Shown verbatim: the complete text as captured from the official PDF posted by the Indiana General Assembly, fetched 2026-09-25. Page and line markers are part of the official record; nothing is edited or removed. This is the current version. The official bill page.
First Regular Session of the 124th General Assembly (2025)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2024 Regular Session of the General Assembly.
HOUSE ENROLLED ACT No. 1003
AN ACT to amend the Indiana Code concerning health.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 4-6-10-1.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 1.5. The state Medicaid
fraud control unit has the authority to:
(1) investigate, in accordance with federal law (42 U.S.C. 1396 et
seq.):
(A) Medicaid fraud (including provider fraud, insurer
fraud, duplicate billing, and other instances of fraud that
the state Medicaid fraud control unit determines may
result in Medicaid fraud);
(B) misappropriation of a Medicaid patient's private funds;
(C) abuse of Medicaid patients; and
(D) neglect of Medicaid patients; and
(2) investigate, in accordance with federal law (42 U.S.C. 1396 et
seq.) and as allowed under 42 U.S.C. 1396b(q)(4)(A)(ii), abuse or
neglect of patients in board and care facilities.
SECTION 2. IC 4-6-10-4 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2025]: Sec. 4. (a) The attorney general may execute a data
sharing agreement with the:
(1) department of state revenue;
(2) office of the secretary of family and social services;
HEA 1003 — CC 1
2
(3) bureau of motor vehicles; and
(4) department of workforce development.
(b) The state Medicaid fraud control unit may analyze and
review data received under subsection (a) to carry out its duties
under section 1.5 of this chapter.
SECTION 3. IC 4-6-10-6 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2025]: Sec. 6. All complaints made to the state Medicaid fraud
control unit are confidential until an action is filed concerning the
complaint.
SECTION 4. IC 12-15-12-24 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 24. The office of the secretary
shall establish:
(1) metrics to assess:
(A) the quality of care provided under; and
(B) patient outcomes of; and
(2) transparency and accountability safeguards for;
the risk based managed care program for the covered population
established by IC 12-15-13-1.8(c).
SECTION 5. IC 16-18-2-92.3, AS ADDED BY P.L.151-2021,
SECTION 1 AND P.L.198-2021, SECTION 4, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 92.3. (a)
"De-identified maximum negotiated charge", for purposes of
IC 16-21-17, has the meaning set forth in IC 16-21-17-0.3(a).
(b) "De-identified maximum negotiated charge", for purposes
of IC 16-41-35.5, has the meaning set forth in IC 16-41-35.5-1.
(b) (c) "De-identified minimum negotiated charge", for purposes of
IC 16-21-17, has the meaning set forth in IC 16-21-17-0.3(b).
(d) "De-identified minimum negotiated charge", for purposes
of IC 16-41-35.5, has the meaning set forth in IC 16-41-35.5-2.
SECTION 6. IC 16-18-2-94.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 94.5. "Diagnostic imaging
facility", for purposes of IC 16-41-35.5, has the meaning set forth
in IC 16-41-35.5-3.
SECTION 7. IC 16-18-2-96.1, AS ADDED BY P.L.151-2021,
SECTION 2 AND P.L.198-2021, SECTION 5, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 96.1. (a)
"Discounted cash price", for purposes of IC 16-21-17, has the meaning
set forth in IC 16-21-17-0.3(c).
(b) "Discounted cash price", for purposes of IC 16-41-35.5, has
HEA 1003 — CC 1
3
the meaning set forth in IC 16-41-35.5-4.
SECTION 8. IC 16-18-2-105.9 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 105.9. "Electronic health record",
for purposes of IC 16-39-9, has the meaning set forth in
IC 16-39-9-1.5.
SECTION 9. IC 16-18-2-106.7 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 106.7. "Eligible facility", for
purposes of IC 16-42-26.5, has the meaning set forth in
IC 16-42-26.5-1.
SECTION 10. IC 16-18-2-153.8, AS ADDED BY P.L.151-2021,
SECTION 3 AND P.L.198-2021, SECTION 6, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 153.8. (a)
"Gross charge", for purposes of IC 16-21-17, has the meaning set forth
in IC 16-21-17-0.3(d).
(b) "Gross charge", for purposes of IC 16-41-35.5, has the
meaning set forth in IC 16-41-35.5-5.
SECTION 11. IC 16-18-2-188.6 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 188.6. "Individualized
investigational treatment", for purposes of IC 16-42-26.5, has the
meaning set forth in IC 16-42-26.5-2.
SECTION 12. IC 16-18-2-194.7, AS ADDED BY P.L.151-2021,
SECTION 4 AND P.L.198-2021, SECTION 7, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 194.7. (a)
"Item or service", for purposes of IC 16-21-17, has the meaning set
forth in IC 16-21-17-0.3(e).
(b) "Item or service", for purposes of IC 16-41-35.5, has the
meaning set forth in IC 16-41-35.5-6.
SECTION 13. IC 16-18-2-204.2 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 204.2. "Life threatening or
severely debilitating disease", for purposes of IC 16-42-26.5, has
the meaning set forth in IC 16-42-26.5-3.
SECTION 14. IC 16-18-2-250.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 250.5. "Non-invasive treatment",
for purposes of IC 16-51-1, has the meaning set forth in
IC 16-51-1-8.5.
SECTION 15. IC 16-18-2-272.5, AS ADDED BY P.L.151-2021,
SECTION 5 AND P.L.198-2021, SECTION 8, IS AMENDED TO
HEA 1003 — CC 1
4
READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 272.5. (a)
"Payer-specific negotiated charge", for purposes of IC 16-21-17, has
the meaning set forth in IC 16-21-17-0.3(f).
(b) "Payer-specific negotiated charge", for purposes of
IC 16-41-35.5, has the meaning set forth in IC 16-41-35.5-7.
SECTION 16. IC 16-18-2-272.7 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 272.7. "Payor", for purposes of
IC 16-51-1, has the meaning set forth in IC 16-51-1-9.5.
SECTION 17. IC 16-18-2-328.7 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 328.7. "Services provided for the
treatment of individuals with psychiatric disorders or chronic
addiction disorders", for purposes of IC 16-51-1, has the meaning
set forth in IC 16-51-1-10.5.
SECTION 18. IC 16-18-2-337.5, AS ADDED BY P.L.151-2021,
SECTION 6 AND P.L.198-2021, SECTION 9, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 337.5. (a)
"Standard charge", for purposes of IC 16-21-17 and IC 16-24.5-1, has
the meaning set forth in IC 16-21-17-0.3(g).
(b) "Standard charge", for purposes of IC 16-41-35.5, has the
meaning set forth in IC 16-41-35.5-8.
SECTION 19. IC 16-18-2-379 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 379. "X-ray film", for
purposes of IC 16-39, has the meaning set forth in IC 16-39-7-2.
includes a microfilm copy of the x-ray film.
SECTION 20. IC 16-18-2-379.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 379.5. "X-ray image", for
purposes of IC 16-39-1-2 and IC 16-39-7-2, has the meaning set
forth in IC 16-39-7-2.
