Overview
Indiana made significant advances in promoting healthcare price competition and transparency in 2020. Most notably, the 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 legislature also enacted new 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.
Indiana also 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. In 2020, Indiana passed new legislation that requires physician non-complete clauses to contain certain provisions to be enforceable. The legislature also recently proposed legislative action to enhance antitrust enforcement of all-or-nothing clauses and anti-tiering/anti-steering clauses to prevent anticompetitive practices.
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 § 12-15-29-5. Liability of insurer for payment of office’s claim: Medicaid — Insurance – Indiana
Introduced: Status: Enacted
An insurer: (1) That is put on notice of a claim by the office under section 4 [IC 12-15-29-4] of this chapter; and (2) Proceeds to pay the claim to a person or an entity …
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Ind. Code § 12-15-29-6. Discharge of insurer: Medicaid — Insurance – Indiana
Introduced: Status: Enacted
Payment to the office by an insurer under section 4 [IC 12-15-29-4] of this chapter discharges the insurer’s obligation with respect to further payment on the claim for the amount paid.
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Ind. Code § 12-15-29-7. Notice to insurer that Medicaid has been furnished; requirements; notification given office by insurer; payment of claim: Medicaid — Insurance – Indiana
Introduced: Status: Enacted
The notice requirements of section 4 [IC 12-15-29-4] of this chapter are satisfied if the following occurs.
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Ind. Code § 12-15-29-8. Unlawful insurance clause: Medicaid — Insurance – Indiana
Introduced: Status: Enacted
A clause of an insurance contract, plan, or agreement administered by an insurer is void if the clause limits or excludes enrollment or payments to an individual who is eligible for Medicaid.
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Ind. Code § 12-15-29-9. State’s acquisition of person’s right to payment: Medicaid — Insurance – Indiana
Introduced: Status: Enacted
To the extent that payment for covered medical expenses has been made under the state Medicaid program for health care items or services furnished to a person, in a case where a third party has …
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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