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.
HB 1001 – Indiana
Introduced: 2019 Status: Enacted
State budget. Appropriates money for capital expenditures, the operation of the state, K-12 and higher education, the delivery of Medicaid and other services, and various other distributions and purposes. Renames the build Indiana fund the …
HB 1003 – Indiana
Introduced: 2023 Status: Inactive / Dead
Health matters. Allows a credit against the state tax liability of an employer with fewer than 50 employees if the employer has adopted a health reimbursement arrangement in lieu of a traditional employer provided health …
HB 1004 – Indiana
Introduced: 2023 Status: Enacted
Establishes the health care cost oversight task force and sets forth duties of the task force. Provides a credit against state tax liability to certain physicians who have an ownership interest in a physician practice …
HB 1004 – Indiana
Introduced: 2020 Status: Enacted
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” …
HB 1005 – Indiana
Introduced: 2020 Status: Inactive / Dead
Health and insurance matters. Establishes the importation of prescription drugs program (program) for the importation of prescription drugs to be administered by the state department of health (state department). Requires the state department to apply …
Ind. Code §§ 27-13-36.2-1 through 27-13-36.2-9: Health Maintenance Organizations — Provider Payment – Indiana
Introduced: Status: Enacted
Statutes governing provider payment by health maintenance organizations. See definition section Ind. Code §§ 27-13-1-1 through 27-13-1-34.
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Ind. Code §§ 27-13-37-1 through 27-13-37-5: Health Maintenance Organizations — Patient Protections; Choice of Health Care Professional – Indiana
Introduced: Status: Enacted
Statutes require health maintenance organizations to allow each enrollee of the HMO to choose the enrollee’s own primary care provider from a list of participating primary care providers within the HMO. The list must be …
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Ind. Code §§ 27-13-4-1 through 27-13-4-3: Health Maintenance Organizations — Powers of Health Maintenance Organizations – Indiana
Introduced: Status: Enacted
Statutes list the powers of a health maintenance organization and the role of the insurance commissioner in regulating HMOs. HMOs may contract with providers and these contracts may include fee for service, cost plus, capitation, …
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Ind. Code §§ 27-13-40-1 through 27-13-40-3: Health Maintenance Organizations– Patient Protection; Health Maintenance Organization Comparison Sheets – Indiana
Introduced: Status: Enacted
Statutes require each health maintenance organization to make available an HMO comparison sheet for each policy or contract that either covers or is marketed to an Indiana resident or the resident’s employer. The comparison sheet …
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Ind. Code §§ 27-13-6-1 through 27-13-6-10: Health Maintenance Organizations — Quality Management Programs – Indiana
Introduced: Status: Enacted
Statutes require HMOs to establish procedures based on professionally recognized standards to assess and monitor the health care services provided to enrollees of the organization. HMOs are required to have an ongoing internal quality management …
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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.