Ind. Code ch. 25-1-9

Ind. Code ch. 25-1-9
in effect

Ind. Code § 25-1-9-1 "Board"

Sec. 1. As used in this chapter, "board" means any of the entities described in IC 25-0.5-11. As added by P.L.152-1988, SEC.1. Amended by P.L.242-1989, SEC.7; P.L.238-1989, SEC.7; P.L.186-1990, SEC.7; P.L.48-1991, SEC.20; P.L.227-1993, SEC.7; P.L.33-1993, SEC.14; P.L.213-1993, SEC.4; P.L.1-1994, SEC.122; P.L.124-1994, SEC.6; P.L.175-1997, SEC.6; P.L.147-1997, SEC.10; P.L.84-1998, SEC.5; P.L.24-1999, SEC.6; P.L.2-2008, SEC.59; P.L.122-2009, SEC.8; P.L.84-2010, SEC.16; P.L.3-2014, SEC.26.

Ind. Code § 25-1-9-2 "Practitioner"

Sec. 2. (a) As used in this chapter, "practitioner" means an individual who holds: (1) an unlimited license, certificate, or registration; (2) a limited or probationary license, certificate, or registration; (3) a temporary license, certificate, registration, or permit; (4) an intern permit; or (5) a provisional license; issued by the board regulating the profession in question, including a certificate of registration issued under IC 25-20. (b) The term includes an individual who held: (1) an unlimited license, certificate, or registration; (2) a limited or probationary license, certificate, or registration; (3) a temporary license, certificate, registration, or permit; (4) an intern permit; or (5) a provisional license; issued by the board regulating the profession in question, including a certificate of registration issued under IC 25-20, when the alleged violation of this chapter occurred. As added by P.L.152-1988, SEC.1. Amended by P.L.36-2022, SEC.5.

Ind. Code § 25-1-9-3 "License"

Sec. 3. As used in this chapter, "license" includes a license, certificate, registration, or permit. As added by P.L.152-1988, SEC.1.

Ind. Code § 25-1-9-3.5 "Sexual contact"

Sec. 3.5. As used in this chapter, "sexual contact" means: (1) sexual intercourse (as defined in IC 35-31.5-2-302); (2) other sexual conduct (as defined in IC 35-31.5-2-221.5); or (3) any fondling or touching intended to arouse or satisfy the sexual desires of either the individual performing the fondling or touching or the individual being fondled or touched. As added by P.L.200-2001, SEC.1. Amended by P.L.114-2012, SEC.50; P.L.158-2013, SEC.278.

Ind. Code § 25-1-9-4 Standards of professional practice; findings required for sanctions; evidence of foreign discipline

