A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Plain English Breakdown

The bill summary does not provide specific details on enforcement mechanisms or funding.

Indiana Mental Health Insurance Act

This act changes Indiana's insurance laws to improve mental health coverage by setting rules on AI use, contract notices, fair reimbursement rates, and claim audits.

What This Bill Does

• Prohibits the use of artificial intelligence systems to impersonate or substitute for licensed mental health professionals.
• Requires the Department of Insurance to contract with an objective third party to verify that health carriers meet network adequacy standards.
• Sets forth notice requirements when amending health provider contracts.
• Forbids downcoding in a specified manner.
• Insurers must pay mental and substance abuse service providers at least as well relative to Medicare rates as they do for medical or surgical services.

Who It Names or Affects

• Health insurance companies
• Licensed mental health professionals
• People with mental health conditions

Terms To Know

downcoding

Lowering the level of care or treatment to a less serious category.

network adequacy standards

Requirements that ensure there are enough healthcare providers in an insurance network to meet members' needs.

Limits and Unknowns

• The bill does not specify the exact time frame for when insurers cannot retroactively audit paid claims.
• It is unclear how much this will cost or who will fund it.
• There are no details on what happens if someone breaks these rules.

Official Summary Text

A BILL FOR AN ACT to amend the Indiana Code concerning insurance.
Various mental health and insurance matters.

Current Bill Text

A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Various mental health and insurance matters.

Prohibits the use of an artificial intelligence system to impersonate or act as a substitute for a licensed mental health professional. Requires the department of insurance to contract with an objective third party to verify that health carriers are in compliance with network adequacy standards. Sets forth notice requirements for an amendment to a health provider contract. Prohibits the use of downcoding in a specified manner. Requires an insurer and a health maintenance organization to reimburse providers of mental illness or substance abuse services at rates that are at least as favorable relative to Medicare rates as reimbursement rates are for providers of medical or surgical services relative to Medicare rates. Prohibits an insurer and a health maintenance organization from retroactively auditing a paid claim or seeking recoupment or a refund of a paid claim after a certain time frame. Sets forth a limitation on the amount that an insured or enrollee may be charged for receiving mental and behavioral care services from an out of network provider under certain circumstances.