Indiana Code-Title 27-Article 1-Chapter 37.5-Health Care Service Prior Authorization

See the bold text below:

Section 27-1-37.5-1. Application of Chapter

Sec. 1. (a) This chapter does not apply to a step therapy protocol exception procedure under IC 5-10-8-17, IC 27-8-5-30 or IC 27-13-7-23.

(b) This chapter does not apply to a health plan that is offered by a local unit public employer under a program of group health insurance provided under IC 5-10-8-2.6.

(c) This chapter does not apply to health care services provided under the following state Medicaid waivers: 

(1) Pathways for aging. 

(2) Health and wellness. 

(d) This chapter does not apply to the extent that it is preempted by a federal statute or regulation relating to the Medicaid program under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).

Section 27-1-37.5-1.5. “Adverse Determination”

Sec. 1.5. As used in this chapter, “adverse determination” means a decision by a utilization review entity to deny, reduce, or terminate benefit coverage of a health care service furnished or proposed to be furnished to a covered individual on the grounds that the health care service:

(1) is not medically necessary, appropriate, effective, or efficient;

(2) is not being provided in or at an appropriate health care setting or level of care; or

(3) is experimental or investigational.

Section 27-1-37.5-1.6.  "Authorization"

Sec. 1.6. As used in this chapter, "authorization" means a determination by a utilization review entity that: 

(1) a health care service: 

(A) has been reviewed; and 

(B) based on the information provided, satisfies the utilization review entity's requirements for medical necessity; and 

(2) payment will be made for the health care service.

Section 27-1-37.5-1.7. “Clinical peer”

Sec. 1.7. As used in this chapter, "clinical peer" means the following: 

(1) Except as provided in subdivision (3), for a review of a request from a physician, a physician who: 

(A) holds a current and valid license under IC 25-22.5, has been granted reciprocity under IC 25-1-21, if reciprocity exists, or (3) holds a license that is part of a compact in which Indiana has entered; 

(B) is certified in the same specialty as the physician under review, as recognized by: 

(i) the American Board of Medical Specialties; or 

(ii) the American Osteopathic Association; and 

(C) if the review specifically concerns subspecialty care, is certified in the same subspecialty as the physician under review, as recognized by: 

(i) the American Board of Medical Specialties; or 

(ii) the American Osteopathic Association. 

(2) For a review of a request from an advanced practice registered nurse, an advanced practice registered nurse who: 

(A) holds a current and valid license under IC 25-23-1 or has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered; and (B) holds equivalent or similar: 

(i) population focus; and 

(ii) role specialty; as the advanced practice registered nurse who is subject to the review. 

(3) For a review of a request from a primary care physician (as defined in IC 25-22.5-5.5-1.5), a physician who: 

(A) holds a current and valid license under IC 25-22.5, has been granted reciprocity under IC 25-1-21, if reciprocity exists, or holds a license that is part of a compact in which Indiana has entered; 

(B) is certified in the same general practice of medicine under review, as recognized by: 

(i) the American Board of Medical Specialties; 

(ii) the American Board of Pediatrics; or 

(iii) the American Osteopathic Association; and (C) has been actively engaged in general practice for at least three (3) years. 

(4) For a review of a request from a practitioner or health care provider other than those specified in subdivisions (1) through (3), a practitioner or health care provider who: 

(A) holds a current and valid license in Indiana; 

(B) has been granted reciprocity in Indiana, if reciprocity exists; or 

(C) holds a license that is part of a compact in which Indiana has entered.

U.R. Criteria

Section 27-1-37.5-1.8. “Clinical criteria”

Sec. 1.8. As used in this chapter, "clinical criteria" means: 

(1) written policies; 

(2) written screen procedures;

(3) drug formularies or lists of covered drugs; 

(4) determination rules; 

(5) determination abstracts; 

(6) clinical protocols; 

(7) practice guidelines; 

(8) medical protocols; and 

(9) any other criteria or rationale; used by the utilization review entity to determine the medical necessity of a health care service.

Section 27-1-37.5-1.9. "Cosmetic surgery."

Sec. 1.9. (a) As used in this chapter, "cosmetic surgery" means any procedure that: 

(1) is directed at improving the patient's appearance; and 

(2) does not meaningfully: 

(A) promote the proper function of the body; or 

(B) prevent or treat illness or disease. 

