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

§ 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.

IC 25-1-9.1Chapter 9.1. Out of Network Provider Referrals

25-1-9.1-1Application of chapter 25-1-9.1-2"Affiliated" 25-1-9.1-3"Covered individual" 25-1-9.1-4"Emergency medical condition" 25-1-9.1-5"Health plan" 25-1-9.1-6"Network" 25-1-9.1-7"Network provider" 25-1-9.1-8"Out of network provider" 25-1-9.1-9"Provider" 25-1-9.1-10"Provider group" 25-1-9.1-11"Referral" 25-1-9.1-12Notice to covered individual upon referral; notice for telephone referral

IC 25-1-9.1-1Application of chapter Sec. 1. (a) This chapter applies to a referral made after December 31, 2017.

(b) This chapter does not apply to the following:

(1) A referral for treatment of an emergency medical condition.

(2) A referral made:

(A) immediately following treatment of an emergency medical condition; and

(B) by the provider that rendered the treatment of the emergency medical condition.

(3) A referral for medically or psychologically necessary therapeutic services rendered to an admitted patient in:

(A) a hospital; or

(B) another facility to which a patient may be admitted for more than twenty-four (24) hours.

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-2"Affiliated" Sec. 2. As used in this chapter, "affiliated" refers to a provider that is a member of the same provider group as another provider.

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-3"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.147-2017, SEC.1.

IC 25-1-9.1-4"Emergency medical condition" Sec. 4. As used in this chapter, "emergency medical condition" means a medical condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent lay person who possesses an average knowledge of health and medicine to:

(1) place an individual's (including, with respect to a pregnant woman, her unborn child's) health in serious jeopardy;

(2) result in serious impairment to the individual's (including, with respect to a pregnant woman, her unborn child's) bodily functions; or

(3) result in serious dysfunction of a bodily organ or part of the individual (including, with respect to a pregnant woman, her unborn child).

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-5"Health plan" Sec. 5. (a) As used in this chapter, "health plan" means:

(1) a policy of accident and sickness insurance (as defined in IC 27-8-5-1);

(2) an individual contract or a group contract with a health maintenance organization under IC 27-13; or

(3) another plan or program that provides payment, reimbursement, or indemnification for the costs of health care items or services;

that conditions the payment of benefits, in whole or in part, on a covered individual's use of providers that have agreed to be part of a network.

(b) The term does not include the following:

(1) Worker's compensation or similar insurance.

(2) Benefits provided under a certificate of exemption issued by the worker's compensation board under IC 22-3-2-5.

(3) Medicaid (IC 12-15).

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-6"Network" Sec. 6. As used in this chapter, "network" means a group of two (2) or more providers that have entered into:

(1) an agreement with an insurer under IC 27-8-11-3;

(2) a participating provider contract with a health maintenance organization under IC 27-13; or

(3) an agreement with another person specifying terms and conditions of the providers' rendering of health care items or services to covered individuals.

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-7"Network provider" Sec. 7. As used in this chapter, "network provider" means a provider described in section 6 of this chapter.

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-8"Out of network provider" Sec. 8. As used in this chapter, "out of network provider" means a provider that is not described in section 6 of this chapter.

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-9"Provider" Sec. 9. (a) As used in this chapter, "provider" means a practitioner described in IC 25-1-9-2(a)(1).

(b) The term does not include an individual who holds a license, certification, registration, or permit issued under the following:

(1) IC 25-19.

(2) IC 25-38.1.

(c) The term includes a provider group.

As added by P.L.147-2017, SEC.1. Amended by P.L.36-2022, SEC.6.

IC 25-1-9.1-10"Provider group" Sec. 10. As used in this chapter, "provider group" means a legal entity:

(1) that is owned by or employs one (1) or more providers; and

(2) through which billing is performed for health care items and services rendered by the providers.

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-11"Referral" Sec. 11. (a) As used in this chapter, "referral" means a recommendation or direction made by a provider to a covered individual that the covered individual receive a health care item or service rendered by another provider that is not affiliated with the first provider.

(b) The term does not include a recommendation or direction made by a provider to a covered individual that the covered individual receive a health care item or service rendered by another provider that is:

(1) affiliated with; or

(2) not specifically identified by name by;

the first provider.

As added by P.L.147-2017, SEC.1.

IC 25-1-9.1-12Notice to covered individual upon referral; notice for telephone referral Sec. 12. (a) This section does not apply to a referral made by a provider that has confirmed that the provider to which a covered individual is referred is a network provider with respect to the covered individual's health plan.

(b) A provider that makes a referral shall provide to the covered individual an electronic or paper copy of written notice that states all of the following:

(1) That an out of network provider may be called upon to render health care items or services to the covered individual during the course of treatment.

(2) That an out of network provider described in subdivision (1) is not bound by the payment provisions that apply to health care items or services rendered by a network provider under the covered individual's health plan.

(3) That the covered individual may contact the covered individual's health plan before receiving health care items or services rendered by an out of network provider described in subdivision (1):

(A) to obtain a list of network providers that may render the health care items or services; and

(B) for additional assistance.

(c) A provider that makes a referral via telephone to a patient of record shall provide to the covered individual all of the following information:

(1) That an out of network provider may be called upon to render health care items or services to the covered individual during the course of treatment.

(2) That an out of network provider described in subdivision (1) is not bound by the payment provisions that apply to health care items or services rendered by a network provider under the covered individual's health plan.

(3) That the covered individual may contact the covered individual's health plan before receiving health care items or services rendered by an out of network provider described in subdivision (1):

(A) to obtain a list of network providers that may render the health care items or services; and

(B) for additional assistance.

(4) The provider shall note in the covered individual's medical chart:

(A) the name of the provider to whom the covered individual was referred; and

(B) that the referral was made via telephone.

As added by P.L.147-2017, SEC.1. Amended by P.L.121-2018, SEC.2; P.L.182-2018, SEC.2.

