Introduced Version






HOUSE BILL No. 1533

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 16-21-2-16 ; IC 27-8-11-7 ; IC 27-13-36.2-7.

Synopsis: Payment for in-network care. Requires a hospital or ambulatory outpatient surgical center that is part of a provider network for an insurer or a health maintenance organization to ensure that care is available to individuals covered by the insurer or health maintenance organization according to the terms of the individual's coverage for in-network services.

Effective: July 1, 2003.





Goodin




    January 16, 2003, read first time and referred to Committee on Insurance, Corporations and Small Business.







Introduced

First Regular Session 113th General Assembly (2003)


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.
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HOUSE BILL No. 1533



    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 16-21-2-16; (03)IN1533.1.1. -->     SECTION 1. IC 16-21-2-16 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 16. (a) This section applies to a hospital or an ambulatory outpatient surgical center that enters into:
        (1) an agreement with an insurer under IC 27-8-11 ; or
        (2) a contract with a health maintenance organization under IC 27-13 to serve as a participating provider.
    (b) As used in this section, "in-network provider" means a provider (as defined in IC 27-8-11-1 ) who is an individual and who has entered into:
        (1) an agreement with an insurer under IC 27-8-11 ; or
        (2) a contract with a health maintenance organization under IC 27-13 to serve as a participating provider.
    (c) A hospital or an ambulatory outpatient surgical center shall:
        (1) ensure that care received by an individual who is:
            (A) treated at the hospital or ambulatory outpatient surgical center; and
            (B) insured by the insurer or has coverage under a contract with the health maintenance organization described in subsection (a);
        is available at all times through an in-network provider; or
        (2) require, as a condition of providing care at the hospital or ambulatory outpatient surgical center, that a provider who is not an in-network provider and provides care to an individual described in subdivision (1):
            (A) accept as payment in full the amount that would be paid by the insurer or health maintenance organization for the care provided if the provider were an in-network provider; and
            (B) not bill or collect from the individual an amount exceeding the amount described in clause (A).

SOURCE: IC 27-8-11-7; (03)IN1533.1.2. -->     SECTION 2. IC 27-8-11-7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 7. (a) An insurer shall make payment for care provided by a provider described in IC 16-21-2-16 (c)(2) in the amount that would have been agreed to if the provider entered into an agreement with the insurer under section 3(a)(1) of this chapter.
    (b) Subsection (a) does not require the insurer to make payment directly to the provider.

SOURCE: IC 27-13-36.2-7; (03)IN1533.1.3. -->     SECTION 3. IC 27-13-36.2-7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 7. (a) A health maintenance organization shall make payment for care provided by a provider described in IC 16-21-2-16 (c)(2) in the amount that would have been agreed to if the provider entered into a contract with the health maintenance organization to serve as a participating provider.
    (b) Subsection (a) does not require the health maintenance organization to make payment directly to the provider.