Reimbursement for emergency medical services

Sec. 23. (a) As used in this section, "covered individual" means an individual who is entitled to coverage under a state employee health plan. (b) As used in this section, "emergency medical services provider organization" means a provider of emergency medical services that is certified by the Indiana emergency medical services commission as an advanced life support provider organization under rules adopted under IC 16-31-3. (c) As used in this section, "state employee health plan" means either of the following that provides coverage for emergency medical services: (1) A self-insurance program established under section 7(b) of this chapter to provide group health coverage. (2) A contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter. (d) A state employee health plan that provides coverage for emergency medical services must at least provide reimbursement, subject to applicable deductible and coinsurance, for a covered individual for emergency medical services that are: (1) rendered by an emergency medical services provider organization; (2) within the emergency medical services provider organization's scope of practice; (3) performed or provided as advanced life support services; and (4) performed or provided during a response initiated through the 911 system, regardless of whether the patient was transported. (e) The director of the state personnel department may make a determination to provide coverage for emergency medical services as part of a mobile integrated healthcare program described in IC 16-31-12. (f) If multiple emergency medical services provider organizations qualify and submit a claim for reimbursement under this section for an encounter, the state employee health plan: (1) may only reimburse, subject to applicable deductible and coinsurance, under this section for one (1) claim per patient encounter; and (2) shall reimburse, subject to applicable deductible and coinsurance, the claim submitted by the emergency medical services provider organization that performed or provided the majority of advanced life support services for the patient. (g) The state personnel department may adopt rules under IC 4-22-2 to implement this section. (h) This section does not restrict the state employee health plan from providing coverage beyond the requirements in this section.