Bill > SB0480

This bill modifies Indiana's laws regarding prior authorization in health insurance, introducing several key provisions to improve the process for patients and healthcare providers. The bill establishes new requirements for utilization review entities (organizations that manage healthcare service approvals) by mandating that they cannot require prior authorization for the first 12 physical therapy or chiropractic visits in a new episode of care. It also prohibits insurers from denying claims solely because the referring provider is out of network. The bill defines important terms like "medical necessity" and "clinical peer" and sets specific timelines for prior authorization responses, including 24 hours for urgent health care services and 48 hours for non-urgent services. Additionally, the bill requires utilization review entities to make their authorization requirements transparent by publishing them on their websites, providing detailed statistics about approvals and denials, and offering clear explanations for any adverse determinations. The legislation aims to streamline the prior authorization process, reduce administrative burdens on healthcare providers, and ensure patients have more timely access to necessary medical services. The bill will take effect on July 1, 2025, and applies to various types of health insurance policies and contracts entered into or renewed after that date.

Budget and Finance, Business and Industry, Health and Social Services

https://iga.in.gov/legislative/2025/bills/senate/480/details