Title 25, PROFESSIONS AND OCCUPATIONS

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 …

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 e…

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 se…

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 t…

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 …

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 rat…

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 mu…

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 violation…

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 req…

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.1…

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…

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.

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 b…

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…

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…

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, o…

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.

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.