IC 25-1-9.3Chapter 9.3. Electronically Transmitted Prescriptions for Controlled Substances

25-1-9.3-1Issuance of prescriptions 25-1-9.3-2"Board" 25-1-9.3-3"Controlled substance" 25-1-9.3-4"Electronically transmitted" 25-1-9.3-5"Prescriber" 25-1-9.3-6"Prescription" 25-1-9.3-7Issuance of a prescription for a controlled substance 25-1-9.3-8Prescription for controlled substance in written or faxed format or by oral order 25-1-9.3-9Rules; substantial similarity to federal requirements and exceptions 25-1-9.3-10Pharmacists and pharmacies and violations 25-1-9.3-11Violations and disciplinary action by governing board

IC 25-1-9.3-1Issuance of prescriptions Sec. 1. A reference to a written or electronically transmitted prescription for a controlled substance in the Indiana Code shall be construed to be issued under this chapter.

As added by P.L.28-2019, SEC.9.

IC 25-1-9.3-2"Board" Sec. 2. As used in this chapter, "board" refers to the Indiana board of pharmacy established by IC 25-26-13-3.

As added by P.L.28-2019, SEC.9.

IC 25-1-9.3-3"Controlled substance" Sec. 3. As used in this chapter, "controlled substance" has the meaning set forth in IC 35-48-1.1-7.

As added by P.L.28-2019, SEC.9. Amended by P.L.186-2025, SEC.136.

IC 25-1-9.3-4"Electronically transmitted" Sec. 4. As used in this chapter, "electronically transmitted" or "electronic transmission" has the meaning set forth in IC 25-26-13-2.

As added by P.L.28-2019, SEC.9.

IC 25-1-9.3-5"Prescriber" Sec. 5. As used in this chapter, "prescriber" means any of the following:

(1) A dentist licensed under IC 25-14.

(2) A physician licensed under IC 25-22.5.

(3) An advanced practice registered nurse licensed and granted the authority to prescribe under IC 25-23.

(4) An optometrist licensed under IC 25-24.

(5) A physician assistant licensed under IC 25-27.5 and granted the authority to prescribe by the physician assistant's supervisory physician in accordance with IC 25-27.5-5-4.

(6) A podiatrist licensed under IC 25-29.

As added by P.L.28-2019, SEC.9.

IC 25-1-9.3-6"Prescription" Sec. 6. As used in this chapter, "prescription" has the meaning set forth in IC 25-26-13-2.

As added by P.L.28-2019, SEC.9.

IC 25-1-9.3-7Issuance of a prescription for a controlled substance Sec. 7. After December 31, 2021, except as provided in section 8 of this chapter, a prescriber shall issue a prescription for a controlled substance:

(1) in an electronic format; and

(2) by electronic transmission from the prescriber to a pharmacy;

in accordance with rules adopted by the board under IC 25-26-13-4(d).

As added by P.L.28-2019, SEC.9. Amended by P.L.207-2021, SEC.22.

IC 25-1-9.3-8Prescription for controlled substance in written or faxed format or by oral order Sec. 8. Beginning January 1, 2022, a prescriber may issue a prescription for a controlled substance in a written format, a faxed format, or an oral order if any of the following apply:

(1) The prescriber cannot transmit an electronically transmitted prescription due to:

(A) temporary technological or electrical failure;

(B) the technological inability to issue a prescription electronically, including but not limited to failure to possess the requisite technology; or

(C) the inability of the dispensing pharmacy or provider to receive or process an electronically transmitted prescription.

(2) The prescriber issues a prescription to be dispensed by a pharmacy located outside Indiana.

(3) The prescriber and the pharmacist are the same entity.

(4) The prescriber issues a prescription that meets any of the following:

(A) The prescription contains elements that are not supported by the technical standards developed by the National Council for Prescription Drug Programs for electronically transmitted prescriptions (NCPDP SCRIPT).

(B) The federal Food and Drug Administration requires the prescription to contain certain elements that cannot be supported in an electronically transmitted prescription.

(C) The prescription is a non-patient specific prescription in response to a public health emergency or another instance allowable under state law and that requires a non-patient specific prescription under:

(i) a standing order;

(ii) approved protocol for drug therapy;

(iii) collaborative drug management; or

(iv) comprehensive medication management.

(D) The prescription is issued under a research protocol.

(5) The prescriber has received a waiver or a renewal of a previously received waiver from the board in accordance with rules adopted under section 9 of this chapter.

(6) The board, in accordance with rules adopted under section 9 of this chapter, has determined that issuing an electronically transmitted prescription would be impractical and cause delay, adversely impacting the patient's medical condition.

(7) The prescriber reasonably determines that it would be impractical for the patient to obtain an electronic prescription in a timely manner and the delay would adversely affect the patient's medical condition.

As added by P.L.28-2019, SEC.9. Amended by P.L.114-2020, SEC.8; P.L.207-2021, SEC.23.

IC 25-1-9.3-9Rules; substantial similarity to federal requirements and exceptions Sec. 9. (a) The board shall, in consultation with the medical licensing board, adopt rules under IC 4-22-2 to implement this chapter, including:

(1) a process to grant or deny waivers or renewals of waivers from the requirement to issue electronically transmitted prescriptions for controlled substances due to:

(A) economic hardship;

(B) technological limitations outside the control of the prescriber that are not otherwise specified in section 8 of this chapter; or

(C) other circumstances determined by the board; and

(2) a list of circumstances in which issuing an electronically transmitted prescription would be impractical and cause delay that would adversely impact the user's medical condition.

(b) Any rules adopted under this chapter must be substantially similar to the requirements and exceptions under:

(1) 42 U.S.C. 1395w-104; and

(2) any regulations adopted under 42 U.S.C. 1395w-104.

(c) A provision described in:

(1) section 8(1) through 8(4);

(2) section 8(6); and

(3) section 8(7);

of this chapter does not require a waiver of any rule adopted under this chapter.

As added by P.L.28-2019, SEC.9. Amended by P.L.114-2020, SEC.9; P.L.207-2021, SEC.24; P.L.93-2024, SEC.181.

IC 25-1-9.3-10Pharmacists and pharmacies and violations Sec. 10. The following do not violate this chapter if the pharmacy or pharmacist fills a written, faxed, or oral prescription for a controlled substance and the pharmacy or pharmacist is unaware that the prescription does not fall within an allowable exception under section 8 of this chapter:

(1) A pharmacy.

(2) A pharmacist.

As added by P.L.28-2019, SEC.9.

IC 25-1-9.3-11Violations and disciplinary action by governing board Sec. 11. A prescriber who violates this chapter is subject to disciplinary action by the prescriber's governing board under IC 25-1-9.