SECTION 21. IC 16-19-9-4 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2025]: Sec. 4. (a) As used in this section, "clinical laboratory"
means a laboratory that:
(1) provides clinical services;
(2) holds a federal Clinical Laboratory Improvement Act
(CLIA) certificate of accreditation; and
(3) is not owned or operated by a hospital licensed under
IC 16-21-2.
(b) As used in this section, "de-identified maximum negotiated
charge" means the highest charge that a clinical laboratory has
HEA 1003 — CC 1
5
negotiated with any third party payer for an item or service.
(c) As used in this section, "de-identified minimum negotiated
charge" means the lowest charge that a clinical laboratory has
negotiated with any third party payer for an item or service.
(d) As used in this section, "discounted cash price" means the
charge that applies to an individual who pays cash or the cash
equivalent for a clinical laboratory item or service.
(e) As used in this section, "gross charge" means the charge for
an individual item or service that is reflected on a clinical
laboratory's chargemaster, absent any discounts.
(f) As used in this section, "item or service" means any item or
service, including service packages, that could be provided by a
clinical laboratory to a patient for which the clinical laboratory has
established a standard charge. The term includes the following:
(1) Supplies.
(2) Procedures.
(3) Use of the facility and other facility fees.
(4) Services of employed physicians and non-physician
practitioners, including professional charges.
(5) Anything that a clinical laboratory has established as a
standard charge.
(g) As used in this section, "payer-specific negotiated charge"
means the charge that a clinical laboratory has negotiated with a
third party payer for an item or service.
(h) As used in this section, "standard charge" means the regular
rate established by the clinical laboratory for an item or service
provided to a specific group of paying patients. The term includes
the following:
(1) Gross charge.
(2) Payer-specific negotiated charge.
(3) De-identified minimum negotiated charge.
(4) De-identified maximum negotiated charge.
(5) Discounted cash price.
(i) Not later than July 31, 2026, a clinical laboratory serving
patients in Indiana shall post on the website of the clinical
laboratory the following information and pricing, to the extent
applicable, for the fifty (50) laboratory services designated by the
department of insurance as shoppable for consumers who would be
self paying for those services without the benefit of a health
insurance plan or government subsidy:
(1) A description of the service in plain language.
(2) The discounted cash price.
HEA 1003 — CC 1
6
(3) The de-identified minimum negotiated charge.
(4) The de-identified maximum negotiated charge.
(j) Not later than May 1, 2026, the department of insurance
shall:
(1) determine the fifty (50) laboratory services to be disclosed
as shoppable for consumers as required under this section;
and
(2) post a list of the designated shoppable services on the
department's website.
SECTION 22. IC 16-21-17-0.3, AS ADDED BY P.L.151-2021,
SECTION 9 AND P.L.198-2021, SECTION 12, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 0.3. (a) As
used in this chapter, "de-identified maximum negotiated charge" means
the highest charge that a hospital or an ambulatory outpatient surgical
center has negotiated with any third party payer for an item or service.
(b) As used in this chapter, "de-identified minimum negotiated
charge" means the lowest charge that a hospital or an ambulatory
outpatient surgical center has negotiated with any third party payer for
an item or service.
(c) As used in this chapter, "discounted cash price" means the
charge that applies to an individual who pays cash or the cash
equivalent for a hospital or an ambulatory outpatient surgical center
item or service.
(d) As used in this chapter, "gross charge" means the charge for an
individual item or service that is reflected on a hospital's or an
ambulatory outpatient surgical center's chargemaster, absent any
discounts.
(e) As used in this chapter, "item or service" means any item or
service, including service packages, that could be provided by a
hospital or an ambulatory outpatient surgical center to a patient for
which the hospital or ambulatory outpatient surgical center has
established a standard charge. The term includes the following:
(1) Supplies.
(2) Procedures.
(3) Use of the facility and other facility fees.
(4) Services of employed physicians and non-physician
practitioners, including professional charges.
(5) Anything that a hospital or an ambulatory outpatient surgical
center has established as a standard charge.
(f) As used in this chapter, "payer-specific negotiated charge" means
the charge that a hospital or an ambulatory outpatient surgical center
has negotiated with a third party payer for an item or service.
HEA 1003 — CC 1
7
(g) As used in this chapter, "standard charge" means the regular rate
established by the hospital or ambulatory outpatient surgical center for
an item or service provided to a specific group of paying patients. The
term includes the following:
(1) Gross charge.
(2) Payer-specific negotiated charge.
(3) De-identified minimum negotiated charge.
(4) De-identified maximum negotiated charge.
(5) Discounted cash price.
SECTION 23. IC 16-21-17-1, AS AMENDED BY P.L.151-2021,
SECTION 11 AND P.L.198-2021, SECTION 14, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 1. (a) Not
later than December 31, 2021, 2025, a hospital and an ambulatory
outpatient surgical center shall post on the Internet web site website of
the hospital or ambulatory outpatient surgical center pricing and other
information specified in this chapter for the following:
(1) For as many of the seventy (70) shoppable services specified
in the final rule of the Centers for Medicare and Medicaid
Services published in 84 FR 65524 that are provided by the
hospital or ambulatory outpatient surgical center.
(2) In addition to the services specified in subdivision (1):
(A) the thirty (30) most common services that are provided by
the hospital or ambulatory outpatient surgical center not
included in subdivision (1); or
(B) if the hospital or ambulatory outpatient surgical center
offers less than thirty (30) services not included under
subdivision (1), all of the services provided by the hospital or
ambulatory outpatient surgical center.
(b) The following information, to the extent applicable, must be
included on the Internet web site website by a hospital and an
ambulatory outpatient surgical center for the shoppable and common
services described in subsection (a):
(1) A description of the shoppable and common service.
(2) The standard charge per item or service for each of the
following categories:
(A) Any nongovernment sponsored health benefit plan or
insurance plan provided by a health carrier in which the
provider is in the network.
(B) Medicare, including fee for service and Medicare
Advantage.
(C) Self-pay without charitable assistance from the hospital or
ambulatory outpatient surgical center.
HEA 1003 — CC 1
8
(D) Self-pay with charitable assistance from The maximum
charitable assistance allowed under the charity or financial
assistance policy of the hospital or ambulatory outpatient
surgical center.
(E) Medicaid, including fee for service and risk based
managed care.
(c) If:
(1) the federal Hospital Price Transparency Rule is repealed; or
(2) federal enforcement of the federal Hospital Price
Transparency Rule is stopped;
the state health commissioner shall notify the legislative council of the
occurrence referred to in subdivision (1) or (2) in an electronic format
under IC 5-14-6.
(d) This subsection takes effect when the legislative council receives
a notification from the state health commissioner under subsection (c).
A hospital shall post pricing information in compliance with the federal
Hospital Price Transparency Rule of the federal Centers for Medicare
and Medicaid Services as published at 84 FR 65524 and in effect on
January 1, 2021.
SECTION 24. IC 16-39-1-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 2. Upon a patient's
written request and reasonable notice, a provider shall, at the provider's
actual costs, at no cost, provide to the patient or the patient's designee:
(1) access to; or
(2) a copy of;
the patient's x-ray film image possessed by the provider.