Sec. 4. (a) A practitioner shall conduct the practitioner's practice in accordance with the standards established by the board regulating the profession in question and is subject to the exercise of the disciplinary sanctions under section 9 of this chapter if, after a hearing, the board finds: (1) a practitioner has: (A) engaged in or knowingly cooperated in fraud or material deception in order to obtain a license to practice, including cheating on a licensing examination; (B) engaged in fraud or material deception in the course of professional services or activities; (C) advertised services in a false or misleading manner; or (D) been convicted of a crime or assessed a civil penalty involving fraudulent billing practices, including fraud under: (i) Medicaid (42 U.S.C. 1396 et seq.); (ii) Medicare (42 U.S.C. 1395 et seq.); (iii) the children's health insurance program under IC 12-17.6; or (iv) insurance claims; (2) a practitioner has been convicted of a crime that: (A) has a direct bearing on the practitioner's ability to continue to practice competently; or (B) is harmful to the public; (3) a practitioner has knowingly violated any state statute or rule, or federal statute or regulation, regulating the profession in question; (4) a practitioner has continued to practice although the practitioner has become unfit to practice due to: (A) professional incompetence that: (i) may include the undertaking of professional activities that the practitioner is not qualified by training or experience to undertake; and (ii) does not include activities performed under IC 16-21-2-9; (B) failure to keep abreast of current professional theory or practice; (C) physical or mental disability; or (D) addiction to, abuse of, or severe dependency upon alcohol or other drugs that endanger the public by impairing a practitioner's ability to practice safely; (5) a practitioner has engaged in a course of lewd or immoral conduct in connection with the delivery of services to the public; (6) a practitioner has allowed the practitioner's name or a license issued under this chapter to be used in connection with an individual who renders services beyond the scope of that individual's training, experience, or competence; (7) a practitioner has had disciplinary action taken against the practitioner or the practitioner's license to practice in any state or jurisdiction on grounds similar to those under this chapter; (8) a practitioner has diverted: (A) a legend drug (as defined in IC 16-18-2-199); or (B) any other drug or device issued under a drug order (as defined in IC 16-42-19-3) for another person; (9) a practitioner, except as otherwise provided by law, has knowingly prescribed, sold, or administered any drug classified as a narcotic, addicting, or dangerous drug to a habitue or addict; (10) a practitioner has failed to comply with an order imposing a sanction under section 9 of this chapter; (11) a practitioner has engaged in sexual contact with a patient under the practitioner's care or has used the practitioner-patient relationship to solicit sexual contact with a patient under the practitioner's care; (12) a practitioner who is a participating provider of a health maintenance organization has knowingly collected or attempted to collect from a subscriber or enrollee of the health maintenance organization any sums that are owed by the health maintenance organization; (13) a practitioner has assisted another person in committing an act that would be grounds for disciplinary sanctions under this chapter; or (14) a practitioner has failed to report to the department of child services or an appropriate law enforcement agency suspected child abuse in accordance with IC 31-33-5. (b) A practitioner who provides health care services to the practitioner's spouse is not subject to disciplinary action under subsection (a)(11). (c) A certified copy of the record of disciplinary action is conclusive evidence of the other jurisdiction's disciplinary action under subsection (a)(7). As added by P.L.152-1988, SEC.1. Amended by P.L.2-1993, SEC.136; P.L.149-1997, SEC.7; P.L.22-1999, SEC.4; P.L.200-2001, SEC.2; P.L.203-2001, SEC.3; P.L.1-2002, SEC.96; P.L.197-2007, SEC.22; P.L.173-2017, SEC.7; P.L.35-2018, SEC.1; P.L.168-2025, SEC.2.

Ind. Code § 25-1-9-4.2 Consent for pelvic, prostate, or rectal examinations; requirements

Sec. 4.2. (a) A practitioner, a student in training in a medical school, an intern, a resident, a graduate student, or an individual participating in a clinical training or resident program may not perform a pelvic, prostate, or rectal examination on a sedated, anesthetized, or unconscious patient unless one (1) of the following conditions is met: (1) The patient, patient's guardian, or patient's health care representative (as defined in IC 16-21-12-4) provides prior written informed consent to the pelvic, prostate, or rectal examination through the notice described in subsection (b). (2) The performance of a pelvic, prostate, or rectal examination is within the scope of care ordered for the surgical procedure or diagnostic examination to be performed on the patient and the patient, patient's guardian, or patient's health care representative has given informed consent. (3) A medical emergency exists and the pelvic, prostate, or rectal examination is immediately necessary for diagnostic examination or treatment of the patient, including the conducting of a rape kit. (4) A court has ordered the performance of the pelvic, prostate, or rectal examination for the purposes of the collection of evidence. (b) A written informed consent described in subsection (a)(1) must meet the following: (1) Be separate from any other notice or agreement. However, the informed consent does not have to be separate if the pelvic, prostate, or rectal examination is within the scope of care for the surgical procedure or diagnostic examination to be performed on the patient. (2) Specify the nature and purpose of the examination. (3) Include a description of the procedure to be performed. (4) State the name of the individual performing or supervising the examination. (5) Disclose whether a student will be performing or observing the examination. (6) Allow the patient, patient's guardian, or patient's health care representative to decline the examination. (7) Allow the patient, patient's guardian, or patient's health care representative to decline allowing a student to perform or observe the examination. (8) Include a signature line for the patient, patient's guardian, or patient's health care representative to consent or refuse to consent to an examination on a sedated, anesthetized, or unconscious patient as described in subsection (a). The signature of consent must be obtained in order to proceed with the pelvic, prostate, or rectal examination on a sedated, anesthetized, or unconscious patient as described in subsection (a)(1). (c) The refusal by the patient, patient's guardian, or patient's health care representative to consent to an examination described in subsection (a)(1) may not affect the medical procedure for which the patient is scheduled to receive. (d) Nothing in this section diminishes any other statutory requirement for a practitioner, a student in training in a medical school, an intern, a resident, a graduate student, or an individual participating in a clinical training or resident program to obtain informed consent. As added by P.L.109-2026, SEC.1.