As added by P.L.28-2019, SEC.9.

IC 25-1-9.5Chapter 9.5. Telehealth Services and Prescriptions

25-1-9.5-0.5Prohibition on using telehealth for abortion 25-1-9.5-1Allows agreements to alternative locations for providing telehealth 25-1-9.5-2"Distant site" 25-1-9.5-2.2"Eye care professional" 25-1-9.5-2.5"Health care services" 25-1-9.5-2.8"Ophthalmic device" 25-1-9.5-3"Originating site" 25-1-9.5-3.5"Practitioner" 25-1-9.5-4"Prescriber" 25-1-9.5-4.5"Refraction" 25-1-9.5-5"Store and forward" 25-1-9.5-6"Telehealth" 25-1-9.5-7Standards for providing telehealth; maintenance of medical records; waiver of confidentiality; prohibition on requiring employee to use telehealth 25-1-9.5-8Issuance of prescription; controlled substance conditions 25-1-9.5-9Practitioner physically located outside Indiana; jurisdiction 25-1-9.5-10Discipline; penalties 25-1-9.5-11Pharmacy filling prescription 25-1-9.5-12Adoption of policies or rules 25-1-9.5-13Prescription prerequisites 25-1-9.5-14No requirement to provide or use telehealth 25-1-9.5-15Veterinarian-client-patient relationship

IC 25-1-9.5-0.5Prohibition on using telehealth for abortion Sec. 0.5. Telehealth may not be used to provide any abortion, including the writing or filling of a prescription for any purpose that is intended to result in an abortion.

As added by P.L.85-2021, SEC.8.

IC 25-1-9.5-1Allows agreements to alternative locations for providing telehealth Sec. 1. (a) This chapter does not prohibit a provider, prescriber, insurer, practitioner, or patient from agreeing to an alternative location of the patient, provider, practitioner, or prescriber to conduct telehealth.

(b) This chapter does not supersede any other statute concerning a provider or prescriber who provides health care to a patient.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.2; P.L.85-2021, SEC.9.

IC 25-1-9.5-2"Distant site" Sec. 2. As used in this chapter, "distant site" means a site at which a practitioner is located while providing health care services through telehealth.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.3; P.L.85-2021, SEC.10.

IC 25-1-9.5-2.2"Eye care professional" Sec. 2.2. As used in this chapter, "eye care professional" means either of the following:

(1) A physician licensed under IC 25-22.5 who practices ophthalmology.

(2) An optometrist licensed under IC 25-24.

As added by P.L.52-2020, SEC.1.

IC 25-1-9.5-2.5"Health care services" Sec. 2.5. (a) As used in this chapter, "health care services" includes the following:

(1) The following concerning a patient:

(A) Assessment.

(B) Diagnosis.

(C) Evaluation.

(D) Consultation.

(E) Treatment.

(F) Monitoring of a patient.

(2) Transfer of medical data.

(3) Patient health related education.

(4) Health administration.

(b) The term does not include case management services, care management services, service coordination services, or care coordination services:

(1) as defined in IC 12-7-2.1-46;

(2) provided to individuals under the Indiana Medicaid program or Medicaid waivers; or

(3) provided to individuals under any other programs administered by the office of the secretary of family and social services or the Indiana department of health.

As added by P.L.85-2021, SEC.11. Amended by P.L.109-2022, SEC.3; P.L.145-2026, SEC.136.

IC 25-1-9.5-2.8"Ophthalmic device" Sec. 2.8. As used in this chapter, "ophthalmic device" means either of the following:

(1) Eye glasses.

(2) Contact lenses.

As added by P.L.52-2020, SEC.2.

IC 25-1-9.5-3"Originating site" Sec. 3. As used in this chapter, "originating site" means any site at which a patient is located at the time health care services through telehealth are provided to the individual.

As added by P.L.78-2016, SEC.2. Amended by P.L.85-2021, SEC.12.

IC 25-1-9.5-3.5"Practitioner" Sec. 3.5. (a) As used in this chapter, "practitioner" means an individual who holds an unlimited license to practice as any of the following in Indiana:

(1) An athletic trainer licensed under IC 25-5.1.

(2) A chiropractor licensed under IC 25-10.

(3) A dental hygienist licensed under IC 25-13.

(4) The following:

(A) A dentist licensed under IC 25-14.

(B) An individual who holds a dental residency permit issued under IC 25-14-1-5.

(C) An individual who holds a dental faculty license under IC 25-14-1-5.5.

(5) A diabetes educator licensed under IC 25-14.3.

(6) A dietitian licensed under IC 25-14.5.

(7) A genetic counselor licensed under IC 25-17.3.

(8) The following:

(A) A physician licensed under IC 25-22.5.

(B) An individual who holds a temporary permit under IC 25-22.5-5-4.

(9) A nurse licensed under IC 25-23.

(10) The following:

(A) An occupational therapist licensed under IC 25-23.5.

(B) An occupational therapy assistant licensed under IC 25-23.5.

(11) Any behavioral health and human services professional licensed under IC 25-23.6.

(12) An optometrist licensed under IC 25-24.

(13) A pharmacist licensed under IC 25-26.

(14) A physical therapist licensed under IC 25-27.

(15) A physician assistant licensed under IC 25-27.5.

(16) A podiatrist licensed under IC 25-29.

(17) A psychologist licensed under IC 25-33.

(18) A respiratory care practitioner licensed under IC 25-34.5.

(19) A speech-language pathologist or audiologist licensed under IC 25-35.6.

(20) A veterinarian licensed under IC 25-38.1.

(21) A behavior analyst licensed under IC 25-8.5.

(22) A school psychologist licensed by the department of education.

(b) The term includes the following:

(1) A developmental therapist enrolled by the bureau of child development services to provide special instruction, as defined in 34 CFR 303.13(b)(14), to infants and toddlers receiving early intervention services.

(2) A peer as defined in IC 12-21-8-5 and certified by the division of mental health and addiction.

(3) A speech-language pathology assistant (IC 25-35.6-1-2(g)(3)).

(4) A clinical fellow in speech language pathology.

(5) A student who:

(A) is pursuing a course of study in, or is a graduate from, a program in a profession specified in subsection (a)(1) through (a)(22); and

(B) is providing services directed by an individual who holds a license in Indiana for that profession.

