HB 1004 IN

0likes☆Favorite🔕SubscribeShare

Became Law

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.

• Martin Carbaugh Republican · author
• Chris Garten Republican · sponsor
• Justin Busch Republican · sponsor

1. Jan 21, 2025 Coauthored by Representatives McGuire and Smaltz · lower
2. Jan 21, 2025 Authored by Representative Carbaugh · lower
3. Jan 21, 2025 First reading: referred to Committee on Public Health · lower
4. Jan 30, 2025 Representative Gore added as coauthor · lower
5. Feb 11, 2025 Committee report: amend do pass, adopted · lower
6. Feb 11, 2025 Recommitted to Committee on Ways and Means pursuant to House Rule 126.3 · lower
7. Feb 17, 2025 Committee report: amend do pass, adopted · lower
8. Feb 19, 2025 Second reading: amended, ordered engrossed · lower
9. Feb 19, 2025 Amendment #1 (Bauer) prevailed; voice vote · lower
10. Feb 19, 2025 Amendment #6 (Carbaugh) prevailed; voice vote · lower
11. Feb 19, 2025 Amendment #4 (Garcia Wilburn) failed; voice vote · lower
12. Feb 20, 2025 Senate sponsors: Senators Garten, Busch, Johnson T · lower
13. Feb 20, 2025 Cosponsor: Senator Charbonneau · lower
14. Feb 21, 2025 Referred to the Senate · lower
15. Feb 20, 2025 Third reading: passed; Roll Call 239: yeas 68, nays 26 · lower
16. Mar 3, 2025 First reading: referred to Committee on Health and Provider Services · upper
17. Mar 20, 2025 Committee report: do pass adopted; reassigned to Committee on Appropriations · upper
18. Apr 10, 2025 Committee report: amend do pass, adopted · upper
19. Apr 10, 2025 Senator Randolph added as cosponsor · upper
20. Apr 14, 2025 Second reading: amended, ordered engrossed · upper
21. Apr 14, 2025 Amendment #23 (Garten) prevailed; Division of the Senate: yeas 34, nays 12 · upper
22. Apr 14, 2025 Amendment #15 (Bohacek) prevailed; voice vote · upper
23. Apr 14, 2025 Amendment #17 (Bohacek) prevailed; voice vote · upper
24. Apr 14, 2025 Amendment #9 (Yoder) failed; Roll Call 412: yeas 13, nays 36 · upper
25. Apr 15, 2025 Third reading: passed; Roll Call 422: yeas 29, nays 19 · upper
26. Apr 15, 2025 Senator Johnson T removed as third sponsor · upper
27. Apr 16, 2025 Returned to the House with amendments · upper
28. Apr 17, 2025 Motion to dissent filed · lower
29. Apr 21, 2025 House advisors appointed: Barrett, Lehman, McGuire, Garcia Wilburn, Gore and Porter · lower
30. Apr 21, 2025 Senate conferees appointed: Garten and Yoder · upper
31. Apr 21, 2025 Senate advisors appointed: Ford J.D., Busch and Charbonneau · upper
32. Apr 21, 2025 House dissented from Senate amendments · lower
33. Apr 21, 2025 House conferees appointed: Carbaugh and Shackleford · lower
34. Apr 24, 2025 Senator Charbonneau removed as advisor · upper
35. Apr 24, 2025 Senator Yoder removed as conferee · upper
36. Apr 24, 2025 Rules Suspended. Conference Committee Report 1: adopted by the Senate; Roll Call 528: yeas 37, nays 13 · upper
37. Apr 24, 2025 Rules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 566: yeas 68, nays 23 · lower
38. Apr 24, 2025 CCR # 1 filed in the Senate · upper
39. May 6, 2025 Public Law 216 · lower
40. Apr 24, 2025 CCR # 1 filed in the House · lower
41. May 6, 2025 Signed by the Governor · executive
42. Apr 29, 2025 Signed by the President of the Senate · upper
43. Apr 24, 2025 Representative Barrett removed as advisor · lower
44. Apr 24, 2025 Representative Barrett added as conferee · lower
45. Apr 24, 2025 Representative Shackleford removed as conferee · lower
46. Apr 24, 2025 Senator Charbonneau added as conferee · upper
47. Apr 28, 2025 Signed by the President Pro Tempore · upper
48. Apr 25, 2025 Signed by the Speaker · lower