March 23, 2001





ENGROSSED

HOUSE BILL No. 1461

_____


DIGEST OF HB 1461 (Updated March 21, 2001 2:56 PM - DI 98)



Citations Affected: IC 27-1; noncode.

Synopsis: Health care provider contracting. Prohibits specified entities from requiring a health care provider to provide health care services to enrollees of a health maintenance organization as a condition of entering into a contract to provide health care services to individuals other than enrollees of a health maintenance organization.

Effective: July 1, 2001.





Pelath , Budak , Becker
(SENATE SPONSORS _ LAWSON C, ALEXA)




    January 11, 2001, read first time and referred to Committee on Public Health.
    February 27, 2001, amended, reported _ Do Pass.
    March 5, 2001, read second time, amended, ordered engrossed.
    March 6, 2001, engrossed. Read third time, passed. Yeas 92, nays 0.

SENATE ACTION

    March 13, 2001, read first time and referred to Committee on Health and Provider Services.
    March 22, 2001, amended, reported favorably _ Do Pass.







March 23, 2001

First Regular Session 112th General Assembly (2001)


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 2000 General Assembly.


ENGROSSED

HOUSE BILL No. 1461



    A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 27-1-37; (01)EH1461.1.1. -->     SECTION 1. IC 27-1-37 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]:
    Chapter 37. Health Provider Contracts
    Sec. 1. As used in this chapter, "health maintenance organization" means a person that undertakes to provide or arrange for the delivery of health care services to individuals on a prepaid basis, except for the individual's responsibility for copayments or deductibles. The term does not include a staff-model health maintenance organization that employs a group of providers and that requires the providers to provide health care services solely to individuals who are entitled to coverage under a contract with the staff-model health maintenance organization or an affiliate of the staff-model health maintenance organization.
    Sec. 2. As used in this chapter, "health provider contract" means an agreement with a provider relating to terms and 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.
    (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 an individual or entity licensed or legally authorized to provide health care services.
    Sec. 5. A person may not require a provider, as a condition of entering into a health provider contract for the provision of health care services other than health care services to enrollees of a health maintenance organization, to provide health care services to enrollees of a health maintenance organization.

SOURCE: ; (01)EH1461.1.2. -->     SECTION 2. [EFFECTIVE JULY 1, 2001] (a) IC 27-1-37, as added by this act, applies to a health provider contract that is entered into or renewed after June 30, 2001.
    (b) This SECTION expires June 30, 2005.