Ind. Code § 25-1-9-4.5 Failure to provide human trafficking information

Sec. 4.5. (a) If a practitioner has been presented with evidence that, if presented to a practitioner of a similar background and training, would cause the practitioner to believe that a patient is a victim of human trafficking, the practitioner shall provide information to the patient concerning available services and resources, including the telephone number for the National Human Trafficking Hotline. (b) In addition to section 4 of this chapter, a practitioner is subject to the exercise of the disciplinary sanctions under section 9 of this chapter if, after a hearing, the board finds that the practitioner failed to provide information required by subsection (a). As added by P.L.35-2018, SEC.2.

Ind. Code § 25-1-9-5 Optometry employment practice

Sec. 5. In addition to section 4 of this chapter, a practitioner licensed to practice optometry is subject to the exercise of disciplinary sanctions under section 9 of this chapter if, after a hearing, the board finds a practitioner has accepted employment to practice optometry from a person other than: (1) a corporation formed by an optometrist under IC 23-1.5; or (2) an individual who is licensed as an optometrist under this article and whose legal residence is in Indiana. As added by P.L.152-1988, SEC.1.

Ind. Code § 25-1-9-6 Veterinary practitioners; cruelty to animals

Sec. 6. In addition to section 4 of this chapter, a practitioner licensed to practice veterinary medicine or registered as a veterinary technician is subject to the exercise of the disciplinary sanctions under section 9 of this chapter if, after a hearing, the board finds a practitioner has engaged in cruelty to animals. As added by P.L.152-1988, SEC.1.

Ind. Code § 25-1-9-6.5 Chiropractors; waiver of deductible or copayment

Sec. 6.5. (a) In addition to section 4 of this chapter, a practitioner licensed to practice chiropractic is subject to the exercise of the disciplinary sanctions under section 9 of this chapter if, after a hearing, the board regulating the profession finds a practitioner has: (1) waived a payment of a deductible or a copayment required to be made to the practitioner by a patient under the patient's insurance or health care plan; and (2) advertised the waiver of a payment described in subdivision (1). (b) This section does not apply to the waiver of a deductible or a copayment by a practitioner if: (1) the practitioner determines chiropractic service is necessary for the immediate health and welfare of a patient; (2) the practitioner determines the payment of a deductible or a copayment would create a substantial financial hardship for the patient; and (3) the waiver is based on the evaluation of the individual patient and is not a regular business practice of the practitioner. As added by P.L.151-1989, SEC.9.

Ind. Code § 25-1-9-6.7 Marriage and family therapists; disciplinary sanctions

Sec. 6.7. In addition to the actions listed under section 4 of this chapter that subject a practitioner to the exercise of disciplinary sanctions, a practitioner who is licensed under IC 25-23.6 is subject to the exercise of disciplinary sanctions under section 9 of this chapter if, after a hearing, the board regulating the profession finds that the practitioner has: (1) performed any therapy that, by the prevailing standards of the mental health professions in the community where the services were provided, would constitute experimentation on human subjects, without first obtaining full, informed, and written consent; (2) failed to meet the minimum standards of performance in professional activities when measured against generally prevailing peer performance in professional activities, including the undertaking of activities that the practitioner is not qualified by training or experience to undertake; (3) performed services, including any duties required of the individual under IC 31, in reckless disregard of the best interests of a patient, a client, or the public; (4) without the consent of the child's parent, guardian, or custodian, knowingly participated in the child's removal or precipitated others to remove a child from the child's home unless: (A) the child's physical health was endangered due to injury as a result of the act or omission of the child's parent, guardian, or custodian; (B) the child had been or was in danger of being a victim of an offense under IC 35-42-4, IC 35-45-4-1, IC 35-45-4-2, IC 35-46-1-3, IC 35-49-2-2, or IC 35-49-3-2; or (C) the child was in danger of serious bodily harm as a result of the inability, refusal, or neglect of the child's parent, guardian, or custodian to supply the child with necessary food, shelter, or medical care, and a court order was first obtained; (5) willfully made or filed a false report or record, failed to file a report or record required by law, willfully impeded or obstructed the filing of a report or record, or induced another individual to: (A) make or file a false report or record; or (B) impede or obstruct the filing of a report or record; or (6) performed a diagnosis (as defined in IC 25-22.5-1-1.1(c)); (7) provided evidence in an administrative or judicial proceeding that had insufficient factual basis for the conclusions rendered by the practitioner; (8) willfully planted in the mind of the patient suggestions that are not based in facts known to the practitioner; or (9) performed services outside of the scope of practice of the license issued under IC 25-23.6. As added by P.L.147-1997, SEC.11. Amended by P.L.2-1998, SEC.65.

