Senate Enrolled Act (SEA) 400 (Health care matters) passed the Indiana General Assembly in the final days of the 2023 legislative session. Gov. Eric Holcomb signed the bill into law on May 4, and it will take effect on July 1.
While several health care issues were addressed in SEA 400, one provision establishes a prior authorization reduction pilot program. SEA 400 provides that the state employee health plan may not require a participating provider to obtain prior authorization for certain specified services and waives prior authorization requirements for and prohibits retroactive denial of a limited set of Current Procedural Terminology (CPT®) codes. SEA 400 lists 49 commonly requested and approved CPT codes gathered from several health care stakeholder groups, including ISMA, the Indiana Hospital Association, the American Physical Therapy Association – Indiana Chapter and the Indiana Dental Association.
SEA 400 also requires the General Assembly to convene a joint interim study committee to review and assess the efficacy of the pilot program before Nov. 1, 2025. Depending on the program’s results and subsequent study, the General Assembly may consider expanding this model beyond the current CPT codes and make it applicable to more than the state employee health plan. The pilot program will expire on June 30, 2026, unless the legislature votes to extend it.
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to view the complete list of CPT codes for which the state employee health plan may not require a participating provider to obtain prior authorization.