SECTION 25. IC 16-39-7-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 2. (a) This section does
not apply to original mammograms, which are governed by section 3
of this chapter.
(b) As used in this section, "x-ray film" image" includes a
microfilm copy of the an x-ray film and a digital image of an x-ray.
(c) A provider shall maintain a patient's x-ray film image for at least
five (5) years.
(d) At the time an x-ray film image is taken, the provider shall do
one (1) of the following:
(1) Inform the patient in writing of the following:
(A) The patient's x-ray film image will be kept on file by the
provider for at least five (5) years.
(B) If the patient would like a copy of the x-ray film image
during that period, the provider will provide the patient with
a copy of the x-ray film image at the actual no cost, to the
HEA 1003 — CC 1
9
provider, as provided in IC 16-39-1-2.
(2) Have posted conspicuously in the x-ray examination area a
sign informing patients of the following:
(A) All x-ray films images will be kept on file by a provider
for at least five (5) years.
(B) On request during that time, the provider will provide the
patient a copy of the patient's x-ray film image at the actual no
cost to the provider.
(e) A provider is immune from civil liability for destroying or
otherwise failing to maintain an x-ray film image in violation of this
section if the destruction or failure to maintain the x-ray film image is
inadvertent and not done in bad faith. However, this subsection does
not prevent the imposition of disciplinary sanctions against the
provider, as described in subsection (f).
(f) A provider who violates this section commits an offense for
which a board may impose disciplinary sanctions against the provider
under the statute that governs the provider's licensure, registration, or
certification under this title or IC 25.
SECTION 26. IC 16-39-9-1.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 1.5. (a) As used in this chapter,
"electronic health record" means a record of an individual's
medical history that is created, generated, sent, communicated,
received, or stored by electronic means.
(b) For purposes of this chapter, the term includes billing
statements and other administrative records that may be provided
through electronic means.
SECTION 27. IC 16-39-9-2, AS AMENDED BY P.L.173-2007,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 2. A provider may not charge a person for:
(1) providing a digital copy or digital access through an
interoperability platform of an individual's electronic health
record; or
(2) making and providing paper copies of medical records at an
amount greater than the amount set in rules adopted by the
department of insurance under section 4 of this chapter.
SECTION 28. IC 16-39-9-4, AS AMENDED BY P.L.173-2007,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 4. (a) As used in this section, "department" refers
to the department of insurance created by IC 27-1-1-1.
(b) The department may adopt rules under IC 4-22-2 to set the
amounts that may be charged for copying and providing paper copies
HEA 1003 — CC 1
10
of medical records under this chapter.
(c) In adopting rules under this section, the department shall
consider the following factors relating to the costs of copying medical
records:
(1) The following labor costs:
(A) Verification of requests.
(B) Logging requests.
(C) Retrieval.
(D) Copying.
(E) Refiling.
(2) Software costs for logging requests.
(3) Expense costs for copying.
(4) Capital costs for copying.
(5) Billing and bad debt expenses.
(6) Space costs.
SECTION 29. IC 16-41-35.5 IS ADDED TO THE INDIANA
CODE AS A NEW CHAPTER TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]:
Chapter 35.5. Diagnostic Imaging Facility: Health Care Pricing
Information
Sec. 1. As used in this chapter, "de-identified maximum
negotiated charge" means the highest charge that a diagnostic
imaging facility has negotiated with any third party payer for an
item or service.
Sec. 2. As used in this chapter, "de-identified minimum
negotiated charge" means the lowest charge that a diagnostic
imaging facility has negotiated with any third party payer for an
item or service.
Sec. 3. (a) As used in this chapter, "diagnostic imaging facility"
means an entity that:
(1) provides diagnostic imaging to an individual for the
purpose of health care; and
(2) is not owned or operated by a hospital licensed under
IC 16-21-2.
(b) The term does not include the following offices where an
x-ray or imaging service is exclusively used by the office:
(1) A dental office.
(2) An optometrist office.
(3) A practitioner's office.
Sec. 4. As used in this chapter, "discounted cash price" means
the charge that applies to an individual who pays cash or the cash
equivalent for a diagnostic imaging facility item or service.
HEA 1003 — CC 1
11
Sec. 5. As used in this chapter, "gross charge" means the charge
for an individual item or service that is reflected on a diagnostic
imaging facility's chargemaster, absent any discounts.
Sec. 6. As used in this chapter, "item or service" means any item
or service, including service packages, that could be provided by a
diagnostic imaging facility to a patient for which the diagnostic
imaging facility has established a standard charge. The term
includes the following:
(1) Supplies.
(2) Procedures.
(3) Use of the facility and other facility fees.
(4) Services of employed physicians and non-physician
practitioners, including professional charges.
(5) Anything that a diagnostic imaging facility has established
as a standard charge.
Sec. 7. As used in this chapter, "payer-specific negotiated
charge" means the charge that a diagnostic imaging facility has
negotiated with a third party payer for an item or service.
Sec. 8. As used in this chapter, "standard charge" means the
regular rate established by the diagnostic imaging facility for an
item or service provided to a specific group of paying patients. The
term includes the following:
(1) Gross charge.
(2) Payer-specific negotiated charge.
(3) De-identified minimum negotiated charge.
(4) De-identified maximum negotiated charge.
(5) Discounted cash price.
Sec. 9. Not later than July 31, 2026, a diagnostic imaging facility
serving patients in Indiana shall post on the diagnostic imaging
facility's website the following information and pricing, to the
extent applicable, for the fifty (50) diagnostic imaging services
designated by the department of insurance as shoppable for
consumers who would be self paying for those services without the
benefit of a health insurance plan or government subsidy:
(1) A description of the service in plain language.
(2) The discounted cash price.
(3) The de-identified minimum negotiated charge.
(4) The de-identified maximum negotiated charge.
Sec. 10. Not later than May 1, 2026, the department of insurance
shall:
(1) determine the fifty (50) diagnostic imaging services to be
disclosed as shoppable for consumers as required under this
HEA 1003 — CC 1
12
section; and
(2) post a list of the designated shoppable services on the
department's website.
SECTION 30. IC 16-42-26.5 IS ADDED TO THE INDIANA
CODE AS A NEW CHAPTER TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]:
Chapter 26.5. Individualized Investigational Treatment
Sec. 1. As used in this chapter, "eligible facility" means an entity
that operates under the Federalwide Assurance for the Protection
of Human Subjects in accordance with 42 U.S.C. 289(a) and 45
CFR 46.
Sec. 2. As used in this chapter, "individualized investigational
treatment" means a drug, biological product, or device that is
unique to and produced exclusively for use by an individual
patient, based on the individual's own genetic profile. The term
includes individualized gene therapy, antisense oligonucleotides
(ASO), and individualized neoantigen vaccines.
Sec. 3. As used in this chapter, "life threatening or severely
debilitating disease" has the meaning described in 21 CFR 312.81.
Sec. 4. An individual must meet the following requirements in
order to qualify as an eligible patient under this chapter:
(1) Has been diagnosed with a life threatening or severely
debilitating disease, as attested by the individual's physician.
