Rep. Brad Barrett

Maddy summaryHB 1097 updates the state's chronic disease registry to include Parkinson's disease by adding it to the legal definition of "chronic disease" under the registry program. This change directly affects individuals diagnosed with Parkinson's disease, as their condition will now be tracked in the state's health data system. The bill modifies the registry's scope through a definitional update, without creating new programs or funding. It ensures Parkinson's disease is included in existing data collection efforts for chronic illness tracking.

Requires the office of the secretary of family and social services to apply, not later than October 1, 2026, for approval of a Section 1115 Medicaid demonstration waiver to provide coverage for health related social needs.

Provides that a physician and a hospital, a parent company of a hospital, an affiliated manager of a hospital, or a hospital system may not enter into a noncompete agreement on or after July 1, 2025.

Allows, subject to a written agreement concerning the transport of individuals, an emergency medical responder, an emergency medical technician, an advanced emergency medical technician, or a paramedic (emergency medical services personnel) to transport an individual to: (1) a health care facility; (2) a mental health facility; or (3) an urgent care facility; that can provide the individual with appropriate and necessary treatment. Specifies information that must be included in a written agreement. Allows reimbursement for transporting the individual to the facility.

Requires certain entities authorized to participate in the federal 340B Drug Pricing Program to annually report specified data to the Indiana department of health (state department). Requires the state department to submit a report of the aggregated data to the legislative council and post the report on the state department's website.

Provides that the director of the state personnel department may make a determination to provide coverage under the state employee health plan for emergency medical services as part of a mobile integrated healthcare program. Provides that the requirement for a policy of accident and sickness insurance and a health maintenance organization contract to provide reimbursement for emergency medical services includes emergency medical services that are performed or provided as part of a mobile integrated healthcare program. Repeals a provision that requires the department of insurance to maintain an electronic system for the collection and storage of information concerning transactions involving residential property. Provides that the article regarding consumer data protection does not apply to any organization exempt from taxation under Section 501(c)(4) of the Internal Revenue Code that is: (1) established to detect or prevent insurance related crime or fraud; and (2) subject to a memorandum of understanding with a statewide law enforcement agency. Changes the deadline for the Indiana Public Employers' Plan, Inc., to apply to the insurance commissioner for a certificate of authority to transact business as a domestic tax exempt reciprocal insurance company from before December 31, 2026, to before December 31, 2030. Repeals the statute requiring carriers of health insurance plans to conduct annual public forums. Provides that provisions requiring a notice of material change apply to personal automobile or homeowner's policies that are issued, delivered, amended, or renewed after June 30, 2026. Amends the definition of "small employer" in the chapter regarding small employer group health insurance. Makes corresponding changes.

Specifies that the Medicaid fraud control unit's (MFCU) investigation of Medicaid fraud may include the investigation of provider fraud, insurer fraud, duplicate billing, and other instances of fraud. Permits the attorney general to enter into a data sharing agreement with specified state agencies and authorizes the MFCU to analyze this data to carry out its investigative duties. Provides that all complaints made to the MFCU are confidential until an action is filed concerning the complaint. Requires the office of the secretary of family and social services to establish: (1) metrics to assess the quality of care and patient outcomes; and (2) transparency and accountability safeguards; for a specified long term care risk based managed care program. Requires, not later than July 31, 2026, a clinical laboratory and diagnostic imaging facility to post certain pricing information for services determined by the department of insurance. Allows: (1) a manufacturer to provide; and (2) a patient to receive; individualized investigational treatment if certain conditions are met. Requires an Indiana nonprofit hospital system to report a list of facilities that may submit a bill on an institutional provider form and report the facility code for each facility. Adds provisions concerning payments by insurers, health maintenance organizations, employers, and other responsible persons to qualified providers that are providing services in an office setting. Requires good faith estimates for health care services to be provided at least two business days (rather than five business days) before the health care services are scheduled to be provided. Removes language concerning the disclosure of a trade secret from provisions that allow for a health plan sponsor to access and audit claims data. Provides that when a health carrier is in the process of negotiating a health provider contract with a health provider facility or provider, the health carrier must provide certain information to the health provider facility or provider. Prohibits certain provisions from being included in a health provider contract. Allows the department of insurance to: (1) enter into partnerships and joint ventures to encourage best practices in the appropriate and effective use of prior authorization in health care; and (2) receive information regarding prior authorization disputes. Requires the department of insurance to prepare a report with findings and recommendations related to the prior authorization dispute information. Requires, not later than September 1, 2025, the department of insurance to issue a request for information concerning ways to better enable medical consumers to compare and shop for medical and health care services. Provides that an insurer or a health maintenance organization may not deny a claim for reimbursement on the sole basis that the referring provider is an out of network provider. Requires, if a fully credentialed physician becomes employed with another employer or establishes or relocates a medical practice in Indiana, an insurer and health maintenance organization to provisionally credential the physician for 60 days or until the physician is fully credentialed, whichever is earlier. Requires the Indiana department of health, in consultation with the office of technology, to study the feasibility of developing certain standards regarding medical records and data.

