SB 249 Indiana Senate · 2022 Regular Session

Health insurance transparency.

Summary
Specifies that the compliance of a practitioner and a provider facility with federal law meets the good faith estimate requirements concerning health service costs. Allows the commissioner of the department of insurance to issue an order to discontinue a violation of a law (current law specifies orders or rules). Requires a domestic stock insurer to file specified information with the department of insurance. Prohibits a health plan from requiring a health care provider to submit a prior authorization request to a third party and requires the health plan to transmit the request to the third party through secure electronic transmission. Amends the deadline by which a health plan must respond to a nonurgent care prior authorization request. Requires a health plan to offer a health care provider that submitted a prior authorization and received an adverse determination the option to request a peer to peer review by a clinical peer concerning the adverse determination. Requires a health plan to post notice of a technical issue with its claims submission system on the health plan's Internet web site. Requires a health plan to post on its Internet web site not later than February 1 of each year: (1) the 30 most frequently submitted CPT codes in the previous calendar year; and (2) the percentage of the 30 most frequently submitted CPT codes that were approved in the previous calendar year. Establishes an approval process for a health plan's proposed premium rate increase of 5% or greater as compared to the previous calendar year. Prohibits an insurer and a health maintenance organization from altering a CPT code for a claim unless the medical record of the claim has been reviewed by an employee who is a licensed physician. Requires an insurer and a health maintenance organization to provide a contracted provider with a current reimbursement rate schedule: (1) every two years; and (2) when three or more CPT code rates change in a 12 month period. Urges the study by an interim committee of prior authorization exemptions for certain health care providers.
Bill status passed 3 of 5 stages cleared
Introduction
Jan 2022
Committee Review
Feb 2022
Senate Passage
Feb 2022
House Passage
Governor
Introduced Jan 10, 2022 Last action Feb 7, 2022
Floor votes · Senate Feb 1, 2022

How they voted

460
Passed
Total votes 46
Feb 1, 2022
D Democratic10
10 Yea
100% Yea
R Republican36
36 Yea
100% Yea
Vote distribution
All Yea All Nay Mixed No data
Full legislative history

Actions timeline

Total actions
14
Key actions
2
Committee
2
Amendments
1
Feb 2, 2022
Committee
Referred to the House
upper
Feb 1, 2022
Upper · Passed
Third reading: passed; Roll Call 163: yeas 49, nays 0
upper
Jan 31, 2022
Amended
Amendment #1 (Brown L) prevailed; voice vote
upper
Jan 27, 2022
Upper · Passed
Committee report: amend do pass, adopted
upper
4 primary · 6 co-sponsors

Sponsors