Sec. 2. The following definitions and those contained in
IC 34-18-2 apply throughout this rule:
(1) "Ancillary provider" means all health care providers as defined in
IC 34-18-2-14, except the following:
(A) Physicians.
(B) Nursing homes.
(C) Hospitals.
(D) Psychiatric hospitals.
(2) "Claims made coverage" means coverage for claims made during a coverage period.
(3) "Comprehensive nursing care" means nursing that includes, but is not limited to, any of the following:
(A) Intravenous feedings.
(B) Enteral feeding.
(C) Nasopharyngeal and tracheostomy aspiration.
(D) Application of dressings to wounds that:
(i) require the use of sterile techniques, packing, or irrigation; or
(ii) are infected or otherwise complicated.
(E) Treatment of Stages 2, 3, and 4 pressure ulcers or other widespread skin disorders.
(F) Heat treatments that:
(i) have been specifically ordered by a physician as part of active treatment; and
(ii) require observation by nurses to adequately evaluate the process.
(G) Initial phases of a regimen involving administration of medical gases.
(4) "Dentist" means any person with a license to practice dentistry under
IC 25-14-1-3 not meeting the definition for dentist - oral surgery set forth in subdivision (5).
(5) "Dentist - oral surgery" means any person with a license to practice dentistry under
IC 25-14-1-3 treating patients with general anesthesia as defined by
IC 25-14-1-1.5 in an office setting.
(6) "Department" means the Indiana department of insurance.
(7) "Employed physician" means a physician for whom an employer:
(A) withholds and pays Social Security and Medicare taxes; and
(B) pays unemployment tax;
on wages paid to the physician. The term does not include a physician that is treated as an independent contractor for purposes of the Internal Revenue Service.
(8) "For-profit facility" means a nursing home not meeting the definition for not-for-profit facility as defined in subdivision (13).
(9) "Independent ancillary provider" means an ancillary provider that holds a state-issued license to provide health care and functions in an advanced role at a specialized level through the application of advanced knowledge and skills in the provision of health care. The term includes, but is not limited to, the following:
(A) A dentist.
(B) A psychologist.
(C) A podiatrist.
(D) An optometrist.
(E) A nurse practitioner.
(F) A nurse midwife.
(G) A certified registered nurse anesthetist.
(H) A physician assistant.
(I) A clinical nurse specialist.
(J) An anesthesiologist assistant.
(10) "Insurer" means any entity that issues a policy of insurance used as proof of financial responsibility under
IC 34-18 including, but not limited to, an insurance company doing business on an admitted or nonadmitted basis or a risk retention group.
(11) "IRMIA" means the Indiana residual malpractice insurance authority created by
IC 34-18-17.
(12) "Medical director" means a licensed physician whose duties primarily relate to oversight of the following:
(A) Program policies and procedures.
(B) Program development.
(C) Improvement of quality of care.
(D) Compliance.
(E) Supervision.
(13) "Not-for-profit facility" means a nursing home that is owned by a nonprofit corporation, governmental entity, or other organization that is exempt from federal income tax under Section 115 or 501, or both, of the Internal Revenue Code of 1986, as amended, or the corresponding provisions of any future United States Internal Revenue law.
(14) "Nurse midwife" means a certified nurse midwife as defined at
848 IAC 3-1-1.
(15) "Nursing home" means a facility named on the license issued by the state department of health under
IC 16-28.
(16) "Occurrence coverage" means coverage for acts that occur during a coverage period.
(17) "PCF" means the Indiana patient's compensation fund.
(18) "PCF certificate of insurance" means the form prescribed by the department to show proof of financial responsibility as required by
IC 34-18-3-2(1) to become a qualified provider.
(19) "Physician" means an individual with an unlimited license to practice medicine under
IC 25-22.5.
(20) "Podiatrist – no surgery" means any podiatrist, as defined by
IC 25-29-1-13, not meeting the definition for podiatrist – surgery set forth in subdivision (21).
(21) "Podiatrist – surgery" means a podiatrist, as defined by
IC 25-29-1-13, performing any procedure requiring an anesthetic, including a local anesthetic as defined by
845 IAC 1-1-1 or intravenous or gaseous sedation, including postoperative treatment. Exceptions to these procedures include the following:
(A) Diagnostic and therapeutic injections.
(B) Surgical procedures involving the nails.
(C) Excision of skin lesions.
(D) Incision and drainage of abscesses.
(E) The treatment of ulcers.
The term includes podiatric physicians assisting in surgery.
(22) "Psychiatric hospital" means an inpatient facility that is a private institution licensed under
IC 12-25 and public institutions under the administrative control of the director of a division as designated by
IC 12-24-1-1 or IC 12-24-1-3 and includes a private mental health institution, as defined by
440 IAC 1.5-1-8, and a private psychiatric institution, as defined by
IC 12-15-18-3.