(2) Has considered other treatment options currently
approved by the United States Food and Drug
Administration.
(3) Has received a recommendation from the individual's
physician for an individualized investigational treatment
based on analysis of the patient's genomic sequence, human
chromosomes, deoxyribonucleic acid, ribonucleic acid, genes,
gene products, or metabolites.
(4) Has given written informed consent as set forth in section
5 of this chapter for the use of the individualized
investigational treatment.
(5) Has documentation from the individual's physician that
the individual meets the requirements of this section.
Sec. 5. (a) Written informed consent as required under section
4(4) of this chapter must include the following:
(1) An explanation of the currently approved products and
treatments for the individual's disease or condition.
(2) An attestation by the individual of the individual's
debilitating condition and that the individual concurs with the
HEA 1003 — CC 1
13
individual's physician that all currently approved treatments
are unlikely to prolong the individual's life or improve the
individual's debilitating condition.
(3) A clear identification of the specific individualized
investigational treatment proposed to be used to treat the
individual.
(4) A description of the best and worst outcomes, including
the most likely outcome, resulting from use of the
individualized investigational treatment of the individual's life
threatening or severely debilitating illness.
(5) A statement acknowledging that new, unanticipated,
different, or worse symptoms or death may result from the
proposed treatment.
(6) A statement that the individual's health insurance may not
be obligated to pay for any care or treatment and that the
patient may be liable for all expenses of the treatment unless
specifically required to do so by contract or law.
(7) A statement that eligibility for hospice care may be
withdrawn if the individual begins individualized
investigational treatment and does not meet hospice care
eligibility requirements.
(8) A statement that the individual or the individual's legal
guardian consents to the individualized investigational
treatment for the life threatening or severely debilitating
illness.
(b) The description of outcomes described in subsection (a)(4)
must be based on the treating physician's knowledge of both the
individualized investigational treatment and the individual's life
threatening or severely debilitating disease.
Sec. 6. (a) A manufacturer operating within an eligible facility
and in accordance with federal law may make available to an
eligible patient the manufacturer's individualized investigational
treatment from an eligible facility.
(b) Nothing in this chapter may be construed to require a
manufacturer of an individualized investigational treatment to
make the individualized investigational treatment available to an
eligible patient.
(c) A manufacturer of an individualized investigational
treatment may do any of the following:
(1) Provide an individualized investigational treatment to an
eligible patient without receiving compensation.
(2) Require an eligible patient to pay the costs of or associated
HEA 1003 — CC 1
14
with the manufacture of the individualized investigational
treatment.
(d) This chapter does not create a cause of action against a
manufacturer of an individualized investigational treatment for
any harm to an eligible patient resulting from use of an
individualized investigational treatment.
Sec. 7. If an eligible patient dies while being treated with an
individualized investigational treatment, the eligible patient's heirs
are not liable for any outstanding debt related to the individualized
investigational treatment.
Sec. 8. The medical licensing board of Indiana may not revoke,
suspend, fail to renew, or take any other disciplinary action against
a physician licensed under IC 25-22.5 based solely on the
physician's recommendations to an eligible patient concerning
access to or treatment with an individualized investigational
treatment.
Sec. 9. This chapter does not affect coverage for clinical trials
set forth in IC 5-10-8-15, IC 12-15-5-9.2, IC 27-8-25, or
IC 27-13-7-20.2.
SECTION 31. IC 16-51-1-8.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 8.5. As used in this chapter,
"non-invasive treatment" means a treatment that is not included
in the definition of surgery or other invasive procedure under 410
IAC 15-1.1-22.
SECTION 32. IC 16-51-1-9, AS ADDED BY P.L.203-2023,
SECTION 18, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 9. (a) As used in this chapter, "office setting"
means a location of a qualified provider where health care services are
provided and that:
(1) is located more than two hundred fifty (250) yards from the
main building of any hospital owned in whole or in part by the
Indiana nonprofit hospital system; and
(2) is where a qualified provider routinely provides health
examinations, diagnosis, or non-invasive treatment of illness or
injury on an ambulatory basis.
(b) The term does not include the following:
(1) A location within the campus (as defined in 42 CFR
413.65(a)(2)) of a hospital.
(2) A location not more than two hundred fifty (250) yards
from the main building of a remote location of a hospital (as
defined in 42 CFR 413.65(a)(2)).
HEA 1003 — CC 1
15
SECTION 33. IC 16-51-1-9.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 9.5. As used in this chapter,
"payor" means an insurer, health maintenance organization,
employer, or other person responsible for the payment of the cost
of health care services provided by a qualified provider.
SECTION 34. IC 16-51-1-10, AS ADDED BY P.L.203-2023,
SECTION 18, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 10. As used in this chapter, "qualified provider"
means an individual or entity owned in whole or in part employed by
an Indiana nonprofit hospital system and that is duly licensed or legally
authorized to provide health care services.
SECTION 35. IC 16-51-1-10.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 10.5. As used in this chapter,
"services provided for the treatment of individuals with psychiatric
disorders or chronic addiction disorders" means services to
diagnose or treat a mental illness or substance-related or addictive
disorder diagnosis under the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition, Text Revision, published by the
American Psychiatric Association (DSM V-TR).
SECTION 36. IC 16-51-1-11, AS ADDED BY P.L.203-2023,
SECTION 18, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 11. (a) As used in this section, "physician fee
schedule" refers to the negotiated agreement between a payor and
a qualified provider specifying reimbursement for services
furnished in an office setting and billed on a CMS 1500 form or its
electronic equivalent.
(a) (b) A bill for health care services provided by a qualified
provider in an office setting:
(1) may not be submitted on an institutional provider form; and
(2) must be submitted on an individual provider form.
(b) (c) An insurer, health maintenance organization, employer, or
other person responsible for the payment of the cost of health care
services provided by a qualified provider in an office setting A payor
shall not accept a bill for the health care services that is submitted on
an institutional provider form.
(d) A qualified provider in an office setting may not bill health
care services with a place of service code 21 or 22, as published in
the place of service code set maintained by the federal Centers for
Medicare and Medicaid Services.
(e) Beginning January 1, 2026, a payor shall pay the claims
HEA 1003 — CC 1
16
incurred by an in-network qualified provider based on the
physician fee schedule.
SECTION 37. IC 16-51-1-11.1 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 11.1. (a) If, after making payment
for health care services provided by a qualified provider, a payor
discovers that a bill was submitted in violation of section 11 of this
chapter, the payor may utilize the remedies set forth in either:
(1) the contract or other arrangement between the payor and
qualified provider; or
(2) IC 27-8-5.7-10.
(b) If a qualified provider disagrees with a determination made
by a payor that a bill was submitted in violation of section 11 of
this chapter, the qualified provider may use the dispute resolution
process set forth in the contract or other arrangement between the
payor and qualified provider.
SECTION 38. IC 16-51-1-11.3 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 11.3. (a) Before July 1, 2025,
and every two (2) years with licensure renewal, an Indiana
nonprofit hospital system shall submit a complete list of facilities
within the Indiana nonprofit hospital system that:
(1) qualify as an institutional provider; and
(2) may submit a bill on an institutional provider form under
this chapter;
to the state department, in a manner prescribed by the state
department. The list submitted under this section must include for
each listed facility the appropriate place of service code, as
published in the place of service code set maintained by the federal
Centers for Medicaid and Medicare Services.
