Indiana

SUMMARY

In the 2018 legislative term, Indiana introduced several legislation aimed at promoting price transparency, lowering healthcare costs, and expanding healthcare markets. Although most of those bills introduced died in committee, the state legislature passed HB 1317, a price transparency bill which would make it easier for pharmacists to discuss more affordable alternatives with patients. In addition, the state passed legislation to establish a comprehensive care health facility Certificate of Need (CON) program to be administered by the sate department.

 

LEGISLATION/REGULATION

Legislative Calendar

Indiana’s most recent legislative session ran from 1/3/2018 – 3/21/2018.

 

Recent Legislative Developments

Healthcare Transparency

2018 HB 1317 HEALTH MATTERS:Would permit a pharmacy or pharmacist to provide individuals with information concerning the individuals cost share for a prescription drug. Would prohibit a third party administrator, health insurer or a health maintenance organization from limiting the ability of a pharmacy or pharmacist to discuss information about,or from selling to the individual, a more affordable alternative. Would prohibit a copayment for a drug under the state employee health plan, an accident and sickness insurance policy, or a health maintenance organization from exceeding the amount payable to the pharmacy for the drug. Requires Board of Pharmacy to adopt rules concerning telepharmacy. Passed – Public Law 209.
HB 1145 HEALTH INSURANCE COVERAGE AND COST INFORMATION. Requires health care providers and health plans to provide to covered individuals and patients certain information concerning the cost of health care services. Requires health care providers to publish a payment policy for medically necessary health care services not covered by a third party payment source. Failed.
2017 HB 1011 HEALTHCARE CHARGES: Beginning in 2018, requires healthcare providers to publish and provide to patients the chargers for procedures rendered by the health care provider. Beginning in 2020, requires healthcare providers to publish and provide to patients the charges for each product or service rendered by the healthcare provider Failed.
HB 1486  HEALTH INSURANCE COVERAGE AND COST INFORMATION: Requires health care providers and health plans to provide to covered individuals and patients certain information concerning the cost of health care services. Requires health care providers to publish a payment policy for medically necessary health care services not covered by a third party payment source. Requires the department of insurance to establish, post, and maintain on the department’s Internet web site a standardized prior authorization form for notice or authorization for health care services. Failed. 

 

Healthcare Cost

2018 HB 1158 PHARMACEUTICAL MATTERS. Would require a state employee plan, health insurer, or health maintenance organization to inform a pharmacy of resources used to create the maximum allowable cost list (MAC). Would require that each entity establish a procedure for updating reimbursement amounts and for the addition or removal of drugs on a plan’s MAC list. Would establish a pharmacy appeals procedure to challenge amount reimbursed for a drug according to MAC list. Failed. 
HB 1345 PRESCRIPTION DRUG PRICING STUDY. Urges the legislative council to assign to the interim study committee on public health, behavioral health, and human services the task of studying issues related to prescription drug price transparency by drug manufacturers in Indiana. Failed.
HB 1142 MEDICAL PAYMENT COVERAGE. Specifies that medical payment coverage is supplemental to coverage under a health plan or public health coverage program. Specifies that: (1) the amount paid under medical payment coverage must not exceed the amount to which the health care provider agreed as payment in full for a health care service under the covered individual’s health plan or public health coverage program; and (2) the covered individual is not liable for any amount that exceeds the amount to which the health care provider agreed as described in (1). Failed.
SB 181 COVERAGE FOR PHARMACIST CARE. Requires an accident and sickness insurer that enters into a preferred provider agreement to: (1) reimburse for health care service provided by a pharmacist within the scope of practice to the same extent and in the same manner as the insurer would reimburse certain other health care providers (reimbursement); and (2) demonstrate an adequate number of pharmacists within a reasonable proximity to insureds. Requires a preferred provider agreement to provide for the reimbursement. Failed.
SB 433 HEALTH CARE COST AND VALUE STUDY. Urges the legislative council to assign the issue of health care cost and value to an appropriate interim study committee for study during the 2018 interim of the general assembly. Requires the interim study committee to study the issue and make recommendations not later than November 1, 2018. Failed.
HR 33 HEALTH CARE COST AND VALUE STUDY. Urging the legislative council to assign to the appropriate study committee the topic of healthcare cost and value. Failed.
2017 SB 481 TAX DEDUCTION FOR HEALTH CARE SHARING EXPENSES: Allows a taxpayer who is an Indiana resident and a member of a health care sharing ministry to deduct from the taxpayer’s adjusted gross income the total amount of qualified health care sharing expenses incurred by the taxpayer in a particular taxable year. Failed. 

 

Healthcare Markets

2018 SB 190 HEALTH FACILITY CERTIFICATE OF NEED: Requires the office of the secretary of family and social services to cooperate with the state department of health (state department) in the provision of certain health facility information. Amends the expiration of statutes placing certain limitations on the licensure of comprehensive care health facilities and the licensure of comprehensive care beds to the date upon which certain administrative rules take effect. Establishes a comprehensive care health facility certificate of need program administered by the state department. Sets forth certificate of need application requirements and exemptions. Passed – Public Law 202.
SB 378 MEDICAID BASED STATEWIDE HEALTH PLAN. Establishes the Indiana statewide health plan within the Medicaid program. Sets forth requirements of the plan. Requires the office of the secretary of the family and social services administration to apply for any federal waivers required for the plan. Failed.
HB 1301 INSURANCE MATTERS. Permits the department of insurance and governor to apply for a state innovation waiver under the federal Patient Protection and Affordable Care Act. Passed – Public Law 208.
2017 SB 304 INDIVIDUAL OUT-OF-STATE HEALTH INSURANCE: Allows an accident and sickness insurer that is licensed in certain other states, but is not licensed in Indiana, and complies with the state examination and premium tax requirements, to issue or deliver an individual policy of accident and sickness insurance to an individual resident of Indiana without complying with other Indiana insurance law. Failed.  

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Transparency in Healthcare

  • Code. Ann. § 16-21-6 requires that each hospital file a report detailing the hospital’s financial position at the end of each fiscal year, including net patient revenue broken down by payer source. Additionally, hospitals must submit after each calendar quarter a uniform patient information report based on discharge information, to include the following data: patient’s length of stay; diagnoses and surgical procedures performed; data of birth, admission and discharge; admission source; gender and race; discharge disposition; payer source; the total charge for the patient’s stay; the zip code of the patient’s residence; and all diagnoses external causes of injury codes. The state health commissioner is directed to make a compilation of the data obtained from the foregoing reports and issue recommendations and findings to the general assembly annually. Further, the state department is directed to publish a consumer guide to Indiana hospitals based on the reports “in an understandable format that assists the consuming public in making both financial and utilization comparisons between hospitals.”

 

  • Code. Ann. § 16-39-5 states that the original health record of a patient is the property of the provider and may be used by the provider without specific written authorization for legitimate business purposes, to include peer review, scientific, statistical and educational purposes.

 

Healthcare Contracting

  • Code. Ann. § 27-8-11-9 prohibits most favored nation clauses, or clauses having a similar effect, in an agreement between an insurance carrier and a participating provider. A most favored nation clause is an agreement between a payer and a provider that typically requires a provider to give the payer the lowest rate granted to any other comparable payer, which can be anticompetitive by encouraging oligopolistic pricing by large payers and increasing barriers for new entrants.

 

Healthcare Markets

 

LITIGATION/ENFORCEMENT

  • None identified

  

KEY RESOURCES

Indiana State General Assembly

Indiana Office of the Attorney General