HEA 1273 Summary

• Adds Indiana Code Chapter 25-1-9.1 establishing notice requirements for provider referrals to out-of-network providers, effective July 1, 2017.

• Applies to referrals made after December 31, 2017, but excludes emergency medical condition referrals, post-emergency referrals by the treating provider, and referrals for therapeutic services to admitted hospital patients.

• Requires providers making out-of-network referrals to provide written notice (electronic or paper) informing covered individuals that out-of-network providers are not bound by the health plan's payment provisions.

• Requires notice to advise covered individuals they may contact their health plan before receiving out-of-network services to obtain a list of network providers and seek additional assistance.

• Does not apply when a provider confirms the referred provider is in-network, or when referring to an affiliated provider or a provider not specifically identified by name.