Sec. 3. (a) The provisions of this section do not apply until July 1, 1999.
(b) Each health maintenance organization shall demonstrate to the department that the health maintenance organization offers an adequate number of:
(1) acute care hospital services;
(2) primary care providers; and
(3) other appropriate providers;
that are located within a reasonable proximity of subscribers of the health maintenance organization. Compliance with the National Committee on Quality Assurance standards or guidelines is sufficient to meet the requirements of this subsection.
(c) If a health maintenance organization provides coverage for:
(1) specialty medical services, including physical therapy, occupational therapy, and rehabilitation services;
(2) mental and behavioral care services; or
(3) pharmacy services;
the health maintenance organization shall demonstrate to the department that the offered services are located within a reasonable proximity of subscribers of the health maintenance organization. Compliance with the National Committee on Quality Assurance standards or guidelines is sufficient to meet the requirements of this subsection.
As added by P.L.69-1998, SEC.14. Amended by P.L.124-2018, SEC.100.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 36. Patient Protection; Clinical Decision Making; Access to Personnel and Facilities
27-13-36-2. Sufficient Number and Type of Primary Care Providers
27-13-36-2.5. Discrimination on Basis of Provider's License or Certification Prohibited
27-13-36-3. Adequate Number of Services and Providers Within Reasonable Proximity of Subscribers
27-13-36-4. Specialty Areas of Primary Care Providers
27-13-36-5. Referrals to Out of Network Providers
27-13-36-6. Continuation of Care Provisions
27-13-36-7. Telephone Access for Authorization of Care
27-13-36-8. Guidelines for Establishing Reasonable Periods for Appointments
27-13-36-9. Coverage and Reimbursement for Expenses for Care Obtained in an Emergency
27-13-36-11. Standards for Continuity of Care
27-13-36-12. Payment to Enrollee for Service Rendered by Nonparticipating Provider; Requirements