(6) The following providers within a community mental health center:

(A) A qualified behavioral health professional.

(B) Other behavioral health professional.

(7) A physical therapist assistant certified under IC 25-27-1-6.3.

(c) The term includes a behavior analyst during the time in which the professional licensing agency is preparing to implement licensure of behavioral analysts under IC 25-8.5. This subsection expires June 30, 2026.

As added by P.L.85-2021, SEC.13. Amended by P.L.207-2021, SEC.25; P.L.109-2022, SEC.4; P.L.102-2025, SEC.1; P.L.37-2025, SEC.1; P.L.186-2025, SEC.268.

IC 25-1-9.5-4"Prescriber" Sec. 4. As used in this chapter, "prescriber" means any of the following:

(1) A physician licensed under IC 25-22.5.

(2) A physician assistant licensed under IC 25-27.5 and granted the authority to prescribe by the physician assistant's collaborating physician in accordance with IC 25-27.5-5-4.

(3) An advanced practice registered nurse licensed and granted the authority to prescribe drugs under IC 25-23.

(4) An optometrist licensed under IC 25-24.

(5) A podiatrist licensed under IC 25-29.

(6) A dentist licensed under IC 25-14.

(7) A veterinarian licensed under IC 25-38.1.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.4; P.L.129-2018, SEC.25; P.L.247-2019, SEC.2; P.L.85-2021, SEC.14.

IC 25-1-9.5-4.5"Refraction" Sec. 4.5. As used in this chapter, "refraction" means a test that is performed to measure an individual's prescription for eye glasses or contact lenses.

As added by P.L.52-2020, SEC.3.

IC 25-1-9.5-5"Store and forward" Sec. 5. As used in this chapter, "store and forward" means the transmission of a patient's medical information from an originating site to the practitioner at a distant site without the patient being present.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.5; P.L.85-2021, SEC.15.

IC 25-1-9.5-6"Telehealth" Sec. 6. (a) As used in this chapter, "telehealth" means the delivery of health care services using interactive electronic communications and information technology, in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), including:

(1) secure videoconferencing;

(2) store and forward technology; or

(3) remote patient monitoring technology;

between a provider in one (1) location and a patient in another location.

(b) The term does not include the use of the following unless the practitioner has an established relationship with the patient:

(1) Electronic mail.

(2) An instant messaging conversation.

(3) Facsimile.

(4) Internet questionnaire.

(5) Internet consultation.

(c) The term does not include a health care service provided by:

(1) an employee of a practitioner; or

(2) an individual who is employed by the same entity that employs the practitioner;

who is performing a health care service listed in section 2.5(a)(2), 2.5(a)(3), or 2.5(a)(4) of this chapter under the direction and that is customarily within the specific area of practice of the practitioner.

As added by P.L.78-2016, SEC.2. Amended by P.L.85-2021, SEC.16; P.L.207-2021, SEC.26; P.L.109-2022, SEC.5.

IC 25-1-9.5-7Standards for providing telehealth; maintenance of medical records; waiver of confidentiality; prohibition on requiring employee to use telehealth Sec. 7. (a) A practitioner who:

(1) provides health care services through telehealth; or

(2) directs an employee of the practitioner to perform a health care service listed in section 2.5(a)(2), 2.5(a)(3), or 2.5(a)(4) of this chapter;

shall be held to the same standards of appropriate practice as those standards for health care services provided at an in-person setting.

(b) A practitioner who uses telehealth shall, if such action would otherwise be required in the provision of the same health care services in a manner other than telehealth, ensure that a proper provider-patient relationship is established. The provider-patient relationship by a practitioner who uses telehealth must at a minimum include the following:

(1) Obtain the patient's name and contact information and:

(A) a verbal statement or other data from the patient identifying the patient's location; and

(B) to the extent reasonably possible, the identity of the requesting patient.

(2) Disclose the practitioner's name and disclose the practitioner's licensure, certification, or registration.

(3) Obtain informed consent from the patient.

(4) Obtain the patient's medical history and other information necessary to establish a diagnosis.

(5) Discuss with the patient the:

(A) diagnosis;

(B) evidence for the diagnosis; and

(C) risks and benefits of various treatment options, including when it is advisable to seek in-person care.

(6) Create and maintain a medical record for the patient. If a prescription is issued for the patient, and subject to the consent of the patient, the prescriber shall notify the patient's primary care provider of any prescriptions the prescriber has issued for the patient if the primary care provider's contact information is provided by the patient. The requirements in this subdivision do not apply when any of the following are met:

(A) The practitioner is using an electronic health record system that the patient's primary care provider is authorized to access.

(B) The practitioner has established an ongoing provider-patient relationship with the patient by providing care to the patient at least two (2) consecutive times through the use of telehealth services. If the conditions of this clause are met, the practitioner shall maintain a medical record for the patient and shall notify the patient's primary care provider of any issued prescriptions.

(7) Issue proper instructions for appropriate follow-up care.

(8) Provide a telehealth visit summary to the patient, including information that indicates any prescription that is being prescribed.

(c) The medical records under subsection (b)(6) must be created and maintained by the practitioner under the same standards of appropriate practice for medical records for patients in an in-person setting.

(d) A patient waives confidentiality of any medical information discussed with the practitioner that is:

(1) provided during a telehealth visit; and

(2) heard by another individual in the vicinity of the patient during a health care service or consultation.

(e) An employer may not require a practitioner, by an employment contract, an agreement, a policy, or any other means, to provide a health care service through telehealth if the practitioner believes that providing a health care service through telehealth would:

(1) negatively impact the patient's health; or

(2) result in a lower standard of care than if the health care service was provided in an in-person setting.

(f) Any applicable contract, employment agreement, or policy to provide telehealth services must explicitly provide that a practitioner may refuse at any time to provide health care services if in the practitioner's sole discretion the practitioner believes:

(1) that health quality may be negatively impacted; or

(2) the practitioner would be unable to provide the same standards of appropriate practice as those provided in an in-person setting.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.6; P.L.129-2018, SEC.26; P.L.85-2021, SEC.17; P.L.109-2022, SEC.6.

