Indiana § 27-1-45-10 - Compliance with federal requirements

§ 27-1-45-10. Compliance with federal requirements

Sec. 10. The requirements of this chapter do not apply to a facility or practitioner that:

(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.9. Amended by P.L.190-2023, SEC.22.

IC 27-1-45.2Chapter 45.2. Independent Dispute Resolution

27-1-45.2-1Application of chapter 27-1-45.2-2"Claim specific payment information" 27-1-45.2-3"Facility" 27-1-45.2-4"Health carrier" 27-1-45.2-5"Independent dispute resolution" 27-1-45.2-6"Initiating party" 27-1-45.2-7"Out of network provider" 27-1-45.2-8"Provider" 27-1-45.2-9"Qualified dispute" 27-1-45.2-10Notice of request for independent dispute resolution 27-1-45.2-11Notice; good faith negotiation 27-1-45.2-12Memorandum of conference 27-1-45.2-13Prohibition on administrative fees or penalties for care involving out of network providers

IC 27-1-45.2-1Application of chapter Sec. 1. This chapter applies to any dispute subject to the federal independent dispute resolution process established under Section 2799A-1 of the Public Health Service Act (42 U.S.C. 300gg-111) and its implementing regulations.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-2"Claim specific payment information" Sec. 2. (a) As used in this chapter, "claim specific payment information" means billed charges, allowed amounts, payment amounts, cost sharing amounts, and any other monetary amounts associated with the adjudication of an identifiable health care claim.

(b) The term does not include aggregated or de-identified data that cannot reasonably be used to identify a specific claim, patient, or provider.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-3"Facility" Sec. 3. As used in this chapter, "facility" means a licensed health care facility in which health care services are provided to individuals.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-4"Health carrier" Sec. 4. (a) As used in this chapter, "health carrier" means an entity:

(1) that is subject to this title and the administrative rules adopted under this title; 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 cost 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 in 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.119-2026, SEC.1.

IC 27-1-45.2-5"Independent dispute resolution" Sec. 5. As used in this chapter, "independent dispute resolution" means the federal independent dispute resolution process established under 42 U.S.C. 300gg-111 and 45 CFR Part 149, Subpart F.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-6"Initiating party" Sec. 6. As used in this chapter, "initiating party" means a health carrier or out of network provider that submits a request for independent dispute resolution under federal law.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-7"Out of network provider" Sec. 7. As used in this chapter, "out of network provider" means a provider that is not contracted with a health carrier to provide health care services to covered individuals at not more than a preestablished rate or amount of compensation.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-8"Provider" Sec. 8. As used in this chapter, "provider" means an individual licensed or legally authorized to provide health care services.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-9"Qualified dispute" Sec. 9. As used in this chapter, "qualified dispute" means a distinct item or service that is included in a request for independent dispute resolution.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-10Notice of request for independent dispute resolution Sec. 10. (a) An initiating party that submits a request for independent dispute resolution shall provide written notice to the facility not later than three (3) business days after submitting the request.

(b) The notice required under subsection (a) must, at a minimum, include a copy of the form used by the initiating party to request independent dispute resolution.

(c) An initiating party that fails to provide notice as required under this section is subject to enforcement as follows:

(1) If the initiating party is an out of network provider, the appropriate board (as defined in IC 25-1-9-1) may take action against the provider:

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

(B) under IC 25-1-9-9(a)(6) for repeated or persistent violations of this section.

(2) If the initiating party is a health carrier, the department may enforce this section in accordance with IC 27-1-3-19.

(3) A penalty under subdivision (1)(B) may not exceed five thousand dollars ($5,000) annually.

(d) An enforcement action under subsection (c) does not relieve any party of the obligation to participate in the conference and good faith negotiation required by this chapter.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-11Notice; good faith negotiation Sec. 11. (a) If, during any ninety (90) day period, an initiating party submits requests for independent dispute resolutions that, in the aggregate, include twenty-five (25) or more qualified disputes, the health carrier may:

(1) provide written notice to the out of network provider and the facility that includes:

(A) a description of the independent dispute resolution requests that are the basis for the notice, including applicable dates of service;

(B) identification of the party involved, including the name and tax identification number, if known;

(C) the name and contact information of a representative authorized to negotiate on behalf of the health carrier; and

(D) the requirement to participate in a conference and good faith negotiation; and

(2) deliver the notice to the out of network provider and the facility by:

(A) electronic mail; and

(B) certified mail.

(b) If a health carrier provides notice under subsection (a), the health carrier, the out of network provider, and the facility shall engage in good faith efforts to negotiate a resolution not later than thirty (30) days after the notice is provided, including:

(1) at least one (1) conference between authorized representatives; and

(2) a reasonable exchange of information necessary to evaluate and address the conduct described in the notice.

(c) A conference under subsection (b) may not:

(1) adjudicate individual claims;

(2) alter rights or obligations under federal or state law; or

(3) occur more than once per calendar quarter.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-12Memorandum of conference Sec. 12. (a) A conference under section 11(b) of this chapter must result in a written memorandum of conference.

(b) The memorandum must include the following information for the disputes reviewed:

(1) Identification of the disputes.

(2) The initial paid claim amount made by the health carrier to the out of network provider.

(3) The health carrier offer made during the applicable federal open negotiation period.

(4) The out of network provider requested amount.

(5) The qualifying payment amount, as determined under federal law.

(c) The memorandum is informational only and does not:

(1) impose penalties, fees, or financial disincentives;

(2) mandate payment outcomes;

(3) affect eligibility for independent dispute resolution; or

(4) alter claim level rights or remedies under federal or state law.

