Overview
In 2020, the Indiana legislature passed a law to mandate an all-payer claims database (APCD) that will include claims from Medicare, Medicaid or a Medicaid managed care organization, health maintenance organizations (HMOs), pharmacy benefit managers (PBMs), and other payers. The law also prohibits gag clauses in contracts with providers, PBMs, or health facilities. That is, the claims data may be disclosed to employers providing insurance coverage under such a contract.
The state also has taken price transparency initiatives to provide more protections against balance billing for non-emergency services, requiring cost-sharing parity for services provided by an out of network provider at an in-network facility unless several specific criteria are met. It also clearly defines and protects an individual’s right to receive a good faith estimate of the total price a practitioner will charge for providing a nonemergency health care service. The state also made strides in drug pricing transparency, enacting a law that prohibits insurers, HMOs, and other payers from limiting the ability of pharmacies and pharmacists to discuss more affordable alternative prescriptions with patients, as well as several transparency requirements regulating PBM contracts.
Additionally, Indiana has robust statutes to prevent anticompetitive practices in healthcare markets. In hospital merger review authority, Indiana requires notice to and approval by the Attorney General prior to the merger of any public benefit corporation, including nonprofit hospitals. Additionally, the state prohibits anticompetitive contract provisions in provider and insurer contracts, including most-favored nation clauses and gag clauses, and has passed laws requiring physician non-complete clauses to contain certain provisions to be enforceable.
In 2024, the state enacted legislation requiring health care entities to provide notice of certain mergers or acquisitions to office of the attorney general.
See below for an overview of existing Indiana state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/10/2023 - 2/8/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
SB 276 – Indiana
Introduced: 2024 Status: In Process
This bill introduces new regulations for hospitals’ billing practices and financial disclosures to patients in Indiana. It prohibits the garnishment of a consumer’s unpaid earnings in satisfaction of any amount of healthcare debt. It also …
SB 282 – Indiana
Introduced: 2020 Status: Inactive / Dead
Health insurance reimbursement rates. Requires an insurer to provide notice to the department of insurance not later than 270 days prior to reducing a reimbursement rate paid to a contracted provider. Requires the department of …
SB 284 – Indiana
Introduced: 2022 Status: Enacted
Telehealth matters. Consolidates Medicaid telehealth language. Provides that “health care services” does not include certain case management services, care management services, service coordination services, or care coordination services for purposes of telehealth. Adds occupational therapist …
SB 287 – Indiana
Introduced: 2021 Status: Inactive / Dead
Health care strategy task force. Establishes the health care strategy task force. Sets forth membership and requires the task force to report to the general assembly by November 1, 2022. The health care strategy task …
SB 296 – Indiana
Introduced: 2021 Status: Inactive / Dead
Health matters. Removes requirements of cost sharing in the healthy Indiana plan. Removes requirements concerning prescribing a drug to a patient receiving services through telemedicine when the individual has not been previously examined by the …
HB 1029 – Indiana
Introduced: 2019 Status: Enacted
Prescription drug pricing study committee. Urges the legislative council to assign to the interim study committee on public health, behavioral health, and human services the task of studying issues consumers face related to prescription drug …
HB 1421 – Indiana
Introduced: 2021 Status: Enacted
Provides that the state employee health plan statute does not prohibit the state personnel department from directly contracting with health care providers for health care services for state employees. Defines “health carrier” for purposes of …
Ind. Code § 12-15-1.3-18. Increase of reimbursement rate for services: Medicaid Waivers and Plan Amendments – Indiana
Introduced: Status: Enacted
The amount of the increase in the reimbursement rate described in subsection (b) for a state fiscal year beginning July 1, 2017, or thereafter is the reimbursement rate in effect as of June 30, 2017, …
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Ind. Code § 12-15-2-16.5. Assignment of rights to state: Medicaid — Eligibility – Indiana
Introduced: Status: Enacted
An individual who is applying for Medicaid or receiving Medicaid is considered to have automatically assigned to the state the individual’s rights, or the rights of any other person who is dependent upon the individual …
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Ind. Code § 12-15-29-0.5. Pharmacy benefit manager: Medicaid — Insurance – Indiana
Introduced: Status: Enacted
As used in this chapter, “insurer” includes a pharmacy benefit manager.
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In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
FY 2019-2021 BUDGET
Indiana operates on a biennial budget. Agencies submit their budget requests to the governor in August and the governor submits his or her budget to the legislature in February. The budget is usually effective beginning July 1st. The budget for the FY 2019 to 2021 can be seen here.
KEY RESOURCES