IC 25-1-9.5-8Issuance of prescription; controlled substance conditions Sec. 8. (a) A prescriber may issue a prescription to a patient who is receiving services through the use of telehealth if the patient has not been examined previously by the prescriber in person if the following conditions are met:

(1) The prescriber has satisfied the applicable standard of care in the treatment of the patient.

(2) The issuance of the prescription by the prescriber is within the prescriber's scope of practice and certification.

(3) The prescription:

(A) meets the requirements of subsection (b); and

(B) is not for an opioid. However, an opioid may be prescribed if the opioid:

(i) has been approved by the federal Food and Drug Administration for the treatment of opioid addiction; and

(ii) is used to treat or manage opioid dependence.

(4) The prescription is not for an abortion inducing drug (as defined in IC 16-18-2-1.6).

(5) If the prescription is for a medical device, including an ophthalmic device, the prescriber must use telehealth technology that is sufficient to allow the provider to make an informed diagnosis and treatment plan that includes the medical device being prescribed. However, a prescription for an ophthalmic device is also subject to the conditions in section 13 of this chapter.

(b) Except as provided in subsection (a), a prescriber may issue a prescription for a controlled substance (as defined in IC 35-48-1.1-7) to a patient who is receiving services through the use of telehealth, even if the patient has not been examined previously by the prescriber in person, if the following conditions are met:

(1) The prescriber maintains a valid controlled substance registration under IC 35-48-3.

(2) The prescriber meets the conditions set forth in 21 U.S.C. 829 et seq., 21 CFR 1300, 1304, and 1306, and any other regulation enforced by the federal Drug Enforcement Agency.

(3) A practitioner acting in the usual course of the practitioner's professional practices issues the prescription for a legitimate medical purpose.

(4) The telehealth communication is conducted using an audiovisual, real time, two-way interactive communication system.

(5) The prescriber complies with the requirements of the INSPECT program (IC 25-26-24).

(6) All other applicable federal and state laws are followed.

(c) A prescription for a controlled substance under this section must be prescribed and dispensed in accordance with IC 25-1-9.3 and IC 25-26-24.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.7; P.L.51-2019, SEC.3; P.L.28-2019, SEC.10; P.L.211-2019, SEC.34; P.L.52-2020, SEC.4; P.L.85-2021, SEC.18; P.L.143-2025, SEC.44; P.L.186-2025, SEC.137.

IC 25-1-9.5-9Practitioner physically located outside Indiana; jurisdiction Sec. 9. (a) A practitioner who is physically located outside Indiana is engaged in the provision of health care services in Indiana when the practitioner:

(1) establishes a provider-patient relationship under this chapter with; or

(2) determines whether to issue a prescription under this chapter for;

an individual who is located in Indiana.

(b) A practitioner described in subsection (a) agrees to be subject to:

(1) the jurisdiction of the courts of law of Indiana; and

(2) Indiana substantive and procedural laws;

concerning any claim asserted against the practitioner, the practitioner's employer, or the practitioner's contractor arising from the provision of health care services under this chapter to an individual who is located in Indiana at the time the health care services were provided. The provision of health care services described in subsection (a)(1) and (a)(2) by a practitioner described in subsection (a) constitutes a voluntary waiver by the practitioner, the practitioner's employer, or the practitioner's contractor of any respective right to avail themselves of the jurisdiction or laws other than those specified in this subsection concerning the claim.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.8; P.L.85-2021, SEC.19; P.L.17-2024, SEC.5.

IC 25-1-9.5-10Discipline; penalties Sec. 10. (a) A practitioner who violates this chapter is subject to disciplinary action under IC 25-1-9.

(b) A practitioner's employer or a practitioner's contractor that violates this section commits a Class B infraction.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.9; P.L.85-2021, SEC.20; P.L.17-2024, SEC.6.

IC 25-1-9.5-11Pharmacy filling prescription Sec. 11. A pharmacy does not violate this chapter if the pharmacy fills a prescription for an opioid and the pharmacy is unaware that the prescription was written or electronically transmitted by a prescriber providing telehealth services under this chapter.

As added by P.L.78-2016, SEC.2. Amended by P.L.150-2017, SEC.10; P.L.28-2019, SEC.11; P.L.85-2021, SEC.21.

IC 25-1-9.5-12Adoption of policies or rules Sec. 12. The Indiana professional licensing agency may adopt policies or rules under IC 4-22-2 necessary to implement this chapter. Adoption of policies or rules under this section may not delay the implementation and provision of telehealth services under this chapter.

As added by P.L.78-2016, SEC.2. Amended by P.L.85-2021, SEC.22.

IC 25-1-9.5-13Prescription prerequisites Sec. 13. (a) As used in this section, "HIPAA" refers to the federal Health Insurance Portability and Accountability Act.

(b) A prescriber may not issue a prescription for an ophthalmic device unless the following conditions are met:

(1) If the prescription is for contact lenses or eyeglasses, the patient must be at least eighteen (18) years of age but not more than fifty-five (55) years of age.

(2) The patient must have completed a medical eye history that includes information concerning the following:

(A) Chronic health conditions.

(B) Current medications.

(C) Eye discomfort.

(D) Blurry vision.

(E) Any prior ocular medical procedures.

(3) The patient must have had a prior prescription from a qualified eye care professional that included a comprehensive in person exam that occurred within two (2) years before the initial use of telehealth for a refraction under subdivision (5)(A).

(4) If the patient desires a contact lens prescription, at the discretion of the eye care professional, that patient must have had a prior contact lens fitting or evaluation by a qualified eye care professional that occurred within two (2) years before the initial use of telehealth for a refraction under subdivision (5)(A).

(5) The patient:

(A) may not use telehealth more than two (2) consecutive times within two (2) years from the date of the examination that occurred under subdivision (3) for a refraction without a subsequent in person comprehensive eye exam; and

(B) must acknowledge that the patient has had a comprehensive eye exam as required under clause (A) before receiving an online prescription.

(6) The patient may allow the prescriber to access the patient's medical records using an appropriate HIPAA compliant process.

(7) The prescriber must ensure that the transfer of all information, including the vision test and prescription, comply with HIPAA requirements.

(8) The prescriber must use technology to allow the patient to have continuing twenty-four (24) hour a day online access to the patient's prescription as soon as the prescription is signed by the prescriber.

As added by P.L.52-2020, SEC.5. Amended by P.L.85-2021, SEC.23.