(23) "Qualified actuary" means an individual that is a member in good standing with the Casualty Actuarial Society of the American Academy of Actuaries who has been approved as qualified for signing casualty loss reserve opinion by the Casualty Practice Council of the American Academy of Actuaries.
(24) "Reporting endorsement" means coverage that extends the time a claim may be made beyond the final claims made policy period. A reporting endorsement is commonly referred to as tail coverage.
(25) "Residential nursing care" means nursing that includes, but is not limited to, any of the following:
(A) Identifying human responses to actual or potential health conditions.
(B) Deriving a nursing diagnosis.
(C) Executing a minor regimen based on a nursing diagnosis or executing minor regimens as prescribed by any of the following:
(i) A physician.
(ii) A physician assistant.
(iii) A chiropractor.
(iv) A dentist.
(v) An optometrist.
(vi) A podiatrist.
(vii) A nurse practitioner.
(viii) A clinical nurse specialist.
(c) Upon request of the commissioner, an insurer shall provide a copy of the policy form and premium rates used as proof of financial responsibility.
(e) The health care provider's coverage with the PCF is of the same coverage type and scope as the policy used for proof of financial responsibility. However, the PCF will not allow retroactive coverage that begins before the date of issue of the first policy of insurance from any insurer used as proof of financial responsibility for the PCF.
(f) A health care provider who fails to purchase a reporting endorsement policy will not be allowed PCF coverage for any claim made after the termination date of the final claims made coverage used as proof of financial responsibility for the PCF, unless the underlying insurer considers the claim to be covered under its policy language because it was previously reported.
(g) In the event a policy of insurance is rescinded, the health care provider's status as a qualified health care provider is similarly rescinded. The department will refund any surcharge that was received for the period that was subject to the rescission. The insurer shall notify the department within ten (10) days of any policy that is rescinded.
Sec. 8. The annual surcharge for an ancillary provider or independent ancillary provider shall be as follows:
(1) An ancillary provider who is not an independent ancillary provider that purchases insurance as proof of financial responsibility shall pay one hundred percent (100%) of the premium charged by the insurer.
(2) An ancillary provider who is not an independent ancillary provider that establishes financial responsibility by means other than insurance under section 3 of this rule shall pay an amount equal to one hundred percent (100%) of the premium that would be charged to the ancillary provider by IRMIA. The payment must be made each year under
IC 34-18-5-3 within thirty (30) days after qualification.
(3) An independent ancillary provider's surcharge shall be calculated at the following percentage of the published surcharge for a specialty class 1 physician:
(A) Twenty percent (20%) for each dentist.
(B) One hundred thirty percent (130%) for each dentist - oral surgery.
(C) Twelve and one-half percent (12.5%) for each psychologist.
(D) Ninety-two and one-half percent (92.5%) for each podiatrist - no surgery.
(E) One hundred forty-five percent (145%) for each podiatrist - surgery.
(F) Twelve and one-half percent (12.5%) for each optometrist.
(G) Thirty-five percent (35%) for each nurse practitioner.
(H) One hundred fifty percent (150%) for each nurse midwife.
(I) Forty-five percent (45%) for each certified registered nurse anesthetist.
(J) Thirty-five percent (35%) for each physician assistant.
(K) Thirty-five percent (35%) for each clinical nurse specialist.
(L) Forty-five percent (45%) for each anesthesiologist assistant.
(4) An independent ancillary provider who provides health care on a part-time basis shall pay a reduced surcharge as follows:
(A) An independent ancillary provider who provides health care twelve (12) hours per week or less on an annual basis shall receive a credit equal to seventy-five percent (75%) of the surcharge amount.
(B) An independent ancillary provider who provides health care more than twelve (12) hours but fewer than twenty-five (25) hours per week on an annual basis shall receive a credit equal to fifty percent (50%) of the surcharge amount.
(C) An independent ancillary provider who provides health care at least twenty-five (25) hours but fewer than thirty-one (31) hours per week on an annual basis shall receive a credit equal to twenty-five percent (25%) of the surcharge amount.
Sec. 8.5. A nursing home shall calculate
their its surcharge rate on a form prescribed by the department. The calculation shall include the following:
(1) The actual number and type of beds licensed by the state department of health.
(2) A per bed charge for for-profit facilities as follows:
(A) Ninety-three Eighty-one dollars and two sixty-one cents ($93.02) ($81.61) for each comprehensive nursing care bed.
(B) Forty-two Thirty-seven dollars and ninety-three sixty-seven cents ($42.93) ($37.67) for each residential nursing care bed.
(3) A per bed charge for not-for-profit facilities as follows:
(A) Seventy-seven Seventy-four dollars and fifty-two nineteen cents ($77.52) ($74.19) for each comprehensive nursing care bed.
(B) Thirty-five Thirty-four dollars and seventy-eight twenty-five cents ($35.78) ($34.25) for each residential nursing care bed.
(4) A charge for each employed physician covered by the nursing home.