Specifies the process for a managed care organization to follow concerning home modification services. Requires a patient of an opioid treatment program (program) who has tested positive on a drug test to be given a random drug test monthly until the patient passes the test. (Current law requires the patient to be tested weekly.) Allows a program to close on Sundays and federal holidays. Prohibits the division of mental health and addiction from: (1) requiring a program's medical director to have admitting privileges at a hospital; and (2) establishing rules or guidelines concerning program admission and medication that are more stringent than federal regulations. Allows specified health care providers to perform the initial assessment, examination, and evaluation of a patient being admitted to a program. Allows the medical staff of an ambulatory outpatient surgical center to make recommendations on the granting of clinical privileges or the appointment or reappointment of an applicant to the governing board of the ambulatory outpatient surgical center for a period not to exceed 36 months. (Current law allows medical staff of hospitals to make recommendations.) Establishes the certified health care professions commission (commission). Sets forth the requirements for the: (1) certification of nurse aides and qualified medication aides; and (2) registration of home health aides. Specifies the duties of the Indiana department of health and the commission in regulating these professions. Relocates provisions concerning training for home health aides and requires the commission to approve the training. Sets forth requirements on facilities in employing nurse aides. Specifies the definition of "nurse aide" for purposes of an administrative rule. Makes changes to the release of medical information statute. Modifies the duties of the center for deaf and hard of hearing education. Adds provisions regarding "family navigators" and specifies the role of family navigators in the provisions of the bill regarding the center for deaf and hard of hearing education. Allows a prescriber to prescribe certain agonist opioids through telehealth services for the treatment or management of opioid dependence. (Current law allows only a partial agonist to be prescribed through telehealth.) Allows certain residential care administrators an exemption from taking continuing education during the initial licensing period. Allows for the provision of certain anesthesia in a physician's office or a podiatrist's office without the office being accredited. (Current law allows for this in dental offices.) Requires adverse events concerning anesthesia in an office based setting to be reported to the medical licensing board of Indiana (board). Requires the board to: (1) determine the types of adverse events to be reported; (2) establish a procedure for reporting; and (3) post the adverse events on the board's website. Creates a process for certain individuals who do not have a Social Security number and who are seeking licensure by examination as a registered nurse or practical nurse to obtain a provisional license. Requires a nursing program to offer a clinical experience for clinical hours in a hospital and a health facility setting.

Sets forth requirements for a utilization review entity that requires prior authorization of a health care service. Prohibits a utilization review entity from requiring prior authorization for the first 12 physical therapy or chiropractic visits of each new episode of care. Provides that a claim for reimbursement for a covered service or item provided to an insured or enrollee may not be denied on the sole basis that the referring provider is an out of network provider. Repeals superseded provisions regarding prior authorization. Makes corresponding changes.

Adds additional duties to a workgroup currently organized concerning the pathways for aging risk based managed care program (program). Requires the office of the secretary of family and social services (office of the secretary) to determine the base reimbursement rate structure, methodology, and reimbursement rates for provider payment by managed care organizations under the program. Allows the office of the secretary to perform claims reviews of claims under the program. Requires a managed care organization participating in the program to do the following: (1) Contract with nursing facilities if certain conditions are met under the same terms for a specified time frame. (2) Submit monthly reports for claims that had a denial rate of at least five percent in the previous month. (3) Pay minimum reimbursement rates to providers. (4) Pay interest on unpaid claims that are later determined to be clean claims. Sets forth the powers and duties of the office of the secretary concerning Medicaid home and community based services waivers. Requires a provider of services under a home and community based services waiver to follow any waiver requirements under federal law and developed by the office of the secretary. Establishes requirements for home and community based services waivers. Relocates provisions requiring reimbursement for assisted living services for individuals who are aged and disabled and receiving services under a Medicaid waiver. Specifies that: (1) these provisions apply to a home and community based services waiver that included assisted living services as an available services before July 1, 2025; (2) these provisions apply to an individual receiving services under a home and community based services waiver; and (3) reimbursement is required for certain services that are part of the individual's home and community based service plan. Relocates provisions establishing limitations concerning assisted living services provided in a home and community based services program. Relocates a provision requiring the office of the secretary to annually determine any state savings generated by home and community based services. Removes a provision allowing the division of aging to adopt rules concerning an appeals process for a housing with services establishment provider's determination that the provider is unable to meet the health needs of a resident and allows the office of the secretary to adopt rules concerning the appeals process. Requires an individual who provides attendant care services for compensation from Medicaid to register with the office of the secretary. Removes the requirement that the division of aging administer programs established under Medicaid waivers for in-home services for treatment of medical conditions. Provides that provisions of law concerning the statewide waiver ombudsman apply to an individual who has a disability and receives services administered by the bureau of disabilities services. (Current law specifies that these provisions apply to an individual who has a developmental disability and receives services under the federal home and community based services program.) Specifies that these provisions do not apply to an individual served by the long term care ombudsman program. Changes references from "statewide waiver ombudsman" to "statewide bureau of disabilities services ombudsman". Requires the unit of services for the deaf and hard of hearing and the division (rather than the unit and the board of interpreters) to adopt rules creating standings for interpreters. Removes provisions concerning the board of interpreters. Repeals a provision providing that licensed home health agencies and licensed personal services agencies are approved to provide certain services under a Medicaid waiver granted to the state under federal law that provides services for treatment of medical conditions. Repeals language concerning a long term care services eligibility screen for purposes of the Community and Home Options to Institutional Care for the Elderly and Disabled program (CHOICE). Authorizes the division of disability and rehabilitative services to charge an authorized service provider that employs a direct service professional an annual fee. Establishes the direct support professional training program fund and appropriates money in the fund.