Provides that an insurer may not adjust a subsequent claim filed by a provider as a method of obtaining reimbursement of an overpayment made by the insurer on a prior claim by the provider. Provides that a health maintenance organization may not adjust a subsequent claim filed by a provider as a method of obtaining reimbursement of an overpayment made by the health maintenance organization on a prior claim by the provider. Provides that an insurer may not, more than one year after the date on which an overpayment on a provider claim was made to the provider by the insurer, request that the provider repay the overpayment (current law is two years). Provides that a health maintenance organization may not, more than one year after the date on which an overpayment on a provider claim was made to the provider by the health maintenance organization, request that the provider repay the overpayment (current law is two years). Makes conforming changes.
Requires a hospital to: (1) disclose information concerning payment assistance programs; (2) post signs concerning the programs in specified locations of the hospital; and (3) make information concerning the programs available to individuals through the hospital's patient portal. Requires a hospital to make a reasonable effort to notify individuals of available payment assistance programs before beginning a collection action against the individual. Prohibits the use of downcoding in a specified manner. Prohibits a provider from using an automated process, system, or tool to submit a health benefits claim without the review of a provider or other person involved in the development of the claim for submission. Prohibits an insurer that issues a policy of accident and sickness insurance (insurer) and a health maintenance organization from retroactively reducing the reimbursement rate for any CPT code. Sets forth limitations on the time frame in which an insurer and a health maintenance organization: (1) may request repayment of an overpayment, adjust a subsequent claim, recoup a paid claim, or retroactively audit a paid claim; and (2) is required to correct a payment error to a provider. Provides that if an insurer or a health maintenance organization recoups payment from a provider due to an error in coordination of benefits, the provider may submit a claim for the same services to the appropriate insurer or health maintenance organization.
Requires, upon issuance and renewal of a policy, an insurer to provide a directory of providers with which the insurer has entered into a reimbursement agreement to an insured or prospective insured. (Under current law, an insurer may provide a directory of providers to an insured.) Provides that: (1) a directory of providers provided by an insurer must include every provider that has entered into a reimbursement agreement with the insurer; and (2) a list of providers provided by a health maintenance organization must include every provider who provides health care services through the health maintenance organization.
Requires an insurer to cap the total amount an insured is required to pay for a 30 day supply of prescription insulin drugs at an amount not to exceed $35, regardless of the number of prescriptions and different types of insulin prescribed and filled during that period.
Prohibits the use of an artificial intelligence system to impersonate or act as a substitute for a licensed mental health professional. Requires the department of insurance to contract with an objective third party to verify that health carriers are in compliance with network adequacy standards. Sets forth notice requirements for an amendment to a health provider contract. Prohibits the use of downcoding in a specified manner. Requires an insurer and a health maintenance organization to reimburse providers of mental illness or substance abuse services at rates that are at least as favorable relative to Medicare rates as reimbursement rates are for providers of medical or surgical services relative to Medicare rates. Prohibits an insurer and a health maintenance organization from retroactively auditing a paid claim or seeking recoupment or a refund of a paid claim after a certain time frame. Sets forth a limitation on the amount that an insured or enrollee may be charged for receiving mental and behavioral care services from an out of network provider under certain circumstances.
Requires a group health insurance program for firefighters to provide coverage for the screening of certain forms of cancer. Requires a local unit public employer to provide cancer insurance for active firefighters, retired firefighters, and firefighters who are receiving disability benefits. Allows the board of trustees of the Indiana public retirement system to enter into agreements with one or more insurance companies to provide group cancer insurance for active firefighters, retired firefighters, and firefighters who are receiving disability benefits. Requires the department of homeland security to develop a firefighter cancer awareness and prevention program to provide relevant information to fire department personnel and volunteers concerning best practices for reducing the risk of cancer.
Prohibits: (1) the state employee health plan; (2) the Medicaid program; (3) an accident and sickness insurance policy; and (4) a health maintenance organization individual or group contract; from imposing a time limit on the amount of anesthesia time for a medical procedure or otherwise restricting or excluding coverage or payment of anesthesia time. Modifies the definitions of "charity care" and "community benefits" for purposes of certain hospital reporting requirements. Requires additional reporting of information by nonprofit hospitals to the Indiana department of health (state department). Requires the report to be posted on the nonprofit hospital's website and the state department's website. Increases the penalty for failure to file the report and changes the time frame in which the penalty may be assessed. Specifies that any penalty be deposited in the local public health fund. Allows for certain practitioners to provide neuroplastogen treatment concerning qualified patients with life threatening conditions if certain requirements are met. Allows for research to be conducted on neuroplastogen access. Requires reporting of adverse events and annual reporting of patient statistical information concerning the neuroplastogen treatment. Provides for immunity when treating using neuroplastogens. Requires a clinical peer to disclose certain information for a peer to peer review of an adverse determination. Prohibits a utilization review entity from using artificial intelligence as the primary means for making adverse determinations. Prohibits a health insurer from engaging in certain downcoding practices and sets forth conditions for downcoding a claim. Authorizes the department of insurance to enforce the downcoding requirements and impose certain penalties for a violation. Prohibits an insurer, pharmacy benefit manager, or other administrator of pharmacy benefits from designating a prescription drug as a specialty drug unless certain conditions are met.
Provides that an insurer: (1) must pay a health care provider the full amount due for health care services under the health care provider's agreement with the insurer, including any cost sharing; (2) has the sole responsibility for collecting cost sharing from a covered individual; and (3) upon request of the covered individual, must collect cost sharing throughout the policy year in increments defined by the insurer. Prohibits an insurer from taking certain actions regarding the collection of cost sharing. Requires each insurer to certify to the insurance commissioner, before December 31 of each year, that the insurer has fully and completely complied with the requirements during the previous calendar year.
Prohibits an Indiana governmental entity from making a payment from any fund under its control for the costs associated with procuring an abortion, including travel expenses, unless the abortion is necessary to preserve the life of the pregnant woman. Specifies that the prohibition does not apply to a payment made by an Indiana governmental entity to provide group health insurance for employees of the Indiana governmental entity.
Requires, beginning January 1, 2028, a health carrier to: (1) implement a shopping and decision support program; and (2) provide incentives for covered individuals in a health plan who elect to receive a comparable health care service from a network provider that is paid less than the average allowed amount paid by the health carrier to network providers for the comparable health care service. Requires, beginning December 1, 2027, a health carrier to make available an interactive member portal that enables a covered individual to request and obtain certain information. Allows a health carrier to make the information available through a toll free telephone number. Sets forth reporting requirements for health carriers and the department of insurance concerning incentive payments made to covered individuals.
