Ind. Code ch. 27-1-2.3

Ind. Code ch. 27-1-2.3
in effect

Ind. Code § 27-1-2.3-0.5 Application

Sec. 0.5. This chapter does not apply to the following: (1) The Medicaid program. (2) Ambulance services owned or operated by a health system (as defined in IC 16-18-2-168.5) that bill for ambulance services under the health system. As added by P.L.163-2024, SEC.4.

Ind. Code § 27-1-2.3-1 "Ambulance"

Sec. 1. As used in this chapter, "ambulance" refers only to a vehicle that is used to provide ambulance service on land. As added by P.L.170-2022, SEC.36.

Ind. Code § 27-1-2.3-2 "Ambulance service provider"

Sec. 2. As used in this chapter, "ambulance service provider" means a person that: (1) provides ambulance service; and (2) holds a valid certificate issued by the commission under IC 16-31-3 authorizing the person to provide ambulance service. As added by P.L.170-2022, SEC.36.

Ind. Code § 27-1-2.3-2.8 "Clean claim"

Sec. 2.8. As used in this chapter, "clean claim" means a claim for payment for ambulance service: (1) that is submitted to a health plan by an ambulance service provider; and (2) about which there is no defect, impropriety, or particular circumstance requiring special treatment that may prevent or delay payment. As added by P.L.163-2024, SEC.5.

Ind. Code § 27-1-2.3-3 "Covered individual"

Sec. 3. As used in this chapter, "covered individual" means an individual who is entitled to coverage under a health plan. As added by P.L.170-2022, SEC.36.

Ind. Code § 27-1-2.3-4 "Health plan"

Sec. 4. (a) As used in this chapter, "health plan" means either of the following: (1) A policy of accident and sickness insurance as defined in IC 27-8-5-1, but not including any insurance, plan, or policy set forth in IC 27-8-5-2.5(a). (2) An individual contract (as defined in IC 27-13-1-21) or a group contract (as defined in IC 27-13-1-16) with a health maintenance organization that provides coverage for basic health care services (as defined in IC 27-13-1-4). (b) The term does not include the state employee health plan. As added by P.L.170-2022, SEC.36. Amended by P.L.163-2024, SEC.6.

Ind. Code § 27-1-2.3-5 "Health plan operator"

Sec. 5. As used in this chapter, "health plan operator" means the following: (1) In the case of a health plan described in section 4(a)(1) of this chapter, the insurer that issued the policy. (2) In the case of a health plan described in section 4(a)(2) of this chapter, the health maintenance organization that entered into the contract. As added by P.L.170-2022, SEC.36. Amended by P.L.163-2024, SEC.7.

Ind. Code § 27-1-2.3-6 "Nonparticipating" or "participating"

Sec. 6. For purposes of this chapter: (1) an ambulance service provider that provides ambulance service to an individual covered by a health plan is "nonparticipating" with respect to the health plan if the ambulance service provider has not, by contract, affiliation, agreement, or any other means, agreed to be compensated by the health plan at no more than a certain amount or rate for the ambulance service; and (2) an ambulance service provider that provides ambulance service to an individual covered by a health plan is "participating" with respect to the health plan if the ambulance service provider has agreed to be compensated by the health plan at no more than a certain amount or rate for the ambulance service. As added by P.L.170-2022, SEC.36.

Ind. Code § 27-1-2.3-7 "Person"

Sec. 7. As used in this chapter, "person" means an individual, a corporation, a limited liability company, a partnership, or another legal entity. As added by P.L.170-2022, SEC.36.

Ind. Code § 27-1-2.3-7.5 "State employee health plan"

Sec. 7.5. As used in this chapter, "state employee health plan" means either of the following: (1) A self-insurance program established under IC 5-10-8-7(b) to provide group coverage. (2) A prepaid health care delivery plan through which health services are provided under IC 5-10-8-7(c). As added by P.L.163-2024, SEC.8.