Ind. Code § 25-1-9-6.8 Practitioner guidelines before prescribing stimulant medication for a child for treatment of certain disorders

Sec. 6.8. (a) This section applies to a practitioner who is: (1) licensed to practice medicine or osteopathic medicine under IC 25-22.5; or (2) an advanced practice registered nurse granted prescriptive authority under IC 25-23 and whose practice agreement with a collaborating physician reflects the conditions specified in subsection (b). (b) Before prescribing a stimulant medication for a child for the treatment of attention deficit disorder or attention deficit hyperactivity disorder, a practitioner described in subsection (a) shall follow the most recent guidelines adopted by the American Academy of Pediatrics or the American Academy of Child and Adolescent Psychiatry for the diagnosis and evaluation of a child with attention deficit disorder or attention deficit hyperactivity disorder. As added by P.L.107-2002, SEC.28. Amended by P.L.129-2018, SEC.23.

Ind. Code § 25-1-9-6.9 Failing to provide or providing false information to agency

Sec. 6.9. In addition to the actions listed under section 4 of this chapter that subject a practitioner to disciplinary sanctions, a practitioner is subject to the exercise of disciplinary sanctions under section 9 of this chapter if, after a hearing, the board finds that the practitioner has: (1) failed to provide information requested by the Indiana professional licensing agency; or (2) knowingly provided false information to the Indiana professional licensing agency; for a provider profile required under IC 25-1-5-10. As added by P.L.211-2001, SEC.2. Amended by P.L.206-2005, SEC.14.

Ind. Code § 25-1-9-7 Physical or mental examination; power to require

Sec. 7. The board may order a practitioner to submit to a reasonable physical or mental examination, at the practitioner's own expense, if the practitioner's physical or mental capacity to practice safely is at issue in a disciplinary proceeding. As added by P.L.152-1988, SEC.1. Amended by P.L.158-2003, SEC.2.

Ind. Code § 25-1-9-8 Failure to submit to physical or mental examination; sanctions

Sec. 8. Failure to comply with a board order to submit to a physical or mental examination makes a practitioner liable to summary suspension under section 10 of this chapter. As added by P.L.152-1988, SEC.1.

Ind. Code § 25-1-9-9 Disciplinary sanctions

Sec. 9. (a) The board may impose any of the following sanctions, singly or in combination, if it finds that a practitioner is subject to disciplinary sanctions under section 4, 5, 6, 6.7, or 6.9 of this chapter or IC 25-1-5-4: (1) Permanently revoke a practitioner's license. (2) Suspend a practitioner's license. (3) Censure a practitioner. (4) Issue a letter of reprimand. (5) Place a practitioner on probation status and require the practitioner to: (A) report regularly to the board upon the matters that are the basis of probation; (B) limit practice to those areas prescribed by the board; (C) continue or renew professional education under a preceptor, or as otherwise directed or approved by the board, until a satisfactory degree of skill has been attained in those areas that are the basis of the probation; or (D) perform or refrain from performing any acts, including community restitution or service without compensation, that the board considers appropriate to the public interest or to the rehabilitation or treatment of the practitioner. (6) Assess a fine as follows for each violation listed in section 4 of this chapter, except for a finding of incompetency due to a physical or mental disability: (A) For an individual practitioner, in an amount not to exceed one thousand dollars ($1,000) per violation. (B) For a business entity, in an amount not to exceed five thousand dollars ($5,000) per violation. When imposing a fine, the board shall consider a practitioner's ability to pay the amount assessed. If the practitioner fails to pay the fine within the time specified by the board, the board may suspend the practitioner's license without additional proceedings. However, a suspension may not be imposed if the sole basis for the suspension is the practitioner's inability to pay a fine. (b) The board may withdraw or modify the probation under subsection (a)(5) if it finds, after a hearing, that the deficiency that required disciplinary action has been remedied, or that changed circumstances warrant a modification of the order. As added by P.L.152-1988, SEC.1. Amended by P.L.48-1991, SEC.21; P.L.22-1999, SEC.5; P.L.32-2000, SEC.10; P.L.211-2001, SEC.3; P.L.29-2026, SEC.26.

