Second Regular Session 112th General Assembly (2002)
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
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Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in
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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.
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between statutes enacted by the 2001 General Assembly.
HOUSE ENROLLED ACT No. 1346
AN ACT to amend the Indiana Code concerning health.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 5-10-8.1-6, AS ADDED BY P.L.162-2001,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 6. (a) The administrator shall pay or deny
each clean claim in accordance with section 7 of this chapter.
(b) An administrator shall notify a provider of any deficiencies in a
submitted claim not less more than:
(1) thirty (30) days for a claim that is filed electronically; or
(2) forty-five (45) days for a claim that is filed on paper;
and describe any remedy necessary to establish a clean claim.
(c) Failure of an administrator to notify a provider as required under
subsection (b) establishes the submitted claim as a clean claim.
SECTION 2. IC 27-8-5.7-5, AS ADDED BY P.L.162-2001,
SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 5. (a) An insurer shall pay or deny each clean
claim in accordance with section 6 of this chapter.
(b) An insurer shall notify a provider of any deficiencies in a
submitted claim not less more than:
(1) thirty (30) days for a claim that is filed electronically; or
(2) forty-five (45) days for a claim that is filed on paper;
and describe any remedy necessary to establish a clean claim.
(c) Failure of an insurer to notify a provider as required under
subsection (b) establishes the submitted claim as a clean claim.
SECTION 3. IC 27-13-36.2-3, AS ADDED BY P.L.162-2001,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 3. (a) A health maintenance organization shall
pay or deny each clean claim in accordance with section 4 of this
chapter.
(b) A health maintenance organization shall notify a provider of any
deficiencies in a submitted claim not
less more than:
(1) thirty (30) days for a claim that is filed electronically; or
(2) forty-five (45) days for a claim that is filed on paper;
and describe any remedy necessary to establish a clean claim.
(c) Failure of a health maintenance organization to notify a provider
as required under subsection (b) establishes the submitted claim as a
clean claim.
SECTION 4. IC 27-13-36.2-4, AS ADDED BY P.L.162-2001,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 4. (a) A health maintenance organization shall
pay or deny each clean claim as follows:
(1) If the claim is filed electronically, not
less more than thirty
(30) days after the date the claim is received by the health
maintenance organization.
(2) If the claim is filed on paper, not
less more than forty-five
(45) days after the date the claim is received by the health
maintenance organization.
(b) If:
(1) a health maintenance organization fails to pay or deny a clean
claim in the time required under subsection (a); and
(2) the health maintenance organization subsequently pays the
claim;
the health maintenance organization shall pay the provider that
submitted the claim interest on the lesser of the usual, customary, and
reasonable charge for the health care services provided to the enrollee
or an amount agreed to between the health maintenance organization
and the provider paid under this section.
(c) Interest paid under subsection (b):
(1) accrues beginning:
(A) thirty-one (31) days after the date the claim is filed under
subsection (a)(1); or
(B) forty-six (46) days after the date the claim is filed under
subsection (a)(2); and
(2) stops accruing on the date the claim is paid.
(d) In paying interest under subsection (b), a health maintenance
organization shall use the same interest rate as provided in
IC 12-15-21-3(7)(A).
SECTION 5. P.L.220-2001, SECTION 1, IS AMENDED TO READ
AS FOLLOWS [EFFECTIVE JULY 1, 2002]: SECTION 1. (a) As used
in this SECTION, "commission" refers to the Indiana commission on
excellence in health care established by subsection (d).
(b) As used in this SECTION, "health care professional" has the
meaning set forth in IC 16-27-1-1.
(c) As used in this SECTION, "health care provider" includes the
following:
(1) A hospital or an ambulatory outpatient surgical center licensed
under IC 16-21.
(2) A hospice program (as defined in IC 16-25-1.1-4).
(3) A home health agency licensed under IC 16-27-1.
(4) A health facility licensed under IC 16-28.
(d) There is established the Indiana commission on excellence in
health care.
(e) The commission consists of the following members:
(1) Four (4) members appointed from the house of representatives
by the speaker of the house of representatives. Not more than two
(2) of the members appointed under this subdivision may be
members of the same political party.
(2) Four (4) members appointed from the senate by the president
pro tempore of the senate. Not more than two (2) of the members
appointed under this subdivision may be members of the same
political party.
(3) The governor or the governor's designee.
(4) The state health commissioner appointed under IC 16-19-4-2
or the commissioner's designee.
(5) One (1) member appointed by the governor who is a former
dean or former faculty member of the Indiana University School
of Medicine.
(6) One (1) member appointed by the governor who is a former
dean or former faculty member of an Indiana school of nursing.
(7) One (1) member appointed by the governor who is a health
care provider or a representative for individuals who have both a
mental illness and a developmental disability.
(f) The commission shall operate under the rules of the legislative
council. The commission shall meet upon the call of the chairperson.
(g) The affirmative votes of at least seven (7) voting members of the
commission are required for the commission to take any action,
including the approval of a final report.
(h) The speaker of the house of representatives shall appoint the
chairperson of the commission during odd-numbered years beginning
January 1. The president pro tempore of the senate shall appoint the
chairperson of the commission during even-numbered years beginning
January 1.
