Introduced Version






SENATE BILL No. 372

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DIGEST OF INTRODUCED BILL



Citations Affected: IC 27-8-17.5.

Synopsis: Health insurance preauthorization procedure. Requires the department of insurance to prescribe a standard preauthorization procedure that must be used by an insurer or a health maintenance organization concerning whether a proposed health care service that a provider proposes to provide to an insured or enrollee is covered.

Effective: July 1, 2007.





Simpson




    January 11, 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 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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SENATE BILL No. 372



    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 27-8-17.5; (07)IN0372.1.1. -->     SECTION 1. IC 27-8-17.5 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2007]:
     Chapter 17.5. Preauthorization for Reimbursement
    Sec. 1. The definitions in IC 27-13-1 apply throughout this chapter.
    Sec. 2. As used in this chapter, "insurer" means an insurer (as defined in IC 27-1-2-3) that issues a policy of accident and sickness insurance.
    Sec. 3. As used in this chapter, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1.
    Sec. 4. As used in this chapter, "preauthorization" means a determination by:
        (1) an insurer concerning whether a proposed health care service that a provider proposes to provide to an insured is covered under the policy of accident and sickness insurance; or
        (2) a health maintenance organization concerning whether a proposed health care service that a provider proposes to provide to an enrollee is covered under the individual contract or the group contract;
before the health care service is provided.
    Sec. 5. (a) The department shall prescribe a standard preauthorization procedure that must be used by an insurer or a health maintenance organization.
    (b) The procedure prescribed under subsection (a) must be automated to the extent possible.
    Sec. 6. The department may adopt rules under IC 4-22-2 necessary to implement this chapter.