IC 25-1-9.5-14No requirement to provide or use telehealth Sec. 14. Nothing in this chapter requires an individual to provide or use telehealth.

As added by P.L.85-2021, SEC.24.

IC 25-1-9.5-15Veterinarian-client-patient relationship Sec. 15. If a veterinarian is required to establish a veterinarian-client-patient relationship to perform a health care service, the veterinarian shall ensure that a proper veterinarian-client-patient relationship is established, as defined in IC 25-38.1-1-14.5, when providing the service using telehealth.

As added by P.L.85-2021, SEC.25.

IC 25-1-9.7Chapter 9.7. Prescribing and Dispensing of Opioids

25-1-9.7-1"Prescriber" 25-1-9.7-2Limitations on prescribing opioids; exemptions; documentation 25-1-9.7-3Opioid prescription for lesser amount upon request 25-1-9.7-4Partial refill; pharmacist responsibilities

IC 25-1-9.7-1"Prescriber" Sec. 1. As used in this chapter, "prescriber" refers to a practitioner who maintains an Indiana controlled substance registration and a federal Drug Enforcement Administration registration.

As added by P.L.182-2017, SEC.1.

IC 25-1-9.7-2Limitations on prescribing opioids; exemptions; documentation Sec. 2. (a) Except as provided in subsections (b) and (d), a prescriber may issue a prescription for an opioid only if the following limitations are met:

(1) If the prescription is for an adult who is being prescribed an opioid for the first time by the prescriber, the initial prescription may not exceed a seven (7) day supply.

(2) If the prescription is for a child who is less than eighteen (18) years of age, the prescription may not exceed a seven (7) day supply.

(3) If the prescription is for an animal that is being prescribed an opioid for the first time by the veterinarian, the initial prescription may not exceed a seven (7) day supply.

(b) The limitations set forth in subsection (a) do not apply under any of the following circumstances:

(1) The prescriber is issuing the prescription for the treatment or provision of any of the following:

(A) Cancer.

(B) Palliative care.

(C) Medication-assisted treatment for a substance use disorder.

(D) A condition that is adopted by rule by the medical licensing board under IC 25-22.5-13-8 to be necessary to be exempted from subsection (a).

(2) If, in the professional judgment of a prescriber, a patient requires more than the prescription limitations specified in subsection (a).

(c) If a prescriber:

(1) determines that a drug other than an opioid is not appropriate; and

(2) uses an exemption specified in subsection (b)(1)(B) or (b)(2) and issues a prescription for a patient that exceeds the limitations set forth in subsection (a);

the prescriber shall document in the patient's medical record the indication that a drug other than an opiate was not appropriate and that the patient is receiving palliative care or that the prescriber is using the prescriber's professional judgment for the exemption.

(d) If a prescriber issues a prescription for an opioid for administration through an intrathecal pump or epidural pain pump:

(1) the prescription may not exceed a one hundred eighty (180) day supply; and

(2) the patient may not be required to have a face-to-face visit with the prescriber more than once every one hundred eighty (180) days unless the prescriber determines an earlier follow up visit is medically necessary.

As added by P.L.182-2017, SEC.1. Amended by P.L.12-2019, SEC.1; P.L.156-2020, SEC.98; P.L.34-2025, SEC.1.

IC 25-1-9.7-3Opioid prescription for lesser amount upon request Sec. 3. A prescriber shall, upon the request of the:

(1) patient;

(2) personal or legal representative of the patient; or

(3) guardian of the patient;

issue the opioid prescription for a lesser amount than the prescriber initially intended to prescribe, issue the opioid prescription for the lesser amount, and indicate the request and who made the request in the patient's medical file.

As added by P.L.182-2017, SEC.1.

IC 25-1-9.7-4Partial refill; pharmacist responsibilities Sec. 4. (a) For a partial fill of an opioid prescription, a pharmacist shall dispense, upon request of the:

(1) patient;

(2) personal or legal representative of the patient; or

(3) guardian of the patient;

the lesser amount requested.

(b) If a prescription for an opioid is partially filled under subsection (a), the pharmacist shall do the following:

(1) Comply with the partial refill requirements set forth in 21 U.S.C. 829.

(2) Document that an individual described in subsection (a) for whom the partial prescription was filled (or the individual's personal or legal representative or guardian) requested the partially filled prescription.

As added by P.L.182-2017, SEC.1.

IC 25-1-9.8Chapter 9.8. Practitioner Good Faith Estimates

25-1-9.8-1"Covered individual" 25-1-9.8-1.5"Episode of care" 25-1-9.8-2"Good faith estimate" 25-1-9.8-3"Health carrier" 25-1-9.8-4"In network" 25-1-9.8-5"Network" 25-1-9.8-6"Network plan" 25-1-9.8-7"Nonemergency health care service" 25-1-9.8-8"Practitioner" 25-1-9.8-8.5"Price" 25-1-9.8-9"Provider" 25-1-9.8-10"Provider facility" 25-1-9.8-11Applicability; request for good faith estimate; requirements 25-1-9.8-12In network good faith estimates; out of network good faith estimates 25-1-9.8-13Provision of good faith estimate 25-1-9.8-14Good faith estimate requirements; information health carrier and provider must provide to practitioner; when practitioner not subject to penalties 25-1-9.8-15Provision of information by practitioner to provider facility 25-1-9.8-16Practitioner duty to give written notice of individual's right to an estimate; rules 25-1-9.8-17Medicare good faith estimates 25-1-9.8-18Practitioner or provider facility communication about right to good faith estimate by at least three means; required contents 25-1-9.8-19Action by appropriate board concerning good faith estimate or communication about right to estimate 25-1-9.8-20Compliance with federal requirements

IC 25-1-9.8-1"Covered individual" Sec. 1. As used in this chapter, "covered individual" means an individual who is entitled to be provided health care services according to a health carrier's network plan.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-1.5"Episode of care" Sec. 1.5. As used in this chapter, "episode of care" means the medical care ordered to be provided for a specific medical procedure, condition, or illness.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-2"Good faith estimate" Sec. 2. As used in this chapter, "good faith estimate" means a reasonable estimate of the price each provider anticipates charging for an episode of care for nonemergency health care services that:

(1) is made by a practitioner or provider facility under this chapter upon the request of:

(A) the individual for whom the nonemergency health care service has been ordered; or

(B) the provider facility in which the nonemergency health care service will be provided; and

(2) is not binding upon the provider.