Ind. Code § 25-1-9-10 Summary license suspension pending final adjudication; notice; opportunity to be heard

Sec. 10. (a) The board may summarily suspend a practitioner's license for ninety (90) days before a final adjudication or during the appeals process if the board finds that a practitioner represents a clear and immediate danger to the public health and safety if the practitioner is allowed to continue to practice. The summary suspension may be renewed upon a hearing before the board, and each renewal may be for ninety (90) days or less. (b) Before the board may summarily suspend a license that has been issued under IC 25-22.5, IC 25-38.1, or IC 25-14, the consumer protection division of the attorney general's office shall make a reasonable attempt to notify a practitioner of a hearing by the board to suspend a practitioner's license and of information regarding the allegation against the practitioner. The consumer protection division of the attorney general's office shall also notify the practitioner that the practitioner may provide a written or an oral statement to the board on the practitioner's behalf before the board issues an order for summary suspension. A reasonable attempt to reach the practitioner is made if the consumer protection division of the attorney general's office attempts to reach the practitioner by telephone or facsimile at the last telephone number of the practitioner on file with the board. (c) After a reasonable attempt is made to notify a practitioner under subsection (b): (1) a court may not stay or vacate a summary suspension of a practitioner's license for the sole reason that the practitioner was not notified; and (2) the practitioner may not petition the board for a delay of the summary suspension proceedings. As added by P.L.152-1988, SEC.1. Amended by P.L.43-1995, SEC.2; P.L.71-2000, SEC.18; P.L.2-2008, SEC.60.

Ind. Code § 25-1-9-10.1 Retention of clinical consultants and experts to advise on suspension

Sec. 10.1. The attorney general may retain the services of a clinical consultant or an expert to provide the attorney general with advice concerning the acts that are the subject of a suspension under this chapter. As added by P.L.43-1995, SEC.3.

Ind. Code § 25-1-9-11 Reinstatement of suspended licenses

Sec. 11. The board may reinstate a license which has been suspended under this chapter if, after a hearing, the board is satisfied that the applicant is able to practice with reasonable skill and safety to the public. As a condition of reinstatement, the board may impose disciplinary or corrective measures authorized under this chapter. As added by P.L.152-1988, SEC.1.

Ind. Code § 25-1-9-12 Reinstatement of revoked license

Sec. 12. The board may not reinstate a license that has been revoked under this chapter. An individual whose license has been revoked under this chapter may not apply for a new license until seven (7) years after the date of revocation. As added by P.L.152-1988, SEC.1.

Ind. Code § 25-1-9-13 Consistency of sanctions prescribed

Sec. 13. The board shall seek to achieve consistency in the application of the sanctions authorized in this section. Significant departures from prior decisions involving similar conduct must be explained in the board's findings or orders. As added by P.L.152-1988, SEC.1.

Ind. Code § 25-1-9-14 Surrender of practitioner's license instead of hearing; approval

Sec. 14. A practitioner may petition the board to accept the surrender of the practitioner's license instead of a hearing before the board. The practitioner may not surrender the practitioner's license without the written approval of the board, and the board may impose any conditions appropriate to the surrender or reinstatement of a surrendered license. As added by P.L.152-1988, SEC.1.

Ind. Code § 25-1-9-15 Costs in disciplinary proceedings

Sec. 15. Practitioners who have been subjected to disciplinary sanctions may be required by a board to pay for the costs of the proceeding. The practitioner's ability to pay shall be considered when costs are assessed. If the practitioner fails to pay the costs, a suspension may not be imposed solely upon the practitioner's inability to pay the amount assessed. These costs are limited to costs for the following: (1) Court reporters. (2) Transcripts. (3) Certification of documents. (4) Photoduplication. (5) Witness attendance and mileage fees. (6) Postage. (7) Expert witnesses. (8) Depositions. (9) Notarizations. (10) Administrative law judges. As added by P.L.152-1988, SEC.1. Amended by P.L.158-2003, SEC.3.

