Introduced Version
SENATE BILL No. 114
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 27-8-11-9; IC 27-13-15-4.
Synopsis: Health provider reimbursement agreements. Prohibits
certain provisions in health provider reimbursement agreements.
Effective: Upon passage.
Gard
January 8, 2007, read first time and referred to Committee on Health and Provider
Services.
Introduced
First Regular Session 115th General Assembly (2007)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
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SENATE BILL No. 114
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 27-8-11-9; (07)IN0114.1.1. -->
SECTION 1. IC 27-8-11-9 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 9. (a) As used in this section, "insurer"
includes the following:
(1) An administrator licensed under IC 27-1-25.
(2) A person that pays or administers claims on behalf of an
insurer.
(b) An agreement between an insurer and a provider under this
chapter may not contain a provision that:
(1) prohibits, or grants the insurer an option to prohibit, the
provider from contracting with another insurer to accept
lower payment for health care services than the payment
specified in the agreement;
(2) requires, or grants the insurer an option to require, the
provider to accept a lower payment from the insurer if the
provider agrees with another insurer to accept lower payment
for health care services;
(3) requires, or grants the insurer an option of, termination or
renegotiation of the agreement if the provider agrees with
another insurer to accept lower payment for health care
services; or
(4) requires the provider to disclose the provider's
reimbursement rates under contracts with other insurers.
(c) A provision that:
(1) is contained in an agreement between an insurer and a
provider under this chapter; and
(2) violates this section;
is void.
SOURCE: IC 27-13-15-4; (07)IN0114.1.2. -->
SECTION 2. IC 27-13-15-4 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 4. (a) As used in this section, "health
maintenance organization" includes the following:
(1) A limited service health maintenance organization.
(2) A person that pays or administers claims on behalf of a
health maintenance organization or a limited service health
maintenance organization.
(b) An agreement between a health maintenance organization
and a participating provider under this chapter may not contain a
provision that:
(1) prohibits, or grants the health maintenance organization
an option to prohibit, the participating provider from
contracting with another health maintenance organization to
accept lower payment for health care services than the
payment specified in the agreement;
(2) requires, or grants the health maintenance organization an
option to require, the participating provider to accept a lower
payment from the health maintenance organization if the
participating provider agrees with another health
maintenance organization to accept lower payment for health
care services;
(3) requires, or grants the health maintenance organization an
option of, termination or renegotiation of the agreement if the
participating provider agrees with another health
maintenance organization to accept lower payment for health
care services; or
(4) requires the participating provider to disclose the
participating provider's reimbursement rates under contracts
with other health maintenance organizations.
(c) A contract provision that violates this section is void.
SOURCE: ; (07)IN0114.1.3. -->
SECTION 3. [EFFECTIVE UPON PASSAGE] (a) IC 27-8-11-9, as
added by this act, applies to an agreement between an insurer and
a provider that is entered into, amended, or renewed on or after
the effective date of this act.
(b) IC 27-13-15-4, as added by this act, applies to a contract
between a health maintenance organization and a participating
provider that is entered into, amended, or renewed on or after the
effective date of this act.
SOURCE: ; (07)IN0114.1.4. -->
SECTION 4.
An emergency is declared for this act.