(b) The term does not include the following: 

(1) A procedure that is necessary to ameliorate a deformity arising from or directly related to a: 

(A) congenital abnormality; 

(B) personal injury resulting from an accident or trauma; or 

(C) disfiguring disease. 

(2) A procedure related to the treatment of breast cancer.

Section 27-1-37.5-2. “Covered individual”

Sec. 2. As used in this chapter, “covered individual” means an individual who is covered under a health plan.  The term includes a covered individual's legally authorized representative.

Section 27-1-37.5-3. “Cpt Code”

Sec. 3. As used in this chapter, “CPT code” refers to the medical billing code that applies to a specific health care service, as published in the Current Procedural Terminology code set maintained by the American Medical Association.

Section 27-1-37.5-3.7. "Emergency health care service"

Sec. 3.7. As used in this chapter, "emergency health care service" means a health care service that is provided in an emergency facility after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson who possesses average knowledge of health and medicine to:

(1) place an individual's health in serious jeopardy;

(2) result in serious impairment to the individual's bodily function; or

(3) result in serious dysfunction of any bodily organ or part of the individual

Section 27-1-37.5-3.8. "Episode of care"

Sec. 3.8. As used in this chapter, "episode of care" means the medical care ordered to be provided for a specific medical procedure, condition, or illness.

Section 27-1-37.5-3.9. "Health care provider"

Sec. 3.9. (a) As used in this chapter, except as provided in subsection (b), "health care provider" means an individual who holds a license issued by a board described in IC 25-0.5-11.

(b) The term does not include the following:

(1) A dentist licensed under IC 25-14.

(2) An optometrist licensed under IC 25-24.

(3) A veterinarian licensed under IC 25-38.1.

Section 27-1-37.5-4. “Health care service”

Sec. 4. (a) As used in this chapter, “health care service” means a health care related service or product rendered or sold by a health care provider within the scope of the health care provider’s license or legal authorization, including hospital, medical, surgical, mental health, and substance abuse services or products.

(b) The term does not include the following:

(1) Dental services.

(2) Vision services.

(3) Long term rehabilitation treatment.

(4) Pharmaceutical services or products.

Section 27-1-37.5-5. “Health plan”

Sec. 5. (a) As used in this chapter, “health plan” means any of the following that provides coverage for health care services:

(1) A policy of accident and sickness insurance (as defined in IC 27-8-5-1). However, the term does not include the coverages described in IC 27-8-5-2.5(a).

(2) A contract with a health maintenance organization (as defined in IC 27-13-1-19) that provides coverage for basic health care services (as defined in IC 27-13-1-4).

(3) After December 31, 2020, the Medicaid risk based managed care program under IC 12-15.

(b) The term includes a person that administers any of the following:

(1) A policy described in subsection (a)(1).

(2) A contract described in subsection (a)(2).

(3) A self-insurance program established under IC 5-10-8-7(b) to provide health care coverage.

(4) After December 31, 2020, Medicaid risk based managed care.

Medical Necessity-Definition

Section 27-1-37.5-5.4. "Medically necessary"

Sec. 5.4. As used in this chapter, "medically necessary" means a health care service that a prudent health care provider would provide to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptoms in a manner that is:

(1) in accordance with generally accepted standards of medical practice;

(2) clinically appropriate in terms of type, frequency, extent, site, and duration; and

(3) not primarily for:

(A) the economic benefit of the health plan or purchaser; or

(B) the convenience of the health plan, patient, treating physician, or other health care provider.

Section 27-1-37.5-6. “Participating provider”

Sec. 6. As used in this chapter, “participating provider” refers to the following:

(1) A health care provider that has entered into an agreement with an insurer under IC 27-8-11-3.

(2) A participating provider (as defined in IC 27-13-1-24).

Section 27-1-37.5-7. “Prior authorization”

Sec. 7. As used in this chapter, “prior authorization” means a practice implemented by a health plan through which coverage of a health care service is dependent on the covered individual or health care provider obtaining approval from the health plan before the health care service is rendered. The term includes prospective or utilization review procedures conducted before a health care service is rendered.

