Establishes: (1) a state directed payment program (program) for hospitals; and (2) a managed care assessment fee. Changes disproportionate share payments when a state directed payment program is in effect. Allows the incremental hospital fee fund to be used to fund the Medicaid program. Requires a nonprofit hospital system to submit audited financial statements. Provides for a $10,000 per day penalty for failure to submit the hospital's financial statements. Requires the office of management and budget (office) to: (1) develop a methodology to be used in conducting a study of commercial inpatient hospital prices and outpatient hospital prices; and (2) upon budget committee review, conduct the study to determine Indiana's statewide average inpatient and outpatient hospital prices. Requires the office to submit a report of the study to the governor and general assembly. Before June 30, 2029, requires an Indiana nonprofit hospital system's aggregate average inpatient and outpatient hospital prices to at least be equal to or less than the statewide average. States that a violation by the Indiana nonprofit hospital system results in a forfeiture of its nonprofit status. Requires, before October 1 of each year, every nonprofit hospital to provide the Indiana department of health with specified federally filed forms and specified data used to complete the forms. Requires the Indiana department of health to submit these forms to the health care cost oversight task force and impose a fine of $10,000 per day on a nonprofit hospital for failure to submit the nonprofit hospital's forms. Provides an exemption from health care billing requirements for a facility located in a specified populated municipality. Requires a third party administrator to disclose commissions and fees to policyholders in a separate notification. Requires an insurer and a health maintenance organization to submit specified data information to the all payer claims data base. Requires an insurance producer or third party administrator to, before or at the time of sale, provide the plan sponsor with a statement from the insurer or health maintenance organization, disclosing commissions and fees that the insurance producer or third party administrator will receive. Changes the time frame in which certain information and claims data must be submitted to a contract holder as part of an audit or claims data request. Sets requirements for certain hospitals concerning a direct to employer health care arrangement. Beginning January 1, 2026, requires a state employee health plan, a policy of accident and sickness insurance, and a health maintenance organization contract to provide a plan sponsor with the national average drug acquisition cost of a generic drug. States that if an agreement between a health plan and a pharmacy benefit manager provides that less than 85% of the estimated rebates will be deducted from the cost of prescription drugs before a covered individual's cost sharing requirement is determined, the pharmacy benefit manager must provide the policyholder with an annual notice that includes: (1) an explanation of what a rebate is; (2) an explanation of how rebates accrue to the health plan from the manufacturer; and (3) the aggregate amount of rebates that accrued to the health plan for prescription drugs dispensed under the policyholder's health plan for the previous year. Places limitations on hospital health provider contracts linking to or negotiating reimbursement or terms under a separate hospital health care provider contract or product. Requires the office to: (1) study the effect, including the fiscal impact, of requiring physician reimbursement rates under a commercial policy to be set at a minimum reimbursement rate; and (2) report its findings under the study. Requires certain health carriers to provide claims data to a contract holder not more than four times per year (current law allows for the provision of the data twice annually). Requires certain insurers and health maintenance organizations to file specified information concerning changes in hospital reimbursement to the department of insurance.
Sponsored bills
Extends the expiration date of language specifying Medicaid reimbursement for certain out-of-state children's hospitals from July 1, 2025, to July 1, 2027.
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.
Allows certain individuals to take the examination for licensure as a social worker before having completed the bachelor's degree. Makes the following changes in regard to marriage and family therapists, mental health counselors, addiction counselors, and clinical addiction counselors: (1) Provides that an individual must be licensed as an associate before obtaining the relevant experience hours, except in certain circumstances. (2) Amends provisions concerning experience hours and the expiration of a temporary license or permit. Removes certain provisions regarding first available examinations.
Provides that a granted waiver or variance expires three years after the date that the waiver or variance becomes effective. Removes the requirement that a child receiving child care from a school must be the child of a student or employee of the school. Provides that, not later than June 30, 2026, the division of family resources (division) shall establish an organizational license category for multi-site child care centers operating under one owner, and specifies obligations of the division with regard to the new license category. Provides that, subject to exceptions, certain properties may not be required to comply with a new or different set of building, fire safety, or equipment laws than were originally enforced by the department: (1) before July 1, 2025; or (2) two years after the earlier of the date of the: (A) initial inspection; or (B) plan review. Allows a child care home that was licensed to operate a Class 2 structure before July 1, 2025, to continue operating in the structure notwithstanding the building, fire safety, or equipment laws and regulations.
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.
Specifies the persons that may file an action to obtain an injunction against an individual practicing dentistry without a license and the action that is required or allowed to be included in an injunction. Specifies information that a dentist who maintains a dental office must submit to the state board of dentistry. States that language concerning the administration of dental anesthetics may not be construed to prohibit a physician from practicing in a dental office. Allows a dentist to delegate the authority to take x-ray images to a dental assistant working in certain correctional facilities without direct supervision as long as the dentist is available to supervise the dental assistant remotely. Removes certain language regarding the regulation of dentists.
Extends the availability of the employer child care expenditure tax credit through July 1, 2027. Provides that under specified circumstances, an individual who: (1) is at least 15 years of age; and (2) is a student at a school corporation that operates a child care program; may volunteer as a caregiver for the child care program before completing the statutory requirements for individuals to act as a volunteer caregiver at a child care program. Adds two representatives of out-of-school-time programs to the membership of the early learning advisory committee. Provides for purposes of regulation of licensed child care centers that the office of the secretary of family and social services (office) shall: (1) ensure that: (A) Indiana's staff to child ratio for a specified age range is not more stringent than the average of the staff to child ratios permitted for that age range under the laws of Illinois, Kentucky, Michigan, and Ohio; and (B) Indiana's maximum group size for a specified age range is not more stringent than the average of the maximum group sizes permitted for that age range under the laws of Illinois, Kentucky, Michigan, and Ohio; and (2) annually publish on the office's website the: (A) staff to child ratio; and (B) maximum group size; that a licensed child care center is required to maintain for the specified age ranges. Provides exceptions to the bill's group size provisions for: (1) an indoor or outdoor area of a child care center that provides at least 75 square feet of space per child; and (2) a child care center's cafeteria. Provides that if the office has received at least five applications from child care providers wishing to participate in the micro center pilot program (pilot program) but has selected less than five applicants for participation in the pilot program, the office shall select additional applicants for participation in the pilot program such that at least five child care providers are participating in the pilot program.
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.
Allows an eligible county and city to establish by ordinance, a Midwest continental divide commission and district for the purpose of acquiring, developing, funding, constructing, equipping, and owning economic improvement projects in or serving the district. Amends an appropriation made in P.L.201-2023 to the northern Indiana regional economic development authority to allow funds to be used to support and fund the commission and the commission's projects.