(b) An Indiana nonprofit hospital system shall notify the state
department of:
(1) a new facility that:
(A) qualifies as an institutional provider; and
(B) may submit a bill on an institutional provider form
under this chapter; or
(2) the closure or change of location of a facility that:
(A) qualifies as an institutional provider; and
(B) may submit a bill on an institutional provider form
under this chapter.
The notice under this subsection must be provided not later than
thirty (30) days after an event under subdivision (1) or (2) occurs.
HEA 1003 — CC 1
17
(c) The state department shall post on the state department's
website a list of the facilities, as identified under subsection (a) or
(b), that:
(1) qualify as an institutional provider; and
(2) may submit a bill on an institutional provider form under
this chapter.
SECTION 39. IC 16-51-1-11.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 11.5. (a) A payor or an Indiana
nonprofit hospital system may report a violation of this chapter to
the state department on a form prescribed by the state department.
(b) The state department may assess a civil penalty of one
thousand dollars ($1,000) per day against a qualified provider for
a violation of this chapter.
SECTION 40. IC 16-51-1-13 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 13. Nothing in this chapter is
intended to change any other billing or coding requirements that
are not specifically addressed in this chapter.
SECTION 41. IC 25-1-9-23, AS AMENDED BY P.L.93-2024,
SECTION 180, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 23. (a) This section does not apply
to emergency services.
(b) As used in this section, "covered individual" means an
individual who is entitled to be provided health care services at a cost
established according to a network plan.
(c) As used in this section, "emergency services" means services
that are:
(1) furnished by a provider qualified to furnish emergency
services; and
(2) needed to evaluate or stabilize an emergency medical
condition.
(d) As used in this section, "in network practitioner" means a
practitioner who is required under a network plan to provide health
care services to covered individuals at not more than a preestablished
rate or amount of compensation.
(e) As used in this section, "network plan" means a plan under
which facilities and practitioners are required by contract to provide
health care services to covered individuals at not more than a
preestablished rate or amount of compensation.
(f) As used in this section, "out of network" means that the health
care services provided by the practitioner to a covered individual are
HEA 1003 — CC 1
18
not subject to the covered individual's health carrier network plan.
(g) As used in this section, "practitioner" means the following:
(1) An individual who holds:
(A) an unlimited license, certificate, or registration;
(B) a limited or probationary license, certificate, or
registration;
(C) a temporary license, certificate, registration, or permit;
(D) an intern permit; or
(E) a provisional license;
issued by the board (as defined in IC 25-0.5-11-1) regulating the
profession in question.
(2) An entity that:
(A) is owned by, or employs; or
(B) performs billing for professional health care services
rendered by;
an individual described in subdivision (1).
The term does not include a dentist licensed under IC 25-14, an
optometrist licensed under IC 25-24, or a provider facility (as defined
in IC 25-1-9.8-10).
(h) An in network practitioner who provides covered health care
services to a covered individual may not charge more for the covered
health care services than allowed according to the rate or amount of
compensation established by the individual's network plan.
(i) An out of network practitioner who provides health care services
at an in network facility to a covered individual may not be reimbursed
more for the health care services than allowed according to the rate or
amount of compensation established by the covered individual's
network plan unless all of the following conditions are met:
(1) At least five (5) business days before the health care services
are scheduled to be provided to the covered individual, the
practitioner provides to the covered individual, on a form separate
from any other form provided to the covered individual by the
practitioner, a statement in conspicuous type that meets the
following requirements:
(A) Includes a notice reading substantially as follows: "[Name
of practitioner] is an out of network practitioner providing
[type of care] with [name of in network facility], which is an
in network provider facility within your health carrier's plan.
[Name of practitioner] will not be allowed to bill you the
difference between the price charged by the practitioner and
the rate your health carrier will reimburse for the services
during your care at [name of in network facility] unless you
HEA 1003 — CC 1
19
give your written consent to the charge.".
(B) Sets forth the practitioner's good faith estimate of the
amount that the practitioner intends to charge for the health
care services provided to the covered individual.
(C) Includes a notice reading substantially as follows
concerning the good faith estimate set forth under clause (B):
"The estimate of our intended charge for [name or description
of health care services] set forth in this statement is provided
in good faith and is our best estimate of the amount we will
charge. If our actual charge for [name or description of health
care services] exceeds our estimate by the greater of:
(i) one hundred dollars ($100); or
(ii) five percent (5%);
we will explain to you why the charge exceeds the estimate.".
(2) The covered individual signs the statement provided under
subdivision (1), signifying the covered individual's consent to the
charge for the health care services being greater than allowed
according to the rate or amount of compensation established by
the network plan.
(j) If an out of network practitioner does not meet the requirements
of subsection (i), the out of network practitioner shall include on any
bill remitted to a covered individual a written statement in conspicuous
type stating that the covered individual is not responsible for more than
the rate or amount of compensation established by the covered
individual's network plan plus any required copayment, deductible, or
coinsurance.
(k) If a covered individual's network plan remits reimbursement to
the covered individual for health care services subject to the
reimbursement limitation of subsection (i), the network plan shall
provide with the reimbursement a written statement in conspicuous
type that states that the covered individual is not responsible for more
than the rate or amount of compensation established by the covered
individual's network plan and that is included in the reimbursement
plus any required copayment, deductible, or coinsurance.
(l) If the charge of a practitioner for health care services provided
to a covered individual exceeds the estimate provided to the covered
individual under subsection (i)(1)(B) by the greater of:
(1) one hundred dollars ($100); or
(2) five percent (5%);
the facility or practitioner shall explain in a writing provided to the
covered individual why the charge exceeds the estimate.
(m) An in network practitioner is not required to provide a covered
HEA 1003 — CC 1
20
individual with the good faith estimate if the nonemergency health care
service is scheduled to be performed by the practitioner within five (5)
two (2) business days after the health care service is ordered.
(n) The department of insurance shall adopt rules under IC 4-22-2
to specify the requirements of the notifications set forth in subsections
(j) and (k).
(o) The requirements of this section do not apply to a practitioner
who:
(1) is required to comply with; and
(2) is in compliance with;
45 CFR Part 149, Subparts E and G, as may be enforced and amended
by the federal Department of Health and Human Services.
SECTION 42. IC 25-1-9.8-11, AS ADDED BY P.L.93-2020,
SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 11. (a) This section does not apply to an
individual who is a Medicaid recipient.
(b) An individual for whom a nonemergency health care service has
been ordered, scheduled, or referred may request from the practitioner
who may provide the nonemergency health care service a good faith
estimate of the total price the practitioner will charge for providing the
nonemergency health care service.
(c) A practitioner who receives a request from a patient under
subsection (b) shall, not more than five (5) two (2) business days after
receiving relevant information from the individual, provide to the
individual a good faith estimate of the price that the practitioner will
charge for providing the nonemergency health care service.
