HB 1004 – Indiana

Status: Enacted
Year Introduced: 2020
Link: http://iga.in.gov/legislative/2020/bills/house/1004/

Health matters. States that the office of the secretary of family and social services and a managed care organization may not prohibit a provider from participating in another insurance network. Defines “weighted average negotiated charge” and requires the weighted average negotiated charge per service per provider type for Medicaid to be reported by hospitals and ambulatory outpatient surgical centers. Requires certain health care providers, beginning July 1, 2021, to provide a good faith estimate to individuals of the price for nonemergency health care services to be provided to the individual by the health care provider and sets forth requirements. Allows an individual to request a good faith estimate from a health care provider for the total price for nonemergency services that have been ordered, scheduled, or referred. and requires the health care provider to provide the good faith estimate. Sets forth requirements for the good faith estimate. Provides that an out of network practitioner who provides health care services to a covered individual in an in network facility may not charge more for the health care services provided to a covered individual than allowed according to the rate or amount of compensation established by the covered individual’s network plan unless: (1) at least five days before the health care services are scheduled to be provided, the covered individual is provided a statement that: (A) informs the covered individual that the facility or practitioner intends to charge more than allowed under the network plan; and (B) sets forth an estimate of the charge; and (2) the covered individual signs the statement, signifying the covered individual’s consent to the charge. Sets forth notice requirements. Sets forth provisions that a physician noncompete agreement must include in order to be enforceable. Provides for information and notification that an employer must give to a physician who leaves the employment of the provider. Allows an individual to request from a health carrier a good faith estimate of the amount of the cost of nonemergency health care services that the health carrier will pay for or reimburse and the applicable benefit limitations of the nonemergency health care service. Sets forth requirements of a good faith estimate by a health carrier and sets penalties for violations.

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