CHAPTER 37.1. TERMINATION OF HEALTH PROVIDER CONTRACTS
IC 27-1-37.1
Chapter 37.1. Termination of Health Provider Contracts
IC 27-1-37.1-1
"Health maintenance organization" defined
Sec. 1. 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.196-2001, SEC.1.
IC 27-1-37.1-2
"Health provider contract" defined
Sec. 2. 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.196-2001, SEC.1.
IC 27-1-37.1-3
"Person" defined
Sec. 3. (a) As used in this chapter, "person" means an individual,an agency, a political subdivision, a partnership, a corporation, anassociation, or any other entity that enters into a health providercontract with a provider.
(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.196-2001, SEC.1.
IC 27-1-37.1-4
"Provider" defined
Sec. 4. As used in this chapter, "provider" means:
(1) a physician licensed under IC 25-22.5; (2) a dentist licensed under IC 25-14;
(3) an advanced practice nurse licensed under IC 25-23;
(4) a chiropractor licensed under IC 25-10;
(5) a podiatrist licensed under IC 25-29;
(6) an optometrist licensed under IC 25-24; or
(7) a clinical psychologist licensed under IC 25-33.
As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-5
Notice of amendment of contract
Sec. 5. A person who enters into a health provider contract witha provider shall provide written notice to the provider of anyamendment to the health provider contract not less than forty-five(45) days before the proposed effective date of the amendment.
As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-6
Termination of contract without penalty
Sec. 6. (a) Subject to subsection (b), a provider who receivesnotice under section 5 of this chapter may terminate the healthprovider contract without penalty by informing the person withwhom the health care provider contracts that the provider choosesnot to approve the amendment.
(b) Notice under subsection (a) must be:
(1) given not later than fifteen (15) days after the providerreceives notice under section 5 of this chapter; and
(2) in writing.
As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-7
Effective date of termination
Sec. 7. The termination of a contract under section 6 of thischapter is effective:
(1) ninety (90) days after the person with whom the providercontracts receives written notice from the provider that theprovider does not approve the amendment; or
(2) on a date earlier than the date described in subdivision (1),if agreed to by the person with whom the provider contracts andthe provider.
As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-8
Compliance with proposed amendment not required
Sec. 8. If a person with whom a provider contracts receives noticefrom a provider under section 6 of this chapter, the person withwhom a provider contracts may not require the provider to complywith the proposed amendment.
As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-9 Notification to patient that provider's contract terminated
Sec. 9. Except in an emergency, a provider who elects toterminate a health provider contract under this section shall, beforeproviding services to a patient who is covered by the contract, notifythe patient that the provider's contract has been or will be terminated.
As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-10
Contrary contract provisions void
Sec. 10. Except as provided in section 7(2) of this chapter, ahealth provider contract provision that is contrary to this chapter isvoid.
As added by P.L.196-2001, SEC.1.
IC 27-1-37.1-11
Chapter inapplicable to compliance with state or federal laws
Sec. 11. This chapter does not apply to an amendment to a healthprovider contract that is required to comply with a state or federallaw.
As added by P.L.196-2001, SEC.1.