(d) A practitioner must ensure that a good faith estimate provided
to an individual under this section is accompanied by a notice stating
that:
(1) an estimate provided under this section is not binding on the
practitioner;
(2) the price the practitioner charges the individual may vary from
the estimate based on the individual's medical needs; and
(3) the estimate provided under this section is only valid for thirty
(30) days.
(e) A practitioner may not charge an individual for information
provided under this section.
SECTION 43. IC 25-1-9.8-16, AS AMENDED BY P.L.202-2021,
SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 16. (a) A practitioner that has scheduled or
ordered for an individual a nonemergency health care service shall
provide to the individual an electronic or paper copy of a written notice
HEA 1003 — CC 1
21
that states the following, or words to the same effect: "A patient may
ask a health care provider for an estimate of the price the health care
providers and health facility will charge for providing a nonemergency
health care service. The law requires that the estimate be provided
within 5 business 2 business days of scheduling the nonemergency
health care service unless the nonemergency health care service is
scheduled to be performed by the practitioner within 5 business 2
business days of the date of the patient's request.".
(b) The appropriate board (as defined in IC 25-1-9-1) may adopt
rules under IC 4-22-2 to establish requirements for practitioners to
provide additional charging information under this section.
SECTION 44. IC 25-1-9.8-17, AS ADDED BY P.L.93-2020,
SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 17. If:
(1) a practitioner receives a request for a good faith estimate
under this chapter; and
(2) the patient is eligible for Medicare coverage;
the practitioner shall provide a good faith estimate to the patient within
five (5) two (2) business days based on available Medicare rates.
SECTION 45. IC 25-1-9.8-18, AS AMENDED BY P.L.202-2021,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 18. (a) Each provider must make diligent attempts
to ensure that the patient is aware of the patient's right to request a good
faith estimate under this chapter. The communication by each provider
of information to the patient concerning the right to a good faith
estimate must be conspicuous and must be provided by at least three
(3) of the following means:
(1) Notice on the provider's Internet web site. website.
(2) On hold messaging.
(3) Waiting room notification.
(4) Preappointment reminders, including through electronic mail
(email) or text messaging.
(5) During appointment or services check in.
(6) During appointment or services check out.
(7) During patient financial services or billing department
inquiries.
(8) Through an electronic medical and patient communication
portal.
(b) The communication required under subsection (a) must state the
following, or words to the same effect: "A patient may ask for an
estimate of the amount the patient will be charged for a nonemergency
medical service provided in our office. The law requires that an
HEA 1003 — CC 1
22
estimate be provided within 5 business 2 business days of scheduling
the nonemergency health care service unless the nonemergency health
care service is scheduled to be performed by the practitioner within 5
business 2 business days of the date of the patient's request.".
SECTION 46. IC 27-1-3-36 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2025]: Sec. 36. (a) As used in this section, "prior authorization"
means a practice implemented by a health plan through which
coverage of a health care service is dependent on the covered
individual or health care provider obtaining approval from the
health plan before the health care service is rendered. The term
includes prospective or utilization review procedures conducted
before a health care service is rendered.
(b) The department may enter into partnerships and joint
ventures to encourage best practices in the appropriate and
effective use of prior authorization in health care.
SECTION 47. IC 27-1-24.5-25, AS AMENDED BY P.L.152-2024,
SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 25. (a) A contract holder may, one (1) time in a
calendar year and not earlier than six (6) months following a previously
requested audit, request an audit of compliance with the contract. If
requested by the contract holder, the audit shall include full disclosure
of the following data specific to the contract holder:
(1) Rebate amounts secured on prescription drugs, whether
product specific or general rebates, that were provided by a
pharmaceutical manufacturer. The information provided under
this subdivision must identify the prescription drugs by
therapeutic category.
(2) Pharmaceutical and device claims received by the pharmacy
benefit manager on any of the following:
(A) The CMS-1500 form or its successor form.
(B) The HCFA-1500 form or its successor form.
(C) The HIPAA X12 837P electronic claims transaction for
professional services, or its successor transaction.
(D) The HIPAA X12 837I institutional form or its successor
form.
(E) The CMS-1450 form or its successor form.
(F) The UB-04 form or its successor form.
The forms or transaction may be modified as necessary to comply
with the federal Health Insurance Portability and Accountability
Act (HIPAA) (P.L. 104-191). or to redact a trade secret (as
defined in IC 24-2-3-2).
HEA 1003 — CC 1
23
(3) Pharmaceutical and device claims payments or electronic
funds transfer or remittance advice notices provided by the
pharmacy benefit manager as ASC X12N 835 files or a successor
format. The files may be modified as necessary to comply with
the federal Health Insurance Portability and Accountability Act
(HIPAA) (P.L. 104-191). or to redact a trade secret (as defined in
IC 24-2-3-2). In the event that paper claims are provided, the
pharmacy benefit manager shall convert the paper claims to the
ASC X12N 835 electronic format or a successor format.
(4) Any other revenue and fees derived by the pharmacy benefit
manager from the contract, including all direct and indirect
remuneration from pharmaceutical manufacturers regardless of
whether the remuneration is classified as a rebate, fee, or another
term.
(b) A pharmacy benefit manager may not impose the following:
(1) Fees for:
(A) requesting an audit under this section; or
(B) selecting an auditor other than an auditor designated by the
pharmacy benefit manager.
(2) Conditions that would restrict a contract holder's right to
conduct an audit under this section, including restrictions on the:
(A) time period of the audit;
(B) number of claims analyzed;
(C) type of analysis conducted;
(D) data elements used in the analysis; or
(E) selection of an auditor as long as the auditor:
(i) does not have a conflict of interest;
(ii) meets a threshold for liability insurance specified in the
contract between the parties;
(iii) does not work on a contingent fee basis; and
(iv) does not have a history of breaching nondisclosure
agreements.
(c) A pharmacy benefit manager shall disclose, upon request from
a contract holder, to the contract holder the actual amounts directly or
indirectly paid by the pharmacy benefit manager to the pharmacist or
pharmacy for the drug and for pharmacist services related to the drug.
(d) A pharmacy benefit manager shall provide notice to a contract
holder contracting with the pharmacy benefit manager of any
consideration, including direct or indirect remuneration, that the
pharmacy benefit manager receives from a pharmaceutical
manufacturer or group purchasing organization for formulary
placement or any other reason.
HEA 1003 — CC 1
24
(e) The commissioner may establish a procedure to release
information from an audit performed by the department to a contract
holder that has requested an audit under this section in a manner that
does not violate confidential or proprietary information laws.
(f) A contract that is entered into, issued, amended, or renewed after
June 30, 2024, may not contain a provision that violates this section.
(g) A pharmacy benefit manager shall:
(1) obtain any information requested in an audit under this section
from a group purchasing organization or other partner entity of
the pharmacy benefit manager; and
(2) confirm receipt of a request for an audit under this section to
the contract holder not later than ten (10) business days after the
information is requested.
(h) Information provided in an audit under this section must be
provided in accordance with the federal Health Insurance Portability
and Accountability Act (HIPAA) (P.L. 104-191).