Ind. Code § 25-1-9-16 Refusal of licensure or grant of probationary license

Sec. 16. (a) The board may refuse to issue a license or may issue a probationary license to an applicant for licensure if: (1) the applicant has been disciplined by a licensing entity of any state or jurisdiction, or has committed an act that would have subjected the applicant to the disciplinary process had the applicant been licensed in Indiana when the act occurred; and (2) the violation for which the applicant was, or could have been, disciplined has a direct bearing on the applicant's ability to competently practice in Indiana. (b) The board may: (1) refuse to issue a license; or (2) issue a probationary license; to an applicant for licensure if the applicant practiced without a license in violation of the law. (c) Whenever the board issues a probationary license, the board may impose one (1) or more of the following conditions: (1) Report regularly to the board upon the matters that are the basis of the discipline of the other state or jurisdiction. (2) Limit practice to those areas prescribed by the board. (3) Continue or renew professional education. (4) Engage in community restitution or service without compensation for a number of hours specified by the board. (5) Perform or refrain from performing an act that the board considers appropriate to the public interest or to the rehabilitation or treatment of the applicant. (d) The board shall remove any limitations placed on a probationary license under this section if the board finds after a hearing that the deficiency that required disciplinary action has been remedied. As added by P.L.33-1993, SEC.15. Amended by P.L.32-2000, SEC.11; P.L.197-2007, SEC.23.

Ind. Code § 25-1-9-17 Applicant appearance before board

Sec. 17. The board may require an applicant for licensure to appear before the board before issuing a license. As added by P.L.33-1993, SEC.16. Amended by P.L.84-2010, SEC.17.

Ind. Code § 25-1-9-18 Fitness determination of health care provider; filing complaint

Sec. 18. (a) If the insurance commissioner forwards to the board the name of a practitioner under IC 34-18-9-4(a) (or IC 27-12-9-4(a) before its repeal), the board shall consider whether: (1) the practitioner has become unfit to practice under section 4 of this chapter; and (2) a complaint should be filed under IC 25-1-7-4. (b) If the board determines that a complaint should be filed under subsection (a), the board must report to the consumer protection division whether the board will schedule the matter: (1) for informal negotiation under IC 25-1-7-6; (2) on the board's agenda for a vote requesting that the attorney general prosecute the matter before the board under IC 25-1-7-7; or (3) on the board's agenda for a vote on summary suspension of the practitioner's license pending prosecution of the matter before the board under IC 25-1-7-7. (c) A board may designate a board member or staff member to act on behalf of the board under this section. As added by P.L.43-1995, SEC.4. Amended by P.L.1-1998, SEC.131.

Ind. Code § 25-1-9-19 Third party billing notice

Sec. 19. A practitioner that provides to a patient notice concerning a third party billing for a health care service provided to the patient shall ensure that the notice: (1) conspicuously states that the notice is not a bill; (2) does not include a tear-off portion; and (3) is not accompanied by a return mailing envelope. As added by P.L.178-2003, SEC.12.

Ind. Code § 25-1-9-21 Rules; management and disposition of health records

Sec. 21. The board may adopt rules under IC 4-22-2 to establish requirements for the management and disposition of health records (as defined in IC 16-18-2-168) on the discontinuation of practice by: (1) sale; (2) transfer; (3) closure; (4) disciplinary action; (5) retirement; or (6) death; of the practitioner. As added by P.L.177-2009, SEC.16.

Ind. Code § 25-1-9-22 Prohibition on release of screening and test results

Sec. 22. (a) This section applies to: (1) a physician licensed under IC 25-22.5; (2) a physician assistant licensed under IC 25-27.5; (3) a certified direct entry midwife licensed under IC 25-23.4; and (4) an advanced practice registered nurse licensed under IC 25-23; who provides prenatal care within the scope of the provider's license. (b) Unless ordered by a court, an individual described in subsection (a) may not release to a law enforcement agency (as defined in IC 35-47-15-2) or the department of child services (established by IC 31-25-1-1) the results of: (1) a verbal screening or questioning concerning drug or alcohol use; (2) a urine test; or (3) a blood test; provided to a pregnant woman without the pregnant woman's consent. As added by P.L.33-2016, SEC.1. Amended by P.L.129-2018, SEC.24; P.L.292-2019, SEC.3.

