Reprinted

April 11, 2001





ENGROSSED

SENATE BILL No. 310

_____


DIGEST OF SB 310 (Updated April 10, 2001 5:04 PM - DI 97)



Citations Affected: IC 5-10; IC 12-15; IC 27-8; IC 27-13.

Synopsis: Updating reimbursement codes. Requires the following entities to begin using, not later than 90 days after the effective date, the most current version of specified diagnostic and procedure codes under which claims for health care services are submitted and paid: (1) an administrator of a state employee health benefit plan; (2) the office of Medicaid policy and planning; (3) an insurer that provides coverage for medical expenses; (4) an insurer that issues a worker's compensation policy; (5) an employer who has received a certificate from the worker's compensation board to carry its own worker's compensation risk without insurance; (6) the Indiana comprehensive health insurance association; (7) a health maintenance organization; (8) a limited service health maintenance organization; and (9) providers of covered health care services. Requires payors to reimburse providers for covered services based on updated codes if the services are provided after the effective date of the updated codes.

Effective: July 1, 2001.





Miller, Craycraft
(HOUSE SPONSORS _ PELATH, RIPLEY)




    January 11, 2001, read first time and referred to Committee on Health and Provider Services.
    January 25, 2001, amended, reported favorably _ Do Pass.
    February 1, 2001, read second time, amended, ordered engrossed.
    February 2, 2001, engrossed.
    February 8, 2001, read third time, passed. Yeas 49, nays 0.

HOUSE ACTION

    February 26, 2001, read first time and referred to Committee on Insurance, Corporations and Small Business.
    April 5, 2001, amended, reported _ Do Pass.
    April 10, 2001, read second time, amended, ordered engrossed.






Reprinted

April 11, 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

SENATE BILL No. 310



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

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

    SECTION 1. IC 5-10-8-11 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 11. (a) As used in this section, "administrator" means:
        (1) the state personnel department;
        (2) an entity with which the state contracts to administer health coverage under section 7(b) of this chapter; or
        (3) a prepaid health care delivery plan with which the state contracts under section 7(c) of this chapter.
    (b) As used in this section, "health care plan" has the meaning set forth in section 7.7 of this chapter.
    (c) As used in this section, "provider" has the meaning set forth in IC 27-8-11-1.
    (d) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:
        (1) an administrator shall begin using the most current version of the:


            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the administrator pays claims for services provided under a health care plan; and
        (2) a provider shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the provider submits claims for payment for services provided under a health care plan.
    (e) If a provider provides services that are covered under a health care plan:
        (1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (d); and
        (2) before the administrator begins using the most current version of the diagnostic or procedure code;
the administrator shall reimburse the provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.

    SECTION 2. IC 12-15-13-7.2 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 7.2. (a) As used in this section, "provider" has the meaning set forth in IC 27-8-11-1.
    (b) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:
        (1) the office shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the office pays claims for services provided under the Medicaid program; and
        (2) a provider shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the provider submits claims for payment for services provided under the Medicaid program.
    (c) If a provider provides services that are covered under the Medicaid program:
        (1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (b); and
        (2) before the office begins using the most current version of the diagnostic or procedure code;
the office shall reimburse the provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.

    SECTION 3. IC 27-8-10-11.2 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 11.2. (a) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:
        (1) the association shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the association pays claims for services provided under an association policy; and
        (2) a health care provider shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the health care provider submits claims for payment for services provided under an association policy.
    (b) If a health care provider provides services that are covered under an association policy:
        (1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (a); and
        (2) before the association begins using the most current version of the diagnostic or procedure code;
the association shall reimburse the health care provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.

    SECTION 4. IC 27-8-22.1 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]:
     Chapter 22.1. Claims
    Sec. 1. As used in this chapter, "accident and sickness insurance policy" means an insurance policy that provides at least one (1) of the types of insurance described in IC 27-1-5-1, Classes 1(b), 2(a), 2(b), 2(e), 2(f), and 2(h).
    Sec. 2. As used in this chapter, "insurer" means:
        (1) an insurer that issues:
            (A) an accident and sickness insurance policy; or
            (B) a worker's compensation policy; or
        (2) an employer who has received a certificate from the worker's compensation board to carry the employer's worker's compensation risk without insurance under IC 22-3-2-5.
    Sec. 3. As used in this chapter, "provider" has the meaning set forth in IC 27-8-11-1.
    Sec. 4. As used in this chapter, "worker's compensation policy"

means a policy of insurance issued to an employer under IC 22-3-2-5.
    Sec. 5. (a) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:
        (1) an insurer shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the insurer pays claims for services provided under an accident and sickness insurance policy or a worker's compensation policy; and
        (2) a provider shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the provider submits claims for payment for services provided under an accident and sickness insurance policy or a worker's compensation policy.

     (b) If a provider provides services that are covered under an accident and sickness insurance policy or a worker's compensation policy:
        (1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (a); and
        (2) before the insurer begins using the most current version of the diagnostic or procedure code;
the insurer shall reimburse the provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.

    SECTION 5. IC 27-13-41 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE

JULY 1, 2001]:
     Chapter 41. Claims
    Sec. 1. Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this section:
        (1) a health maintenance organization and a limited service health maintenance organization shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS);
and
            (F) third party administrator (TPA);

        codes under which the health maintenance organization and limited service health maintenance organization pay claims for health care services covered under an individual contract or a group contract; and
        (2) a provider shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Health Care Financing Administration's common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the provider submits claims for payment for health care services covered under an individual contract or a group contract.
    Sec. 2. If a provider provides health care services that are covered under an individual contract or a group contract:
        (1) after the effective date of the most current version of a diagnostic or procedure code described in section 1 of this chapter; and
        (2) before the health maintenance organization or limited service health maintenance organization begins using the most current version of the diagnostic or procedure code;
the health maintenance organization or limited service health maintenance organization shall reimburse the provider under the

version of the diagnostic or procedure code that was in effect on the date that the health care services were provided.