Section 27-1-37.5-8.1.  "Urgent health care service"

Sec. 8.1. As used in this chapter, "urgent health care service" means a health care service in which the application of the time period for making a nonexpedited prior authorization, in the opinion of a physician with knowledge of the covered individual's medical condition, could:

(1) seriously jeopardize:

(A) the life or health of the covered individual; or

(B) the covered individual's ability to regain maximum function; or

(2) subject the covered individual to severe pain that cannot be adequately managed without the health care service.

The term includes a mental and behavioral health care service.

Section 27-1-37.5-8.3. "Utilization review entity"

Sec. 8.3. As used in this chapter, "utilization review entity" means an individual or entity that performs prior authorization for one (1) or more of the following:

(1) An employer who employs a covered individual.

(2) A health plan.

(3) A preferred provider organization.

(4) Any other individual or entity that:

(A) provides;

(B) offers to provide; or

(C) administers;

hospital, outpatient, medical, prescription drug, or other health benefits to a covered individual.

Section 27-1-37.5-10. Request for prior authorization; electronic transmission or application programming interface; standardized form

Sec. 10. (a) This section does not apply to prior authorization for a prescription drug.

(b) A utilization review entity shall accept a request for prior authorization delivered to the utilization review entity by a covered individual's health care provider through a secure electronic transmission or an application programming interface. A health care provider shall submit a request for prior authorization through a secure electronic transmission or an application programming interface. A utilization review entity shall provide for:

(1) a secure electronic transmission or an application programming interface; and

(2) acknowledgment of receipt, by use of a transaction number or another reference code;

of a request for prior authorization and any supporting information.

(c) Subsection (b) does not apply and a utilization review entity that requires prior authorization shall accept a request for prior authorization that is not submitted through a secure electronic transmission or an application programming interface if a covered individual's health care provider and the utilization review entity have entered into an agreement under which the utilization review entity agrees to process prior authorization requests that are not submitted through a secure electronic transmission or an application programming interface because:

(1) a secure electronic transmission or an application programming interface of prior authorization requests would cause financial hardship for the health care provider;

(2) the area in which the health care provider is located lacks sufficient Internet access; or

(3) the health care provider has an insufficient number of covered individuals as patients or customers, as determined by the commissioner, to warrant the financial expense that compliance with subsection (b) would require.

(d) If a covered individual's health care provider is described in subsection (c), the utilization review entity shall accept from the health care provider a request for prior authorization as follows:

(1) The prior authorization request must be made on the standardized prior authorization form established by the department under section 16 of this chapter.

(2) The utilization review entity shall provide for a secure electronic transmission or an application programming interface and acknowledgment of receipt of the standardized prior authorization form and any supporting information for the prior authorization by use of a transaction number or another reference code.

Section27-1-37.5-12. Claim for Which Prior Authorization Was Given; Denial; Resubmission of Claim

Sec. 12. (a) This section applies to a claim for a health care service rendered by a health care provider:

(1) for which:

(A) prior authorization is requested after June 30, 2025; and

(B) a utilization review entity gives prior authorization; and

(2) that is rendered in accordance with the authorization.

Retroactive denial

(b) The utilization review entity shall not deny the claim described in subsection (a) unless:

(1) the health care provider knowingly and materially misrepresented the health care service in the prior authorization request with the specific intent to deceive and obtain an unlawful payment from the utilization review entity;

(2) the health care service was no longer a covered benefit on the date the health care service was provided;

(3) the health care provider was no longer contracted with the patient's health plan on the date the health care service was provided;

(4) the health care provider failed to meet the utilization review entity's timely filing requirements;

(5) the utilization review entity does not have liability for the claim; or

(6) the patient was not covered under the health plan on the date on which the health care service was rendered.

(c) If:

(1) the claim described in subsection (a) contains an unintentional and inaccurate inconsistency with the request for prior authorization; and

(2) the inconsistency results in denial of the claim;

the health care provider may resubmit the claim with accurate, corrected information.

Section 27-1-37.5-13. Unanticipated, medically necessary health care service

Sec. 13. (a) This section applies to a claim filed after June 30, 2025, for a medically necessary health care service rendered by a health care provider, the necessity of which:

(1) is not anticipated at the time of scheduling another health care service that:

(A) was authorized by the utilization review entity; or

(B) is not subject to a prior authorization requirement; and

(2) is determined at the time the other health care service is rendered.

(b) A utilization review entity may not:

(1) require retrospective review of; or

(2) deny a claim based solely on lack of prior authorization for;

an unanticipated health care service described in subsection (a).