(d) The completed memorandum of conference shall be filed with the department. Claim specific payment information contained in the memorandum is confidential under IC 5-14-3-4 and is exempt from public access and disclosure under Indiana law.

(e) The department may not publish a memorandum that is filed under subsection (d). However, the department shall publish on the department's website information concerning the aggregate number of memorandums filed with the department.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.2-13Prohibition on administrative fees or penalties for care involving out of network providers Sec. 13. (a) A health carrier may not assess a facility or a provider an administrative fee or penalty related to the provision of care to an individual that involves an out of network provider.

(b) If a health carrier assesses an administrative fee or penalty under subsection (a), the health carrier commits an unfair and deceptive act or practice in the business of insurance under IC 27-4-1-4 and is subject to the penalties and procedures set forth in IC 27-4-1.

As added by P.L.119-2026, SEC.1.

IC 27-1-45.5Chapter 45.5. Indiana Public Employers' Plan

27-1-45.5-1"IPEP" 27-1-45.5-2"Political subdivision" 27-1-45.5-3Application for certificate of authority; application deadline 27-1-45.5-4Domestic tax exempt reciprocal insurance company

IC 27-1-45.5-1"IPEP" Sec. 1. As used in this chapter, "IPEP" refers to the Indiana Public Employers' Plan, Inc., which was originally incorporated under the name Indiana Employers' Compensation Plan, Inc., as a domestic nonprofit corporation on December 11, 1989.

As added by P.L.117-2021, SEC.4.

IC 27-1-45.5-2"Political subdivision" Sec. 2. As used in this chapter, "political subdivision" has the meaning set forth in IC 34-6-2.1-155.

As added by P.L.117-2021, SEC.4. Amended by P.L.186-2025, SEC.147.

IC 27-1-45.5-3Application for certificate of authority; application deadline Sec. 3. (a) Before December 31, 2030, IPEP shall apply to the insurance commissioner for a certificate of authority to transact the business of insurance in Indiana as a domestic tax exempt reciprocal insurance company.

(b) The bylaws or articles of incorporation prepared by IPEP for purposes of IPEP's conversion to a domestic tax exempt reciprocal insurance company must require that the board of the domestic tax exempt reciprocal insurance company be made up of at least seven (7) individuals.

(c) IPEP, in converting to a domestic tax exempt reciprocal insurance company, must meet the requirements and conditions for the formation of a domestic tax exempt reciprocal insurance company set forth in IC 27-1-6, including an examination under IC 27-1-6-17.

As added by P.L.117-2021, SEC.4. Amended by P.L.226-2023, SEC.17; P.L.236-2025, SEC.6.

IC 27-1-45.5-4Domestic tax exempt reciprocal insurance company Sec. 4. (a) After:

(1) receiving a certificate of authority from the insurance commissioner to transact the business of insurance in Indiana as a domestic tax exempt reciprocal insurance company; and

(2) making any changes in structure and legal status necessary or beneficial to the conversion of IPEP from a domestic nonprofit corporation into a domestic tax exempt reciprocal insurance company;

IPEP shall begin transacting the business of insurance as a domestic tax exempt reciprocal insurance company.

(b) All of the following apply on the date on which IPEP begins transacting the business of insurance as a domestic tax exempt reciprocal insurance company:

(1) All powers, duties, agreements, and liabilities that IPEP had as a domestic nonprofit corporation immediately before the date are transferred to the domestic tax exempt reciprocal insurance company as the successor entity.

(2) All records and property that IPEP had as a domestic nonprofit corporation immediately before the date, including all funds under the control or supervision of IPEP, are transferred to the domestic tax exempt reciprocal insurance company as the successor entity.

(3) Any amounts owed to IPEP immediately before the date are considered to be owed to the domestic tax exempt reciprocal insurance company as the successor entity.

(4) A reference to IPEP in a statute, rule, or other document is considered a reference to the domestic insurance company as the successor entity.

(5) All powers, duties, agreements, and liabilities of IPEP immediately before the date with respect to bonds issued by IPEP in connection with any trust agreement or indenture securing the bonds are transferred to the domestic tax exempt reciprocal insurance company as the successor entity. The rights of the trustee under any trust agreement or indenture and the rights of the bondholders of IPEP remain unchanged despite the transfer of the powers, duties, agreements, and liabilities of IPEP to the domestic tax exempt reciprocal insurance company as the successor entity.

As added by P.L.117-2021, SEC.4.

IC 27-1-46Chapter 46. Provider Facility Good Faith Estimates

27-1-46-0.5Provision of information by certain health plans 27-1-46-1"Covered individual" 27-1-46-1.5"Episode of care" 27-1-46-2"Good faith estimate" 27-1-46-3"Health carrier" 27-1-46-4"In network" 27-1-46-5"Network" 27-1-46-6"Network plan" 27-1-46-7"Nonemergency health care service" 27-1-46-8"Practitioner" 27-1-46-8.5"Price" 27-1-46-9"Provider" 27-1-46-10"Provider facility" 27-1-46-10.5"Urgent care facility" 27-1-46-11Right of individual to request good faith estimate from provider facility; duty of provider facility to provide estimate; required contents 27-1-46-12In network good faith estimates; out of network good faith estimates 27-1-46-13Provision of good faith estimates 27-1-46-14Requirements of good faith estimates; provision of information by health carriers and practitioners to provider facility 27-1-46-15Provider facility or practitioner duty to communicate right to good faith estimate by at least three means 27-1-46-16Good faith estimate request from patient eligible for Medicare 27-1-46-17Provider facility failure to provide estimate or communication about right to estimate; civil penalty 27-1-46-18Compliance with federal requirements