Indiana § 27-13-7-27 Reimbursement for emergency medical services

Indiana Statutes

§ 27-13-7-27 — Reimbursement for emergency medical services

Indiana·Title 27 INSURANCE·Art. 13 HEALTH MAINTENANCE ORGANIZATIONS·Ch. 7 Requirements for Group Contracts, Individual Contracts,

(a)This section applies to each of the following:

(1)An individual contract.

(2)A group contract.

(b)As used in this section, "emergency medical services" has the meaning set forth in IC 16-18-2-110.

(c)As used in this section, "emergency medical services provider organization" means a provider of emergency medical services that is certified by the Indiana emergency medical services commission as an advanced life support provider organization under rules adopted under IC 16-31-3.

(d)An individual contract and a group contract that provide coverage for emergency medical services must provide reimbursement for emergency medical services that are:

(1)rendered by an emergency medical services provider organization;

(2)within the emergency medical services provider organization's scope

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(a) This section applies to each of the
following:
(1) An individual contract.
(2) A group contract.
(b) As used in this section, "emergency medical services" has the
meaning set forth in IC 16-18-2-110.
(c) As used in this section, "emergency medical services provider
organization" means a provider of emergency medical services that is
certified by the Indiana emergency medical services commission as an
advanced life support provider organization under rules adopted under
IC 16-31-3.
(d) An individual contract and a group contract that provide
coverage for emergency medical services must provide reimbursement
for emergency medical services that are:
(1) rendered by an emergency medical services provider
organization;
(2) within the emergency medical services provider organization's
scope of practice;
(3) performed or provided as advanced life support services; and
(4) performed or provided:
(A) during a response initiated through the 911 system; or
(B) as part of a mobile integrated healthcare program described
in IC 16-31-12;
regardless of whether the patient is transported.
(e) Reimbursement for basic and advanced life support services
through a contract to which this section applies must be provided on an
equal basis regardless of whether the services involve transportation of
the patient by ambulance.
(f) If multiple emergency medical services provider organizations
qualify and submit a claim for reimbursement under this section, the
health maintenance organization:
(1) may reimburse under this section only for one (1) claim per
patient encounter; and
(2) shall reimburse the claim submitted by the emergency medical
services provider organization that performed or provided the
majority of advanced life support services.
(g) The department may adopt rules under IC 4-22-2 to implement
this section.
(h) This section does not require an individual contract or a group
contract to provide coverage for emergency medical services.

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