§ 27-1-37.5-24 — Emergency admission or provision of emergency health care services

Indiana § 27-1-37.5-24

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 1: DEPARTMENT OF INSURANCE
• Ch. 37.5: Health Care Service Prior Authorization

Text

(a) A utilization review entity shall allow
a covered individual and a covered individual's health care provider at
least twenty-four (24) hours (excluding weekends and state and federal
legal holidays) after an emergency admission or provision of
emergency health care services for the covered individual or health
care provider to notify the utilization review entity of the emergency
admission or provision of the emergency health care service.
(b) A utilization review entity shall cover emergency health care
services necessary to screen and stabilize a covered individual. If a
health care provider certifies in writing to a utilization review entity not
later than seventy-two (72) hours (excluding weekends and state and
federal legal holidays) after a covered individual's emergency
admission that the covered individual's condition required the
emergency health care service, the certification will create a
presumption that the emergency health care service was medically
necessary. The presumption may be rebutted only if the utilization
review entity can establish, with clear and convincing evidence, that
the emergency health care service was not medically necessary.
(c) The medical necessity of an emergency health care service may
not be based on whether the service was provided by a participating or
nonparticipating provider. Any restriction on the coverage of an
emergency health care service provided by a nonparticipating provider
may not be greater than the restriction that applies when the service is
provided by a participating provider.

Legislative History

As added by P.L.144-2025, SEC.32.