(c) A health care provider that renders an unanticipated health care service described in subsection (a) shall submit to the utilization review entity documentation explaining why the unanticipated health care service was medically necessary.

Section 27-1-37.5-13.5. State employee health plan prohibited from requiring prior authorization for certain CPT codes; retroactive denial; review of impact

Sec. 13.5. (a) This section applies only to the state employee health plan (as defined in IC 5-10-8-6.7(a)).

(b) The state employee health plan may not require a participating provider to obtain prior authorization for the following CPT codes:

(1) 11200.

(2) 11201.

(3) 17311.

(4) 17312.

(5) 17313.

(6) 17314.

(7) 44140.

(8) 44160.

(9) 44970.

(10) 49505.

(11) 70450.

(12) 70551.

(13) 70552.

(14) 70553.

(15) 71250.

(16) 71260.

(17) 71275.

(18) 72141.

(19) 72148.

(20) 72158.

(21) 73221.

(22) 73721.

(23) 74150.

(24) 74160.

(25) 74176.

(26) 74177.

(27) 74178.

(28) 74179.

(29) 74181.

(30) 74183.

(31) 78452.

(32) 92507.

(33) 92526.

(34) 92609.

(35) 93303.

(36) 93306.

(37) 95044.

(38) 95806.

(39) 95810.

(40) 97110.

(41) 97112.

(42) 97116.

(43) 97129.

(44) 97130.

(45) 97140.

(46) 97530.

(47) V5010.

(48) V5256.

(49) V5261.

(50) V5275.

(c) The state employee health plan may not issue a retroactive denial for medical necessity for a CPT code listed in subsection (b).

 (d) Before November 1, 2025, the:

(1) interim study committee on public health, behavioral health, and human services; and

(2) interim study committee on financial institutions and insurance;

shall jointly review the impact of this section, including any relief on the administrative burdens to participating providers and any differences in utilization of the CPT codes listed in subsection (b).

(e) This section expires June 30, 2026.

Section 27-1-37.5-13.7. Limitations on prior authorization requirements for physical therapy or chiropractic visits

Sec. 13.7. (a) This section does not apply to the following:

(1) A state employee health plan (as defined in IC 5-10-8-6.7(a)).

(2) The Medicaid program.

(b) A utilization review entity may not require prior authorization for the first twelve (12):

(1) physical therapy; or

(2) chiropractic;

visits of each new episode of care.

Section 27-1-37.5-14. Contrary Contract Provision Void

Sec. 14. A provision that:

(1) is contained in a policy or contract that is entered into, amended, or renewed after June 30, 2025; and

(2) contradicts this chapter;

is void.

Section 27-1-37.5-15, Violation of chapter

Sec. 15. A violation of this chapter by a utilization review entity is an unfair or deceptive act or practice in the business of insurance under IC 27-4-1-4.

Section 27-1-37.5-16. Department of insurance; standardized prior authorization form

Sec. 16. (a) Except as provided in subsection (b), the department shall establish, post, and maintain on the department's website a standardized prior authorization form for use by health care providers and utilization review entities for purposes of any notice or authorization required by a utilization review entity with respect to payment for a health care service rendered to a covered individual.

(b) After December 31, 2020, a Medicaid managed care organization (as defined in IC 12-7-2-126.9) shall use a standardized prior authorization form prescribed by the office of the secretary of family and social services.

Section 27-1-37.5-17. Peer to peer review; request

Sec. 17. (a) As used in this section, "necessary information" includes the results of any face-to-face clinical evaluation, second opinion, or other clinical information that is directly applicable to the requested health care service that may be required.

(b) If a utilization review entity makes an adverse determination on a prior authorization request by a covered individual's health care provider, the utilization review entity must offer the covered individual's health care provider the option to request a peer to peer review by a clinical peer concerning the adverse determination.

(c) A covered individual's health care provider may request a peer to peer review by a clinical peer either in writing or electronically.

(d) If a peer to peer review by a clinical peer is requested under this section:

(1) the utilization review entity's clinical peer and the covered individual's health care provider or the health care provider's designee shall make every effort to provide the peer to peer review not later than forty-eight (48) hours (excluding weekends and state and federal legal holidays) after the utilization review entity receives the request by the covered individual's health care provider for a peer to peer review if the utilization review entity has received the necessary information for the peer to peer review; and

(2) the utilization review entity must have the peer to peer review conducted between the clinical peer and the covered individual's health care provider or the provider's designee.

