, to implement this section.
3 (h) (i) This section does not require an individual contract or a
4 group contract to provide coverage for emergency medical services.
5 (j) Not later than July 1, 2026, an individual contract and a
6 group contract that provides coverage of emergency medical
7 services shall submit to the department claims and reimbursement
8 rate data necessary for the department to prepare the report
9 required by this subsection. Not later than November 1, 2026, the
10 department shall compile the data from each individual contract
11 and group contract and prepare and submit a report concerning
12 the reimbursement for emergency medical services as part of a
13 mobile integrated healthcare program under this section. The
14 report must include the following:
15 (1) The number of claims submitted by a mobile integrated
16 healthcare program for emergency medical services.
17 (2) The total reimbursement amount paid for the claims
18 described in subdivision (1).
19 The department shall submit the report in an electronic format
20 under IC 5-14-6 to the legislative council. This subsection expires
21 December 31, 2026.
SB 142—LS 6486/DI 154 7
COMMITTEE REPORT
Madam President: The Senate Committee on Health and Provider
Services, to which was referred Senate Bill No. 142, has had the same
under consideration and begs leave to report the same back to the
Senate with the recommendation that said bill be AMENDED as
follows:
Page 1, line 11, after "(c)" insert "As used in this section, "mobile
integrated healthcare program" refers to a program developed
under IC 16-31-12 and operating in the following counties before
July 1, 2024:
(1) Delaware.
(2) White.
(3) Montgomery.
(d)".
Page 2, line 1, strike "(d)" and insert "(e)".
Page 2, delete lines 10 through 13, begin a new line block indented
and insert:
"(4) performed or provided:
(A) during a response initiated through the 911 system; or
(B) beginning July 1, 2024, and ending June 30, 2027, as
part of a mobile integrated healthcare program;
regardless of whether the patient was transported.".
Page 2, line 14, strike "(e)" and insert "(f)".
Page 2, line 24, strike "(f)" and insert "(g)".
Page 2, line 27, strike "(g)" and insert "(h)".
Page 2, between lines 28 and 29, begin a new paragraph and insert:
"(i) Not later than July 1, 2026, the state personnel department
shall prepare and submit a report concerning the reimbursement
for emergency medical services as part of a mobile integrated
healthcare program under this section. The report must include the
following:
(1) The number of claims submitted by a mobile integrated
healthcare program for emergency medical services.
(2) The total reimbursement amount paid for the claims
described in subdivision (1).
The state personnel department shall submit the report in an
electronic format under IC 5-14-6 to the legislative council. This
subsection expires December 31, 2026.".
Page 2, line 38, after "(c)" insert "As used in this section, "mobile
integrated healthcare program" refers to a program developed
under IC 16-31-12 and operating in the following counties before
July 1, 2024:
SB 142—LS 6486/DI 154 8
(1) Delaware.
(2) White.
(3) Montgomery.
(d)".
Page 3, line 8, strike "(d)" and insert "(e)".
Page 3, delete lines 16 through 19, begin a new line block indented
and insert:
"(4) performed or provided:
(A) during a response initiated through the 911 system; or
(B) beginning July 1, 2024, and ending June 30, 2027, as
part of a mobile integrated healthcare program;
regardless of whether the patient is transported.".
Page 3, line 20, strike "(e)" and insert "(f)".
Page 3, line 24, strike "(f)" and insert "(g)".
Page 3, line 32, strike "(g)" and insert "(h)".
Page 3, line 34, strike "(h)" and insert "(i)".
Page 3, between lines 35 and 36, begin a new paragraph and insert:
"(j) Not later than July 1, 2026, a policy of accident and sickness
insurance shall submit to the department claims and
reimbursement rate data necessary for the department to prepare
the report required by this subsection. Not later than November 1,
2026, the department shall compile the data from each policy of
accident and sickness insurance and prepare and submit a report
concerning the reimbursement for emergency medical services as
part of a mobile integrated healthcare program under this section.
The report must include the following:
(1) The number of claims submitted by a mobile integrated
healthcare program for emergency medical services.
(2) The total reimbursement amount paid for the claims
described in subdivision (1).
The department shall submit the report in an electronic format
under IC 5-14-6 to the legislative council. This subsection expires
December 31, 2026.".
Page 4, line 7, after "(d)" insert "As used in this section, "mobile
integrated healthcare program" refers to a program developed
under IC 16-31-12 and operating in the following counties before
July 1, 2024:
(1) Delaware.
(2) White.
(3) Montgomery.
(e)".
Page 4, delete lines 15 through 18, begin a new line block indented
SB 142—LS 6486/DI 154 9
and insert:
"(4) performed or provided:
(A) during a response initiated through the 911 system; or
(B) beginning July 1, 2024, and ending June 30, 2027, as
part of a mobile integrated healthcare program;
regardless of whether the patient is transported. Reimbursement
for a service performed or provided as part of a mobile
integrated healthcare program under this subdivision may not
be construed to require coverage for the service under the
Medicaid program.".
Page 4, line 19, strike "(e)" and insert "(f)".
Page 4, line 23, strike "(f)" and insert "(g)".
Page 4, line 31, strike "(g)" and insert "(h)".
Page 4, line 33, strike "(h)" and insert "(i)".
Page 4, after line 34, begin a new paragraph and insert:
"(j) Not later than July 1, 2026, an individual contract and a
group contract that provides coverage of emergency medical
services shall submit to the department claims and reimbursement
rate data necessary for the department to prepare the report
required by this subsection. Not later than November 1, 2026, the
department shall compile the data from each individual contract
and group contract and prepare and submit a report concerning
the reimbursement for emergency medical services as part of a
mobile integrated healthcare program under this section. The
report must include the following:
(1) The number of claims submitted by a mobile integrated
healthcare program for emergency medical services.
(2) The total reimbursement amount paid for the claims
described in subdivision (1).
The department shall submit the report in an electronic format
under IC 5-14-6 to the legislative council. This subsection expires
December 31, 2026.".
and when so amended that said bill do pass.
(Reference is to SB 142 as introduced.)
CHARBONNEAU, Chairperson
Committee Vote: Yeas 7, Nays 0.
SB 142—LS 6486/DI 154