SECTION 48. IC 27-1-37-0.1 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 0.1. As used in this chapter,
"administrative denial" means the denial by a health carrier for
nonmedical reasons of a health provider facility's or provider's
claim for reimbursement.
SECTION 49. IC 27-1-37-7.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 7.5. (a) This section applies to a
health provider contract entered into, amended, or renewed after
June 30, 2025.
(b) When a health carrier is in the process of negotiating a
health provider contract with a health provider facility or
provider, the health carrier must provide to the health provider
facility or provider the following:
(1) A current fee schedule that must include the following
information:
(A) The proposed reimbursement for each covered service
under the proposed health provider contract.
(B) The twenty-fifth percentile, fiftieth percentile, and
seventy-fifth percentile reimbursement amounts in Indiana
for each covered service under the proposed health
provider contract.
(2) The current criteria that the health carrier uses when
determining whether to issue an administrative denial.
(c) When a health provider facility or provider is in the process
HEA 1003 — CC 1
25
of negotiating a health provider contract with a health carrier, the
health provider facility or provider shall provide the health carrier
with the twenty-fifth percentile, fiftieth percentile, and
seventy-fifth percentile reimbursement amounts that the health
provider facility or provider receives for each covered service
under the proposed health provider contract.
SECTION 50. IC 27-1-37-8, AS ADDED BY P.L.198-2021,
SECTION 22, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 8. (a) This section applies to a health provider
contract entered into, amended, or renewed after June 30, 2021. 2025.
(b) A health provider contract, including a contract with a pharmacy
benefit manager, may not contain a provision that does any of the
following:
(1) Limits the ability of either the health carrier, or the health
provider facility, or the provider to disclose the allowed amount
and fees of services to any insured (as defined in IC 27-8-5.8-3)
or enrollee (as defined in IC 27-13-1-12), or to the treating health
provider facility or physician provider of the insured or enrollee.
(2) Limits the ability of either the health carrier, or the health
provider facility, or the provider to disclose out-of-pocket costs
to an insured (as defined in IC 27-8-5.8-3) or an enrollee (as
defined in IC 27-13-1-12).
(3) Limits the ability of the health carrier to introduce or
modify a select network plan or tiered network plan by
granting the provider a guaranteed right of participation.
(4) Requires the health carrier to place all facilities in the
same tier of a tiered network plan.
(5) Requires the health carrier to include all facilities in a
select network plan on an all-or-nothing basis.
(6) Requires a provider to participate in a new select network
or tiered network plan that the health carrier introduces
without granting the provider the right to opt out of the new
plan at least sixty (60) days before the new plan is submitted
to the commissioner for approval.
(c) Any provision of a health provider contract that includes a
provision described in subsection (b) in violation of this section is
severable and the provision in violation is null and void. The remaining
provisions of the health provider contract, excluding the provision in
violation of this section, remain in effect and are enforceable.
(d) The attorney general may issue a civil investigative demand to
obtain information from a party of, or pertaining to, a health provider
contract and compliance of this section.
HEA 1003 — CC 1
26
SECTION 51. IC 27-1-37-10 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 10. (a) This section applies to a
health provider contract in which at least one (1) of the parties is
a health provider facility.
(b) A health provider contract that:
(1) requires the parties to commence negotiations to amend
the terms of the contract if there is a change in law; or
(2) guarantees that the health carrier or provider will be
made whole for the financial effects of a law or regulation;
is against public policy and is void and unenforceable.
SECTION 52. IC 27-1-37-11 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 11. The department shall do the
following:
(1) Require health carriers to meet network adequacy
standards that are no less stringent than the network
adequacy standards established by the Centers for Medicare
and Medicaid Services.
(2) When assessing whether a health carrier has met the
network adequacy standards, consider the availability and
variety of independent specialty providers that provide
services within in network provider facilities in the health
carrier's network.
SECTION 53. IC 27-1-37.7 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]:
Chapter 37.7. Reporting of Prior Authorization Disputes
Sec. 1. As used in this chapter, "department" refers to the
department of insurance created by IC 27-1-1-1.
Sec. 2. As used in this chapter, "health plan" has the meaning
set forth in IC 27-1-37.5-5.
Sec. 3. As used in this chapter, "prior authorization" has the
meaning set forth in IC 27-1-37.5-7.
Sec. 4. A health care provider or health plan may submit
information concerning a dispute between a health care provider
and a health plan regarding prior authorization to the department.
Sec. 5. (a) The department may:
(1) receive;
(2) categorize; and
(3) maintain;
any information provided by a health care provider or a health
HEA 1003 — CC 1
27
plan under this chapter.
(b) The department may not adjudicate or otherwise mediate
any of the disputes between health care providers and health plans.
Sec. 6. If the department receives information under section 4
of this chapter from a health care provider or health plan, the
department shall keep the following information of the individual
who submitted the information confidential:
(1) Name.
(2) Address.
(3) Telephone number.
(4) Electronic mail address.
(5) Personal health information.
(6) Any other information that could identify the individual.
Sec. 7. (a) Before December 1, 2026, the department shall
provide a report in an electronic format under IC 5-14-6 to the
general assembly with any findings and recommendations related
to the information received under section 4 of this chapter.
(b) This section expires July 1, 2027.
SECTION 54. IC 27-1-44.5-3.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 3.5. (a) Not later than September
1, 2025, the department shall issue a request for information in
compliance with IC 5-23-4.5 concerning ways to better enable
medical consumers to compare and shop for medical and health
care services using real time price and health quality information
from respected sources approved by the advisory board, including
claims data maintained by the data base.
(b) The request for information must consider:
(1) the convenience of medical consumers, including whether
and how to develop, procure, or license one (1) or more
services into a single application that is available on both
desktop and mobile; and
(2) whether and how to benchmark price and health quality
comparison shopping by medical consumers in Indiana.
(c) The department shall set the deadline for submissions of the
request for information under this section that may not be later
than December 1, 2025.
SECTION 55. IC 27-1-45-7, AS AMENDED BY P.L.165-2022,
SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 7. (a) This section is effective beginning January
1, 2022.
(b) A facility or a practitioner is not required to provide the good
HEA 1003 — CC 1
28
faith estimate if the health care service to be provided to the covered
individual is scheduled to be performed within five (5) two (2)
business days after the health care service is ordered.
SECTION 56. IC 27-1-46-11, AS AMENDED BY P.L.202-2021,
SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 11. (a) This section does not:
(1) apply to an individual who is a Medicaid recipient; or
(2) limit the authority of a legal representative of the patient.
(b) An individual for whom a nonemergency health care service has
been ordered, scheduled, or referred may request from the provider
facility in which the nonemergency health care service will be provided
a good faith estimate of the price that will be charged for the
nonemergency health care service.
(c) A provider facility that receives a request from an individual
under subsection (b) shall, not more than five (5) two (2) business days
after receiving relevant information from the individual, provide to the
individual a good faith estimate of:
(1) the price that the provider facility in which the health care
service will be performed will charge for:
(A) the use of the provider facility to care for the individual for
the nonemergency health care service;
(B) the services rendered by the employed or contracted staff
of the provider facility in connection with the nonemergency
health care service; and
(C) medication, supplies, equipment, and material items to be
provided to or used by the individual while the individual is
present in the provider facility in connection with the
nonemergency health care service; and
(2) the price charged for the services of all practitioners, support
staff, and other persons who provide professional health services:
(A) who may provide services to or for the individual during
the individual's presence in the provider facility for the
nonemergency health care service; and
(B) for whose services the individual will be charged
separately from the charge of the provider facility.