(a) As used in this section, “necessary information” includes the results of any face-to-face
clinical evaluation, second opinion, or other clinical information that is directly applicable to the requested service that may be required.

(b) If a health plan makes an adverse determination on a prior authorization request by a covered individual’s health care provider, the health plan must offer the covered individual’s health care provider the option to request a peer to peer review by a clinical peer concerning the adverse determination.

(c) A covered individual’s health care provider may request a peer to peer review by a clinical peer either in writing or electronically.

(d) If a peer to peer review by a clinical peer is requested under this section:

(1) the health plan’s clinical peer and the covered individual’s health care provider or the health care provider’s designee shall make every effort to provide the peer to peer review not later than seven (7) business days from the date of receipt by the health plan of the request by the covered individual’s health care provider for a peer to peer review if the health plan has received the necessary information for the peer to peer review; and

(2) the health plan must have the peer to peer review conducted between the clinical peer and the covered individual’s health care provider or the provider’s designee.

Section 27-1-37.5-19. Publishing prior authorization requirements and restrictions and information about prior authorization approvals and denials; implementing new or amending current prior authorization requirements or restrictions; annual report

Sec. 19. (a) A utilization review entity shall make any current prior authorization requirements and restrictions, including written clinical criteria, readily accessible on the utilization review entity's website to covered individuals, health care providers, and the general public. The prior authorization requirements and restrictions must be described in detail and in easily understandable language.

Amendments

(b) A utilization review entity may not implement a new prior authorization requirement or restriction or amend an existing requirement or restriction unless:

(1) the utilization review entity's website has been updated to reflect the new or amended requirement or restriction; and

(2) the utilization review entity provides written notice to covered individuals and health care providers at least sixty (60) days before the requirement or restriction is implemented.

(c) A utilization review entity shall make statistics available regarding prior authorization approvals and denials on the utilization review entity's website in a readily accessible format, including statistics for the following categories:

(1) Health care provider specialty.

(2) Medication or diagnostic test or procedure.

(3) Indication offered.

(4) Reason for denial.

(5) If a decision was appealed.

(6) If a decision was approved or denied on appeal.

(7) The time between submission and the response.

(d) Not later than December 31 of each year, a utilization review entity shall:

(1) prepare a report of the statistics compiled under subsection (c); and

(2) submit the report to the department.

Section 27-1-37.5-20. Use of clinical peer when an adverse determination is made or when reviewing or deciding an appeal

Sec. 20. (a) A utilization review entity must ensure that:

(1) all:

(A) adverse determinations based on medical necessity are made; and

(B) appeals are reviewed and decided;

by a clinical peer; and

(2) when making an adverse determination based on medical necessity or reviewing and deciding an appeal, the clinical peer is under the clinical direction of a medical director of the utilization review entity who is:

(A) responsible for the provision of health care services provided to covered individuals; and

(B) a physician licensed in Indiana under IC 25-22.5.

(b) An appeal may not be reviewed or decided by a clinical peer who:

(1) has a financial interest in the outcome of the appeal; or

(2) was involved in making the adverse determination that is the subject of the appeal.

Section 27-1-37.5-21. Clinical peer's duty to a covered individual

A clinical peer who:

(1) makes an adverse determination; or

(2) reviews and decides an appeal;

owes a duty to the covered individual to exercise the applicable standard of care.

Section 27-1-37.5-23Request for prior authorization; process

Sec. 23. (a) The time frames set forth in this section do not include weekends and state and federal legal holidays.

(b) A utilization review entity shall respond to a request for prior authorization as follows:

State Medical Necessity Decisions-Deadlines

(1) If the request for prior authorization is for an urgent health care service, the utilization review entity shall respond with an authorization or adverse determination not later than twenty-four (24) hours after receiving the request.

(2) If the request for prior authorization is:

(A) for a health care service other than the health care services described in subdivision (1); or

(B) for a prescription drug;

the utilization review entity shall respond with an authorization or adverse determination not later than forty-eight (48) hours after receiving the request.

(c) If a utilization review entity issues an adverse determination in a response under subsection (b), the response must include the following information:

(1) Specific reasons for the adverse determination.