As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.2.

IC 25-1-9.8-3"Health carrier" Sec. 3. (a) As used in this chapter, "health carrier" means an entity:

(1) that is subject to IC 27 and the administrative rules adopted under IC 27; and

(2) that enters into a contract to:

(A) provide health care services;

(B) deliver health care services;

(C) arrange for health care services; or

(D) pay for or reimburse any of the costs of health care services.

(b) The term includes the following:

(1) An insurer, as defined in IC 27-1-2-3(x), that issues a policy of accident and sickness insurance, as defined in IC 27-8-5-1(a).

(2) A health maintenance organization, as defined in IC 27-13-1-19.

(3) An administrator (as defined in IC 27-1-25-1(a)) that is licensed under IC 27-1-25.

(4) A state employee health plan offered under IC 5-10-8.

(5) A short term insurance plan (as defined by IC 27-8-5.9-3).

(6) Any other entity that provides a plan of health insurance, health benefits, or health care services.

(c) The term does not include:

(1) an insurer that issues a policy of accident and sickness insurance;

(2) a limited service health maintenance organization (as defined in IC 27-13-34-4); or

(3) an administrator;

that only provides coverage for, or processes claims for, dental or vision care services.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-4"In network" Sec. 4. As used in this chapter, "in network", when used in reference to a practitioner, means that the health care services provided by the practitioner are subject to a health carrier's network plan.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-5"Network" Sec. 5. (a) As used in this chapter, "network" means a group of provider facilities and practitioners that:

(1) provide health care services to covered individuals; and

(2) have agreed to, or are otherwise subject to, maximum limits on the prices for the health care services to be provided to the covered individuals.

(b) The term includes the following:

(1) A network described in subsection (a) that is established pursuant to a contract between an insurer providing coverage under a group health policy and:

(A) individual provider facilities and practitioners;

(B) a preferred provider organization; or

(C) an entity that employs or represents providers, including:

(i) an independent practice association; and

(ii) a physician-hospital organization.

(2) A health maintenance organization, as defined in IC 27-13-1-19.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-6"Network plan" Sec. 6. As used in this chapter, "network plan" means a plan of a health carrier that:

(1) requires a covered individual to receive; or

(2) creates incentives, including financial incentives, for a covered individual to receive;

health care services from one (1) or more providers that are under contract with, managed by, or owned by the health carrier.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-7"Nonemergency health care service" Sec. 7. As used in this chapter, "nonemergency health care service" means a discrete service or series of services ordered by a practitioner for an episode of care for the:

(1) diagnosis;

(2) prevention;

(3) treatment;

(4) cure; or

(5) relief;

of a physical, mental, or behavioral health condition, illness, injury, or disease that is not provided on an emergency or urgent care basis.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-8"Practitioner" Sec. 8. (a) As used in this chapter, "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).

(b) The term does not include the following:

(1) A dentist licensed under IC 25-14.

(2) An optometrist licensed under IC 25-24.

(3) A provider facility.

As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.3.

IC 25-1-9.8-8.5"Price" Sec. 8.5. As used in this chapter, "price" means the negotiated rate between the:

(1) provider facility and practitioner; and

(2) covered individual's primary health carrier.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-9"Provider" Sec. 9. As used in this chapter, "provider" means:

(1) a provider facility; or

(2) a practitioner.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-10"Provider facility" Sec. 10. (a) As used in this chapter, "provider facility" means any of the following:

(1) A hospital licensed under IC 16-21-2.

(2) An ambulatory outpatient surgical center licensed under IC 16-21-2.

(3) A birthing center licensed under IC 16-21-2.

(4) Except for an urgent care facility (as defined by IC 27-1-46-10.5), a facility that provides diagnostic services to the medical profession or the general public.

(5) A laboratory where clinical pathology tests are carried out on specimens to obtain information about the health of a patient.

(6) A facility where radiologic and electromagnetic images are made to obtain information about the health of a patient.

(7) An infusion center that administers intravenous medications.

(b) The term does not include the following:

(1) A private mental health institution licensed under IC 12-25.

(2) A Medicare certified, freestanding rehabilitation hospital.

As added by P.L.93-2020, SEC.7. Amended by P.L.9-2022, SEC.46; P.L.179-2022(ss), SEC.40.

IC 25-1-9.8-11Applicability; request for good faith estimate; requirements Sec. 11. (a) This section does not apply to an individual who is a Medicaid recipient.

(b) An individual for whom a nonemergency health care service has been ordered, scheduled, or referred may request from the practitioner who may provide the nonemergency health care service a good faith estimate of the total price the practitioner will charge for providing the nonemergency health care service.

(c) A practitioner who receives a request from a patient under subsection (b) shall, not more than two (2) business days after receiving relevant information from the individual, provide to the individual a good faith estimate of the price that the practitioner will charge for providing the nonemergency health care service.

(d) A practitioner must ensure that a good faith estimate provided to an individual under this section is accompanied by a notice stating that:

(1) an estimate provided under this section is not binding on the practitioner;

(2) the price the practitioner charges the individual may vary from the estimate based on the individual's medical needs; and

(3) the estimate provided under this section is only valid for thirty (30) days.

(e) A practitioner may not charge an individual for information provided under this section.

As added by P.L.93-2020, SEC.7. Amended by P.L.215-2025, SEC.42.

IC 25-1-9.8-12In network good faith estimates; out of network good faith estimates Sec. 12. (a) If:

(1) the individual who requests a good faith estimate from a practitioner under this chapter is a covered individual with respect to a network plan; and

(2) the practitioner from which the individual requests the good faith estimate is in network with respect to the same network plan;

the good faith estimate that the practitioner provides to the individual under this chapter must be based on the negotiated price to which the practitioner has agreed as an in network provider.

