CHAPTER 37. HEALTH PROVIDER CONTRACTS

IC 27-1-37
    Chapter 37. Health Provider Contracts

IC 27-1-37-1
"Emergency" defined
    Sec. 1. As used in this chapter, "emergency" means a medicalcondition that arises suddenly and unexpectedly and manifests itselfby acute symptoms of such severity, including severe pain, that theabsence of immediate medical attention could reasonably beexpected by a prudent lay person who possesses an averageknowledge of health and medicine to:
        (1) place an individual's health in serious jeopardy;
        (2) result in serious impairment to the individual's bodilyfunctions; or
        (3) result in serious dysfunction of a bodily organ or part of theindividual.
As added by P.L.197-2001, SEC.1.

IC 27-1-37-2
"Health maintenance organization" defined
    Sec. 2. As used in this chapter, "health maintenance organization"means a person that undertakes to provide or arrange for the deliveryof health care services to individuals on a prepaid basis, except forthe individual's responsibility for copayments or deductibles. Theterm includes a limited service health maintenance organization. Theterm does not include a staff-model health maintenance organizationthat employs a group of providers and that requires the providers toprovide health care services solely to individuals who are entitled tocoverage under a contract with the staff-model health maintenanceorganization or an affiliate of the staff-model health maintenanceorganization.
As added by P.L.197-2001, SEC.1.

IC 27-1-37-3
"Health provider contract" defined
    Sec. 3. As used in this chapter, "health provider contract" meansan agreement with a provider relating to terms and conditions ofreimbursement for health care services provided to an individualunder:
        (1) an employee welfare benefit plan (as defined in 29 U.S.C.1002 et seq.);
        (2) a policy of accident and sickness insurance (as defined inIC 27-8-5-1);
        (3) a contract with a health maintenance organization;
        (4) a self-insurance program established under IC 5-10-8-7(b);or
        (5) a prepaid health care delivery plan entered into underIC 5-10-8-7(c).
As added by P.L.197-2001, SEC.1.
IC 27-1-37-4
"Person" defined
    Sec. 4. (a) As used in this chapter, "person" means an individual,an agency, a political subdivision, a partnership, a corporation, anassociation, or any other entity.
    (b) The term does not include a health care provider described inIC 16-18-2-163(a)(1), IC 16-18-2-163(a)(2), IC 16-18-2-163(a)(3),or IC 16-18-2-163(a)(4).
As added by P.L.197-2001, SEC.1.

IC 27-1-37-5
"Provider" defined
    Sec. 5. As used in this chapter, "provider" means an individual orentity licensed or legally authorized to provide health care services.
As added by P.L.197-2001, SEC.1.

IC 27-1-37-6
Requiring provider to provide health care services
    Sec. 6. (a) Except as provided in subsection (b), a person may notrequire a provider, as a condition of entering into a health providercontract for the provision of health care services other than healthcare services to enrollees of a health maintenance organization, toprovide health care services to enrollees of a health maintenanceorganization.
    (b) A person may require a provider, as a condition of enteringinto a health provider contract for the provision of health careservices other than health care services to enrollees of a healthmaintenance organization, to provide health care services to enrolleesof a health maintenance organization:
        (1) in an emergency; or
        (2) upon referral.
    (c) If a person requires a provider to provide health care servicesto enrollees of a health maintenance organization under subsection(b), the person:
        (1) shall reimburse the provider at rates established under thehealth provider contract; and
        (2) may not require the provider to comply with the terms andconditions of the health maintenance organization.
As added by P.L.197-2001, SEC.1.