Ind. Code § 25-1-9-23 In network practitioner charge limited to network plan rate; conditions for reimbursement of out of network practitioner at higher rate

Sec. 23. (a) This section does not apply to emergency services. (b) As used in this section, "covered individual" means an individual who is entitled to be provided health care services at a cost established according to a network plan. (c) As used in this section, "emergency services" means services that are: (1) furnished by a provider qualified to furnish emergency services; and (2) needed to evaluate or stabilize an emergency medical condition. (d) As used in this section, "in network practitioner" means a practitioner who is required under a network plan to provide health care services to covered individuals at not more than a preestablished rate or amount of compensation. (e) As used in this section, "network plan" means a plan under which facilities and practitioners are required by contract to provide health care services to covered individuals at not more than a preestablished rate or amount of compensation. (f) As used in this section, "out of network" means that the health care services provided by the practitioner to a covered individual are not subject to the covered individual's health carrier network plan. (g) As used in this section, "practitioner" means the following: (1) An individual who holds: (A) an unlimited license, certificate, or registration; (B) a limited or probationary license, certificate, or registration; (C) a temporary license, certificate, registration, or permit; (D) an intern permit; or (E) a provisional license; issued by the board (as defined in IC 25-0.5-11-1) regulating the profession in question. (2) An entity that: (A) is owned by, or employs; or (B) performs billing for professional health care services rendered by; an individual described in subdivision (1). The term does not include a dentist licensed under IC 25-14, an optometrist licensed under IC 25-24, or a provider facility (as defined in IC 25-1-9.8-10). (h) An in network practitioner who provides covered health care services to a covered individual may not charge more for the covered health care services than allowed according to the rate or amount of compensation established by the individual's network plan. (i) An out of network practitioner who provides health care services at an in network facility to a covered individual may not be reimbursed more for the health care services than allowed according to the rate or amount of compensation established by the covered individual's network plan unless all of the following conditions are met: (1) At least five (5) business days before the health care services are scheduled to be provided to the covered individual, the practitioner provides to the covered individual, on a form separate from any other form provided to the covered individual by the practitioner, a statement in conspicuous type that meets the following requirements: (A) Includes a notice reading substantially as follows: "[Name of practitioner] is an out of network practitioner providing [type of care] with [name of in network facility], which is an in network provider facility within your health carrier's plan. [Name of practitioner] will not be allowed to bill you the difference between the price charged by the practitioner and the rate your health carrier will reimburse for the services during your care at [name of in network facility] unless you give your written consent to the charge.". (B) Sets forth the practitioner's good faith estimate of the amount that the practitioner intends to charge for the health care services provided to the covered individual. (C) Includes a notice reading substantially as follows concerning the good faith estimate set forth under clause (B): "The estimate of our intended charge for [name or description of health care services] set forth in this statement is provided in good faith and is our best estimate of the amount we will charge. If our actual charge for [name or description of health care services] exceeds our estimate by the greater of: (i) one hundred dollars ($100); or (ii) five percent (5%); we will explain to you why the charge exceeds the estimate.". (2) The covered individual signs the statement provided under subdivision (1), signifying the covered individual's consent to the charge for the health care services being greater than allowed according to the rate or amount of compensation established by the network plan. (j) If an out of network practitioner does not meet the requirements of subsection (i), the out of network practitioner shall include on any bill remitted to a covered individual a written statement in conspicuous type stating that the covered individual is not responsible for more than the rate or amount of compensation established by the covered individual's network plan plus any required copayment, deductible, or coinsurance. (k) If a covered individual's network plan remits reimbursement to the covered individual for health care services subject to the reimbursement limitation of subsection (i), the network plan shall provide with the reimbursement a written statement in conspicuous type that states that the covered individual is not responsible for more than the rate or amount of compensation established by the covered individual's network plan and that is included in the reimbursement plus any required copayment, deductible, or coinsurance. (l) If the charge of a practitioner for health care services provided to a covered individual exceeds the estimate provided to the covered individual under subsection (i)(1)(B) by the greater of: (1) one hundred dollars ($100); or (2) five percent (5%); the facility or practitioner shall explain in a writing provided to the covered individual why the charge exceeds the estimate. (m) An in network practitioner is not required to provide a covered individual with the good faith estimate if the nonemergency health care service is scheduled to be performed by the practitioner within two (2) business days after the health care service is ordered. (n) The department of insurance shall adopt rules under IC 4-22-2 to specify the requirements of the notifications set forth in subsections (j) and (k). (o) The requirements of this section do not apply to a practitioner who: (1) is required to comply with; and (2) is in compliance with; 45 CFR Part 149, Subparts E and G, as may be enforced and amended by the federal Department of Health and Human Services. As added by P.L.93-2020, SEC.6. Amended by P.L.32-2021, SEC.68; P.L.202-2021, SEC.1; P.L.165-2022, SEC.1; P.L.190-2023, SEC.8; P.L.93-2024, SEC.180; P.L.215-2025, SEC.41.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/25Fetched: 10/17/2026