Bill Text: IN SB0178 | 2011 | Regular Session | Engrossed
Bill Title: Outpatient benefit study.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Passed) 2011-05-18 - Effective 07/01/2011 [SB0178 Detail]
Download: Indiana-2011-SB0178-Engrossed.html
Citations Affected: Noncode.
Synopsis: Outpatient benefit study. Requires the health finance
commission to study possible prohibitions on certain insurer and health
maintenance organization activities related to outpatient benefits.
Effective: July 1, 2011.
(HOUSE SPONSORS _ BROWN T, BROWN C)
January 5, 2011, read first time and referred to Committee on Health and Provider
Services.
February 17, 2011, amended, reported favorably _ Do Pass.
February 21, 2011, read second time, amended, ordered engrossed.
February 22, 2011, engrossed. Read third time, passed. Yeas 47, nays 2.
March 28, 2011, read first time and referred to Committee on Insurance.
April 4, 2011, amended, reported _ Do Pass.
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
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A BILL FOR AN ACT concerning insurance.
(b) As used in this SECTION, "health maintenance organization" has the meaning set forth in IC 27-13-1-19. The term includes a pharmacy benefit manager.
(c) As used in this SECTION, "insured" means an individual entitled to coverage under a policy of accident and sickness insurance.
(d) As used in this SECTION, "insurer" means an insurer that issues a policy of accident and sickness insurance. The term includes a pharmacy benefit manager.
(e) As used in this SECTION, "policy of accident and sickness insurance" has the meaning set forth in IC 27-8-5-1.
(f) As used in this SECTION, "subscriber" has the meaning set forth in IC 27-13-1-32.
(g) As used in this SECTION, "substitution" means a substitution of a treatment, including a drug, a device, or a
therapy, for the treatment ordered by an insured's or enrollee's
treating physician.
(h) The health finance commission established by IC 2-5-23-3
shall, during the 2011 interim of the general assembly, study the
following possible prohibitions on insurers and health maintenance
organizations related to outpatient benefits:
(1) Requesting a substitution from an insured's or enrollee's
treating physician.
(2) Contacting an insured, enrollee, or subscriber concerning
a substitution.
(3) Requesting from an insured's or enrollee's treating
physician a change in the quantity of a covered drug to be
dispensed.
(i) In studying the prohibitions described in subsection (h), the
health finance commission shall consider the following:
(1) The physician/patient relationship.
(2) The time and administrative costs related to unsolicited
requests and contacts from insurers.
(3) Whether such requests and contacts:
(A) are beneficial to the insured or enrollee; or
(B) should be limited or prohibited.
(j) This SECTION expires December 31, 2011.