(b) If the individual who requests a good faith estimate from a practitioner under this chapter:

(1) is not a covered individual with respect to any network plan; or

(2) is not a covered individual with respect to a network plan with respect to which the practitioner is in network;

the good faith estimate that the practitioner provides to the individual under this chapter must be based on the price that the practitioner charges for the nonemergency health care service in the absence of any network plan.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-13Provision of good faith estimate Sec. 13. A practitioner may provide a good faith estimate to an individual under this chapter:

(1) in a writing delivered to the individual;

(2) by electronic mail; or

(3) through a mobile application or other Internet web based method, if available;

according to the preference expressed by the individual.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-14Good faith estimate requirements; information health carrier and provider must provide to practitioner; when practitioner not subject to penalties Sec. 14. (a) A good faith estimate provided by a practitioner to an individual under this chapter must meet the following requirements:

(1) Provide a summary of the services and material items that the good faith estimate is based on.

(2) Include:

(A) the price charged for the services and material items that the practitioner will provide and charge the individual; and

(B) the price that the provider facility in which the health care service will be performed charged for:

(i) the use of the provider facility to care for the individual for the nonemergency health care service;

(ii) the services rendered by the employed or contracted staff of the provider facility in connection with the nonemergency health care service; and

(iii) medication, supplies, equipment, and material items to be provided to or used by the individual while the individual is present in the provider facility in connection with the nonemergency health care service;

for imaging, laboratory services, diagnostic services, therapy, observation services, and other services expected to be provided to the individual for the episode of care.

(3) Include a total figure that is a sum of the estimated prices referred to in subdivisions (1) and (2).

(b) Subsection (a) does not prohibit a practitioner from providing to an individual a good faith estimate that indicates how much of the total figure stated under subsection (a)(2) will be the individual's out-of-pocket expense after the health carrier's payment of charges.

(c) A health carrier and a provider facility must provide a practitioner with the information needed by the practitioner to comply with the requirements under this chapter not more than two (2) business days after receiving the request. The provider facility shall provide the practitioner with all relevant information for services and costs for the good faith estimate that are to be provided by the provider facility for inclusion in a good faith estimate by the practitioner.

(d) A practitioner is not subject to the penalties under section 19 of this chapter if:

(1) a health carrier or provider facility fails to provide the practitioner with the information as required under subsection (c);

(2) the practitioner provides the individual with a good faith estimate based on any information that the practitioner has; and

(3) the practitioner provides the individual with an updated good faith estimate after the health carrier or provider facility has provided the information required under subsection (c).

As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.4.

IC 25-1-9.8-15Provision of information by practitioner to provider facility Sec. 15. If:

(1) a practitioner is expected to provide a nonemergency health care service to an individual in a provider facility; and

(2) the provider facility receives a request from an individual for a good faith estimate under IC 27-1-46;

the practitioner, upon request from the provider facility, shall provide to the provider facility a good faith estimate of the practitioner's price for providing the nonemergency health care service to enable the provider facility to comply with IC 27-1-46-11.

As added by P.L.93-2020, SEC.7.

IC 25-1-9.8-16Practitioner duty to give written notice of individual's right to an estimate; rules Sec. 16. (a) A practitioner that has scheduled or ordered for an individual a nonemergency health care service shall provide to the individual an electronic or paper copy of a written notice that states the following, or words to the same effect: "A patient may ask a health care provider for an estimate of the price the health care providers and health facility will charge for providing a nonemergency health care service. The law requires that the estimate be provided within 2 business days of scheduling the nonemergency health care service unless the nonemergency health care service is scheduled to be performed by the practitioner within 2 business days of the date of the patient's request.".

(b) The appropriate board (as defined in IC 25-1-9-1) may adopt rules under IC 4-22-2 to establish requirements for practitioners to provide additional charging information under this section.

As added by P.L.93-2020, SEC.7. Amended by P.L.32-2021, SEC.69; P.L.202-2021, SEC.5; P.L.215-2025, SEC.43.

IC 25-1-9.8-17Medicare good faith estimates Sec. 17. If:

(1) a practitioner receives a request for a good faith estimate under this chapter; and

(2) the patient is eligible for Medicare coverage;

the practitioner shall provide a good faith estimate to the patient within two (2) business days based on available Medicare rates.

As added by P.L.93-2020, SEC.7. Amended by P.L.215-2025, SEC.44.

IC 25-1-9.8-18Practitioner or provider facility communication about right to good faith estimate by at least three means; required contents Sec. 18. (a) Each provider must make diligent attempts to ensure that the patient is aware of the patient's right to request a good faith estimate under this chapter. The communication by each provider of information to the patient concerning the right to a good faith estimate must be conspicuous and must be provided by at least three (3) of the following means:

(1) Notice on the provider's website.

(2) On hold messaging.

(3) Waiting room notification.

(4) Preappointment reminders, including through electronic mail (email) or text messaging.

(5) During appointment or services check in.

(6) During appointment or services check out.

(7) During patient financial services or billing department inquiries.

(8) Through an electronic medical and patient communication portal.

(b) The communication required under subsection (a) must state the following, or words to the same effect: "A patient may ask for an estimate of the amount the patient will be charged for a nonemergency medical service provided in our office. The law requires that an estimate be provided within 2 business days of scheduling the nonemergency health care service unless the nonemergency health care service is scheduled to be performed by the practitioner within 2 business days of the date of the patient's request.".

As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.6; P.L.215-2025, SEC.45.

IC 25-1-9.8-19Action by appropriate board concerning good faith estimate or communication about right to estimate Sec. 19. The appropriate board (as defined in IC 25-1-9-1) may take action against a practitioner:

(1) under IC 25-1-9-9(a)(3) or IC 25-1-9-9(a)(4) for an initial violation or isolated violations of this chapter; or

(2) under IC 25-1-9-9(a)(6) for repeated or persistent violations of this chapter;

concerning the providing of a good faith estimate to an individual for whom a nonemergency health care service has been ordered or the communication to a patient under section 18 of this chapter of information concerning the patient's right to a good faith estimate of the price that the patient will be charged for a medical service.

As added by P.L.93-2020, SEC.7. Amended by P.L.202-2021, SEC.7.

IC 25-1-9.8-20Compliance with federal requirements Sec. 20. The requirements of this chapter 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.165-2022, SEC.2. Amended by P.L.190-2023, SEC.9.

IC 25-1-10Chapter 10. Direct Primary Care Agreements

25-1-10-1"Direct primary care agreement" 25-1-10-2"Primary care provider" 25-1-10-3"Primary care health services" 25-1-10-4Direct primary care agreement not insurance; not subject to IC 27 25-1-10-5Requirements for direct primary care agreement