(i) Each member of the commission who is not a state employee is
entitled to the minimum salary per diem provided by IC 4-10-11-2.1(b).
The member is also entitled to reimbursement for traveling expenses
as provided under IC 4-13-1-4 and other expenses actually incurred in
connection with the member's duties as provided in the state policies
and procedures established by the Indiana department of administration
and approved by the budget agency.
(j) Each member of the commission who is a state employee but
who is not a member of the general assembly is entitled to
reimbursement for traveling expenses as provided under IC 4-13-1-4
and other expenses actually incurred in connection with the member's
duties as provided in the state policies and procedures established by
the Indiana department of administration and approved by the budget
agency.
(k) Each member of the commission who is a member of the general
assembly is entitled to receive the same per diem, mileage, and travel
allowances paid to members of the general assembly serving on interim
study committees established by the legislative council.
(l) The legislative services agency shall provide staff to support the
commission. The legislative services agency is not required to provide
staff assistance to the subcommittees of the commission except to the
extent the subcommittees require copying services.
(m) The expenses of the commission shall be paid from funds
appropriated to the legislative services agency.
(n) The commission shall study the quality of health care, including
mental health, and develop a comprehensive statewide strategy for
improving the health care delivery system. The commission shall do
the following:
(1) Identify existing data sources that evaluate quality of health
care in Indiana and collect, analyze, and evaluate this data.
(2) Establish guidelines for data sharing and coordination.
(3) Identify core sets of quality measures for standardized
reporting by appropriate components of the health care
continuum.
(4) Recommend a framework for quality measurement and
outcome reporting.
(5) Develop quality measures that enhance and improve the
ability to evaluate and improve care.
(6) Make recommendations regarding research and development
needed to advance quality measurement and reporting.
(7) Evaluate regulatory issues relating to the pharmacy profession
and recommend changes necessary to optimize patient safety.
(8) Facilitate open discussion of a process to ensure that
comparative information on health care quality is valid, reliable,
comprehensive, understandable, and widely available in the
public domain.
(9) Sponsor public hearings to share information and expertise,
identify best practices, and recommend methods to promote their
acceptance.
(10) Evaluate current regulatory programs to determine what
changes, if any, need to be made to facilitate patient safety.
(11) Review public and private health care purchasing systems to
determine if there are sufficient mandates and incentives to
facilitate continuous improvement in patient safety.
(12) Analyze how effective existing regulatory systems are in
ensuring continuous competence and knowledge of effective
safety practices.
(13) Develop a framework for organizations that license, accredit,
or credential health care professionals and health care providers
to more quickly and effectively identify unsafe providers and
professionals and to take action necessary to remove an unsafe
provider or professional from practice or operation until the
professional or provider has proven safe to practice or operate.
(14) Recommend procedures for development of a curriculum on
patient safety and methods of incorporating the curriculum into
training, licensure, and certification requirements.
(15) Develop a framework for regulatory bodies to disseminate
information on patient safety to health care professionals, health
care providers, and consumers through conferences, journal
articles and editorials, newsletters, publications, and Internet
websites.
(16) Recommend procedures to incorporate recognized patient
safety considerations into practice guidelines and into standards
related to the introduction and diffusion of new technologies,
therapies, and drugs.
(17) Recommend a framework for development of community
based collaborative initiatives for error reporting and analysis and
implementation of patient safety improvements.
(18) Evaluate the role of advertising in promoting or adversely
affecting patient safety.
(19) Evaluate and make recommendations regarding the need for
licensure of additional persons who participate in the delivery of
health care to Indiana residents.
(20) Evaluate the benefits and problems of the current
disciplinary systems and make recommendations regarding
alternatives and improvements.
(21) Study and make recommendations concerning the long term
care system, including self-directed care plans and the regulation
and reimbursement of public and private facilities that provide
long term care.
(22)
Study and make recommendations concerning increasing
the number of:
(1) nurses;
(2) respiratory care practitioners;
(3) speech pathologists; and
(4) dental hygienists.
(23) Study any other topic required by the chairperson.
(o) The commission may create subcommittees to study topics,
receive testimony, and prepare reports on topics assigned by the
commission. The chairperson shall select from the topics listed under
subsection (n) the topics to be studied by the commission and
subcommittees each year. The chairperson shall appoint persons to act
as chairperson and secretary of each subcommittee. The commission
shall by majority vote appoint
initial members to each subcommittee.
Each subcommittee may by a majority vote of the members
appointed to the subcommittee make a recommendation to the
commission to appoint additional members to the subcommittee.
The commission may by a majority vote of the members appointed
to the commission appoint or remove members of a subcommittee.
A member of a subcommittee, including a commission member while
serving on a subcommittee, is not entitled to per diem, mileage, or
travel allowances.
(p) The commission shall submit:
(1) interim reports not later than October 1, 2001, and October 1,
2002; and
(2) a final report not later than October 1, 2003;
to the governor, members of the health finance commission, and the
legislative council. With the consent of the chairperson of the
commission and the chairperson of the health finance commission, the
commission and the health finance commission may conduct joint
meetings.
(q) This SECTION expires July 1, 2004.
SECTION 6.
An emergency is declared for this act.