Citations Affected: IC 27-1; IC 27-13; noncode.
Synopsis: Amendments to health provider contracts. Requires an
employee welfare benefit plan, an insurer, a health maintenance
organization, or a self-insurance plan or prepaid health care delivery
plan for state employees that enters into a contract with certain health
care providers to provide at least 45 days written notice to the provider
of an amendment to the contract. Allows a provider to terminate the
contract without penalty at the end of 90 days, or earlier if agreed to by
the parties, if the provider, within 15 days after receiving notice of the
proposed amendment, chooses not to approve the amendment. Requires
a provider who terminates a contract to notify a patient of the contract
termination before providing services, except in an emergency.
Prohibits an employee welfare benefit plan, an insurer, a health
maintenance organization, or a self-insurance plan or prepaid health
care delivery plan for state employees from requiring a provider who
terminates a contract to comply with the proposed amendment.
Specifies that a contrary contractual provision is void. Provides an
exception to amendments to contracts required by state or federal law.
Requires a health maintenance organization to notify enrollees if a
hospital's contract with the health maintenance organization is
terminated and requires the notice to include the names of all
participating providers employed by the hospital.
Effective: July 1, 2001.
January 11, 2001, read first time and referred to Committee on Public Health.
February 14, 2001, amended, reported _ Do Pass.
February 20, 2001, read second time, ordered engrossed.
February 21, 2001, engrossed.
February 26, 2001, read third time, passed. Yeas 96, nays 0.
A BILL FOR AN ACT to amend the Indiana Code concerning
insurance.
conditions of reimbursement for health care services provided to
an individual under:
(1) an employee welfare benefit plan (as defined in 29 U.S.C.
1002 et seq.);
(2) a policy of accident and sickness insurance (as defined in
IC 27-8-5-1);
(3) a contract with a health maintenance organization;
(4) a self-insurance program established under
IC 5-10-8-7(b); or
(5) a prepaid health care delivery plan entered into under
IC 5-10-8-7(c).
Sec. 3. (a) As used in this chapter, "person" means an
individual, an agency, a political subdivision, a partnership, a
corporation, an association, or any other entity that enters into a
health provider contract with a provider.
(b) The term does not include a health care provider described
in IC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3),
or IC 16-18-2-163(a)(4).
Sec. 4. As used in this chapter, "provider" means:
(1) a physician licensed under IC 25-22.5;
(2) a dentist licensed under IC 25-14;
(3) an advanced practice nurse licensed under IC 25-23;
(4) a chiropractor licensed under IC 25-10;
(5) a podiatrist licensed under IC 25-29;
(6) an optometrist licensed under IC 25-24; or
(7) a clinical psychologist licensed under IC 25-33.
Sec. 5. A person who enters into a health provider contract with
a provider shall provide written notice to the provider of any
amendment to the health provider contract not less than forty-five
(45) days before the proposed effective date of the amendment.
Sec. 6. (a) Subject to subsection (b), a provider who receives
notice under section 5 of this chapter may terminate the health
provider contract without penalty by informing the person with
whom the health care provider contracts that the provider chooses
not to approve the amendment.
(b) Notice under subsection (a) must be:
(1) given not later than fifteen (15) days after the provider
receives notice under section 5 of this chapter; and
(2) in writing.
Sec. 7. The termination of a contract under section 6 of this
chapter is effective:
(1) ninety (90) days after the person with whom the provider
contracts receives written notice from the provider that the
provider does not approve the amendment; or
(2) on a date earlier than the date described in subdivision (1),
if agreed to by the person with whom the provider contracts
and the provider.
Sec. 8. If a person with whom a provider contracts receives
notice from a provider under section 6 of this chapter, the person
with whom a provider contracts may not require the provider to
comply with the proposed amendment.
Sec. 9. Except in an emergency, a provider who elects to
terminate a health provider contract under this section shall,
before providing services to a patient who is covered by the
contract, notify the patient that the provider's contract has been or
will be terminated.
Sec. 10. Except as provided in section 7(2) of this chapter, a
health provider contract provision that is contrary to this chapter
is void.
Sec. 11. This chapter does not apply to an amendment to a
health provider contract that is required to comply with a state or
federal law.