Requires an initiating party that submits a request for independent dispute resolution to provide written notice to the facility not later than three business days after submitting the request. Allows a health carrier to provide notice to an out of network provider and a facility if, during any 90 day period, an initiating party submits requests for independent dispute resolutions that, in the aggregate, include 25 or more qualified disputes. Provides that if a health carrier provides the notice, the health carrier, the out of network provider, and the facility shall engage in good faith efforts to negotiate a resolution. Prohibits a health carrier from assessing a facility or a provider an administrative fee or penalty related to the provision of care to an individual that involves an out of network provider. Provides that if a health carrier assesses a facility or a provider an administrative fee or penalty related to the provision of care to an individual that involves an out of network provider, the health carrier commits an unfair and deceptive act or practice in the business of insurance.
Repeals provisions requiring a state employee health plan, policy of accident and sickness insurance, and health maintenance organization contract to provide certain post-mastectomy coverage. Requires a state employee health plan, policy of accident and sickness insurance, and health maintenance organization contract to: (1) provide coverage for breast reconstruction surgery and all modalities, types, and techniques of a health care service provided for the breast reconstruction surgery; and (2) provide access to an adequate breast reconstruction surgeon network. Prohibits a utilization review entity from denying a claim for breast reconstruction surgery for which prior authorization was granted unless the utilization review entity provides a formal declaration of compelling evidence of health care provider fraud in the prior authorization or claim submission process.
Requires a state employee health plan, a policy of accident and sickness insurance, and a health maintenance organization contract to: (1) grant an exception to a step therapy protocol for a prescription drug prescribed for the treatment of postpartum depression that is not indicated by the federal Food and Drug Administration for postpartum depression on the prescription drug's approved labeling; (2) provide coverage for biomarker testing for preeclampsia, doula services, mental health screenings, and treatment for maternal mental health; and (3) develop a maternal mental health program. Requires Medicaid pregnancy services to include reimbursement for doula services and biomarker testing for preeclampsia. Requires the division of mental health and addiction to develop and implement a program for pregnant women and children with a substance use disorder. Requires the office of women's health to: (1) develop, maintain, and disseminate certain information concerning resources that are available to pregnant women and new mothers; and (2) provide continuing education courses concerning postpartum depression and other related mental health disorders. Requires a hospital or birthing center to, before a patient's discharge from the hospital or birthing center following birth, providethe patient with information concerning postpartum depression and other related mental health disorders. Sets forth requirements for screening for preeclampsia using biomarker testing. Establishes the Hoosier family leave insurance program and the Hoosier family leave insurance trust fund. Prohibits an employer from discriminating against an employee who has a condition related to pregnancy or childbirth. Repeals a chapter regarding pregnancy and childbirth accommodation. Requires certain health care practitioners to screen caregivers for signs and symptoms of postpartum depression or other related mental health disorders and provide a referral for the caregiver if the screening is positive for a mental health disorder.
Provides that a taxpayer who is covered by a health insurance plan may deduct from the taxpayer's adjusted gross income an amount equal to the total amount of premiums on the health insurance plan the taxpayer paid for coverage during the taxable year.
Sets forth requirements for coverage of orthotic devices and prosthetic devices by a state employee health plan, a policy of accident and sickness insurance, and a health maintenance organization contract. Requires, not later than October 1, 2027, the state personnel department, an insurer that issues a policy of accident and sickness insurance, and a health maintenance organization to submit a report to the insurance commissioner regarding the total number of claims and the total amount of claims paid for orthotic devices and prosthetic devices during the preceding plan year. Requires the insurance commissioner to: (1) aggregate the data received in the reports regarding coverage of orthotic devices and prosthetic devices; and (2) report the aggregated data, not later than December 1, 2027, to the standing committees of the house of representatives and the senate that consider insurance matters. Makes corresponding changes.
Provides that the insurance commissioner shall discharge the powers and duties of the commissioner's office with respect to policies of accident and sickness insurance and health maintenance organization contracts in a specified manner. Requires the commissioner to consider, before approving or disapproving a rate increase or decrease for a policy of accident and sickness insurance or a health maintenance organization contract, whether the filer's products are affordable and whether the filer has implemented effective strategies to enhance the affordability of the filer's products. Allows the commissioner to disapprove a rate increase if the rate is increased by an amount that exceeds the Consumer Price Index for All Urban Consumers: All Items Less Food and Energy percentage increase plus 1%.
Requires a state employee health plan to reimburse the provider of behavior analysis services that provides behavior analysis services to a covered individual at a rate of not less than 110% of the Medicaid reimbursement rate for behavior analysis services under certain circumstances. Requires a policy of accident and sickness insurance to reimburse the provider of behavior analysis services that provides behavior analysis services to an insured at a rate of not less than 110% of the Medicaid reimbursement rate for behavior analysis services under certain circumstances. Requires a health maintenance organization contract to reimburse the provider of behavior analysis services that provides behavior analysis services to an enrollee at a rate of not less than 110% of the Medicaid reimbursement rate for behavior analysis services under certain circumstances.
Requires a state employee health plan to cover supplemental breast examinations. Requires a policy of accident and sickness insurance and a health maintenance organization to cover diagnostic breast examinations and supplemental breast examinations. Provides that the coverage for diagnostic breast examinations and supplemental breast examinations may not be subject to any cost sharing requirements.
Allows individuals with a terminal illness who meet certain requirements to make a request to an attending provider for medication that the individual may self-administer to bring about death. Specifies requirements a provider must meet in order to prescribe the medication to a patient. Prohibits an insurer from denying payment of benefits under a life insurance policy based upon a suicide clause in the life insurance policy if the death of the insured individual is the result of medical aid in dying. Establishes a Level 1 felony if a person: (1) without authorization of the patient, willfully alters, forges, conceals, or destroys a request for medication or a rescission of a request for medication with the intent or effect of causing the individual's death; or (2) knowingly or intentionally coerces or exerts undue influence on an individual to request medication to bring about death or to destroy a rescission of a request for medication to bring about death. Establishes a Class A misdemeanor if a person, without authorization of the patient, willfully alters, forges, conceals, or destroys a request for medication or a rescission of a request for medication in order to affect a health care decision by the individual. Establishes certain criminal and civil immunity for health care providers.
Provides that a policy of accident and sickness insurance and health maintenance organization that require an insured to select a primary care provider to receive coverage may permit an insured to select a participating provider who is a physical therapist to provide physical therapy services or an occupational therapist to provide occupational therapy services.