Ind. Code § 27-1-2.3-8 Fair negotiation of rates and terms for ambulance service; rate negotiations; considerations

Sec. 8. (a) The state shall fairly negotiate rates and terms with any ambulance service provider willing to become a participating provider with respect to the state employee health plan. (b) In negotiations under subsection (a), the state employee health plan must consider all of the following: (1) The ambulance service provider's usual and customary rates. (2) The ambulance service provider's resources, and whether the ambulance service provider's staff is available twenty-four (24) hours per day every day. (3) The average wages and fuel costs in the geographical area in which the ambulance service provider operates. (4) The number of times in which individuals covered by the state employee health plan have sought ambulance service from the ambulance service provider but the ambulance service provider's response was canceled or did not result in a transport. (5) The local ordinances and state rules concerning staffing, response times, and equipment under which the ambulance service provider must operate. (6) The types of requests for ambulance service for individuals covered by the state employee health plan that the ambulance service provider generally receives, and the requesting party or agency by which those requests are generally made. (7) The average reimbursement rate per level of service that the ambulance service provider generally receives as a nonparticipating provider. (8) The specific: (A) clinical and staff capabilities; and (B) equipment resources; that an ambulance service provider must have to adequately meet the needs of individuals covered by the state employee health plan, such as for the transportation of individuals covered by the state employee health plan from one (1) hospital to another after traumatic injury. (9) The average transport cost data reported to the office of the secretary of family and social services by governmental ambulance service providers located within the counties, and contiguous counties, that the nonparticipating ambulance service provider serves. As added by P.L.170-2022, SEC.36. Amended by P.L.92-2023, SEC.1; P.L.163-2024, SEC.9.

Ind. Code § 27-1-2.3-8.1 Health plan operator payment to a nonparticipating ambulance service

Sec. 8.1. A health plan operator shall provide payment to a nonparticipating ambulance service provider for ambulance service provided to a covered individual: (1) at a rate set or approved, by contract or ordinance, by the county or municipality in which the ambulance service originated; (2) at the rate of four hundred percent (400%) of the current published rate for ambulance service as established by the Centers for Medicare and Medicaid Services under Title XVIII of the federal Social Security Act (42 U.S.C. 1395 et seq.) for the same ambulance service provided in the same geographic area; or (3) according to the nonparticipating ambulance service provider's billed charges; whichever is less. As added by P.L.163-2024, SEC.10.

Ind. Code § 27-1-2.3-8.2 Health plan operator payment in full to a nonparticipating ambulance service provider; limits on cost sharing amounts that a covered individual pays

Sec. 8.2. (a) If a health plan operator makes payment to a nonparticipating ambulance service provider according to section 8.1 of this chapter for ambulance service provided to a covered individual: (1) the payment shall be considered payment in full for the ambulance service provided, except for any copayment, coinsurance, deductible, and other cost sharing amounts that the health plan requires the covered individual to pay; and (2) the nonparticipating ambulance service provider is prohibited from billing the covered individual for any additional amount for the ambulance service provided. (b) The copayment, coinsurance, deductible, and other cost sharing amounts that a health plan requires a covered individual to pay in connection with ambulance service provided to the covered individual by a nonparticipating ambulance service provider shall not exceed the copayment, coinsurance, deductible, and other cost sharing amounts that the covered individual would be required to pay if the ambulance service had been provided to the covered individual by a participating ambulance service provider. As added by P.L.163-2024, SEC.11.

Ind. Code § 27-1-2.3-8.3 Procedures for remitting payment to a nonparticipating ambulance provider for claims

Sec. 8.3. (a) A health plan operator that receives a clean claim for ambulance service provided to a covered individual by a nonparticipating ambulance service provider: (1) shall remit payment for the ambulance service directly to the nonparticipating ambulance service provider not more than thirty (30) days after receiving the clean claim; and (2) shall not send payment to the covered individual. (b) If a claim that a health plan operator receives for ambulance service provided to a covered individual by a nonparticipating ambulance service provider is not a clean claim, the health plan operator, not more than thirty (30) days after receiving the claim, shall: (1) remit payment for the ambulance service directly to the nonparticipating ambulance service provider; or (2) send to the nonparticipating ambulance service provider a written notice that: (A) acknowledges the date of the receipt of the claim; and (B) either: (i) states that the health plan operator is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full; or (ii) states that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed. As added by P.L.163-2024, SEC.12.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/27Fetched: 10/17/2026

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