(2) Suggested alternatives to the requested health care service.

(d) A health care provider shall respond not later than forty-eight (48) hours after receiving an adverse determination under subsection (b) if the health care provider:

(1) needs to correct a typographical, clerical, or spelling error; or

(2) accepts an alternative suggested by the utilization review entity.

(e) Not later than forty-eight (48) hours after receiving a health care provider's response under subsection (d), the utilization review entity shall:

(1) render a prior authorization or adverse determination based on the information provided in the health care provider's response; and

(2) notify the health care provider of the authorization or adverse determination.

State Medical Necessity Appeals-Deadlines 

(f) A health care provider may appeal an adverse determination received under subsection (b) or (e). The health care provider shall notify the utilization review entity of an appeal not later than forty-eight (48) hours after receiving notice of the adverse determination.

(g) A utilization review entity shall respond to an appeal under subsection (f) not later than forty-eight (48) hours after receiving notice of the appeal.

Section 27-1-37.5-24. Emergency admission or provision of emergency health care services

Sec. 24. (a) A utilization review entity shall allow a covered individual and a covered individual's health care provider at least twenty-four (24) hours (excluding weekends and state and federal legal holidays) after an emergency admission or provision of emergency health care services for the covered individual or health care provider to notify the utilization review entity of the emergency admission or provision of the emergency health care service.

(b) A utilization review entity shall cover emergency health care services necessary to screen and stabilize a covered individual. If a health care provider certifies in writing to a utilization review entity not later than seventy-two (72) hours (excluding weekends and state and federal legal holidays) after a covered individual's emergency admission that the covered individual's condition required the emergency health care service, the certification will create a presumption that the emergency health care service was medically necessary. The presumption may be rebutted only if the utilization review entity can establish, with clear and convincing evidence, that the emergency health care service was not medically necessary.

(c) The medical necessity of an emergency health care service may not be based on whether the service was provided by a participating or nonparticipating provider. Any restriction on the coverage of an emergency health care service provided by a nonparticipating provider may not be greater than the restriction that applies when the service is provided by a participating provider.

Section 27-1-37.5-25. Limitation on a utilization review entity's authority to revoke, limit, condition, or restrict an authorization

Retroactive denial

Sec. 25. A utilization review entity may not revoke, limit, condition, or restrict an authorization if the health care provider begins providing the health care service not later than forty-five (45) days (excluding weekends and state and federal legal holidays) after the date the health care provider received the authorization.

Section 27-1-37.5-26. Authorization periods

Retroactive denial

Sec. 26. (a) The authorization periods in this section do not apply if:

(1) the health care provider has not begun providing the health care service within forty-five (45) days (excluding weekends and state and federal legal holidays) after receiving the authorization as set forth in section 25 of this chapter; and

(2) the utilization review entity revokes, limits, conditions, or restricts the authorization.

(b) An authorization for a health care service shall be valid for at least one (1) year after the date the health care provider receives the authorization.

(c) The authorization period under subsection (b) is effective regardless of any changes in dosage for a prescription drug prescribed by the health care provider.

Section 27-1-37.5-27.  Utilization review entity's duty to honor certain authorizations

Sec. 27. (a) A utilization review entity shall honor an authorization that was granted to a covered individual by a previous utilization review entity for at least the initial ninety (90) days of the covered individual's coverage under a new health plan if:

(1) the utilization review entity receives information documenting the authorization from the covered individual or the covered individual's health care provider; and

(2) the authorization is for a health care service that is covered under the new health plan.

(b) During the time period described in subsection (a), a utilization review entity may perform its own review of the prior authorization request.

(c) If there is a change in:

(1) coverage of; or

(2) approval criteria for;

a previously authorized health care service, the change in coverage or approval criteria may not affect a covered individual who received authorization before the effective date of the change for the remainder of the plan year.

(d) A utilization review entity shall continue to honor an authorization that the utilization review entity granted to a covered individual when the covered individual changes products under the same health insurance company.

Section 27-1-37.5-28. Automatic authorization for failure to comply with deadlines or requirements

Sec. 28. If a utilization review entity fails to comply with the deadlines or other requirements under this chapter, the health care service subject to prior authorization shall be automatically deemed authorized by the utilization review entity.

See https://iga.in.gov/laws/2025/ic/titles/27#27-1-37.5-1