(d) The price that must be included in a good faith estimate under
this section includes all services under subsection (c)(1) or (c)(2) for
imaging, laboratory services, diagnostic services, therapy, observation
services, and other services expected to be provided to the individual
for the episode of care.
(e) A provider facility shall ensure that a good faith estimate states
that:
HEA 1003 — CC 1
29
(1) an estimate provided under this section is not binding on the
provider facility;
(2) the price the provider facility charges the individual may vary
from the estimate based on the individual's medical needs; and
(3) the estimate provided under this section is only valid for thirty
(30) days.
(f) A provider facility may not charge a patient for information
provided under this section.
SECTION 57. IC 27-1-46-15, AS AMENDED BY P.L.202-2021,
SECTION 14, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 15. (a) Each provider must make diligent attempts
to ensure that the patient is aware of the patient's right to request a good
faith estimate under this chapter. The communication by a provider to
the patient concerning the right to a good faith estimate must be
conspicuous and must be provided by at least three (3) of the following
means:
(1) Notice on the provider's Internet web site. website.
(2) On hold messaging.
(3) Waiting room notification.
(4) Preappointment reminders, including through electronic mail
(email) or text messaging.
(5) During appointment or services check in.
(6) During appointment or services check out.
(7) During patient financial services or billing department
inquiries.
(8) Through an electronic medical and patient communication
portal.
(b) The communication required under subsection (a) must state the
following, or words to the same effect: "A patient may ask for an
estimate of the amount the patient will be charged for a nonemergency
health care service provided in our facility. The law requires that an
estimate be provided within 5 business 2 business days.".
SECTION 58. IC 27-1-46-16, AS AMENDED BY P.L.202-2021,
SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 16. If:
(1) a provider facility receives a request for a good faith estimate
under this chapter; and
(2) the patient is eligible for Medicare coverage;
the provider facility shall provide a good faith estimate to the patient
within five (5) two (2) business days based on available Medicare cost
sharing rates.
SECTION 59. IC 27-2-25-12, AS ADDED BY P.L.93-2020,
HEA 1003 — CC 1
30
SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 12. (a) A covered individual may request from the
health carrier a good faith estimate of:
(1) the amount of the cost of the nonemergency health care
service that the health carrier will:
(A) pay for; or
(B) reimburse to;
the covered individual; or
(2) the applicable benefit limitations of the ordered nonemergency
health care service a covered individual is entitled to receive from
the health carrier.
(b) If:
(1) a health carrier provides coverage to a covered individual
through a network plan; and
(2) the health carrier receives a request for a good faith estimate
from a covered individual for whom a nonemergency health care
service has been ordered;
the health carrier shall inform the covered individual whether the
provider facility in which the nonemergency health care service will be
provided is in network and whether each scheduled practitioner who
may provide the nonemergency health care service is in network.
(c) A health carrier that receives a request from a covered individual
patient under subsection (b) shall, not more than five (5) two (2)
business days after receiving relevant information, provide to the
individual a good faith estimate as described in section 14 of this
chapter.
(d) A health carrier must ensure that a good faith estimate states that
the estimate provided under this section is only valid for thirty (30)
days and that:
(1) the amount that the health carrier will:
(A) pay; or
(B) reimburse;
for or to the covered individual for the nonemergency health care
services the individual receives; and
(2) the applicable benefit limitations of the nonemergency health
care services the individual will receive;
may vary from the health carrier's good faith estimate based on the
individual's medical needs.
(e) A health carrier may not charge an individual for information
provided under this section.
(f) A practitioner and provider facility shall provide a health carrier
with the information needed by the health carrier to comply with the
HEA 1003 — CC 1
31
requirements under this chapter not more than two (2) business days
after receiving the request.
SECTION 60. IC 27-2-25-15, AS ADDED BY P.L.93-2020,
SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 15. A health carrier that provides an Internet web
site a website for the use of its covered individuals shall ensure that the
Internet web site website includes a printed notice that:
(1) is designed, lettered, and featured on the Internet web site
website so as to be conspicuous to and readable by any individual
with normal vision who visits the Internet web site; website; and
(2) states the following, or words to the same effect: "A covered
individual may at any time ask the health carrier for an estimate
of the amount the health carrier will pay for or reimburse to a
covered individual for nonemergency health care services that
have been ordered for the covered individual or the applicable
benefit limitations of the ordered nonemergency health care
services a covered individual is entitled to receive from the health
carrier. The law requires that an estimate be provided within 5
business 2 business days.".
SECTION 61. IC 27-2-25.5-3, AS ADDED BY P.L.152-2024,
SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 3. (a) This section applies to a contract entered
into, issued, amended, or renewed after June 30, 2024.
(b) A contract:
(1) between a:
(A) third party administrator; and
(B) plan sponsor;
(2) between a:
(A) prepaid health care delivery plan under IC 5-10-8-7(c) to
provide group health coverage for state employees; and
(B) plan sponsor; or
(3) between:
(A) a pharmacy benefit manager (as defined in
IC 27-1-24.5-12); and
(B) either a:
(i) plan sponsor; or
(ii) third party administrator for the administration of a
self-funded health benefit plan on behalf of the plan
sponsor;
must provide that the plan sponsor owns the claims data relating to the
contract. However, a plan sponsor's ownership of the claims data under
this section may not be construed to require the pharmacy benefit
HEA 1003 — CC 1
32
manager or third party administrator to disclose a trade secret (as
defined in IC 24-2-3-2).
(c) Any claims data provided under this section must be provided in
accordance with the federal Health Insurance Portability and
Accountability Act (HIPAA) (P.L. 104-191).
SECTION 62. IC 27-2-25.5-4, AS ADDED BY P.L.152-2024,
SECTION 16, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 4. (a) A plan sponsor that contracts with a third
party administrator, the office of the secretary of family and social
services that contracts with a managed care organization (as defined in
IC 12-7-2-126.9) to provide services to a Medicaid recipient, or the
state personnel department that contracts with a prepaid health care
delivery plan under IC 5-10-8-7(c) to provide group health coverage for
state employees may, one (1) time in a calendar year and not earlier
than six (6) months following a previously requested audit, request an
audit of compliance with the contract. If requested by the plan sponsor,
office of the secretary of family and social services, or state personnel
department, the audit shall include full disclosure of the following
concerning data specific to the plan sponsor, office of the secretary, or
state personnel department:
(1) Claims data described in section 1 of this chapter.
(2) Claims received by the third party administrator, managed
care organization, or prepaid health care delivery plan on any of
the following:
(A) The CMS-1500 form or its successor form.
(B) The HCFA-1500 form or its successor form.
(C) The HIPAA X12 837P electronic claims transaction for
professional services, or its successor transaction.
(D) The HIPAA X12 837I institutional form or its successor
form.
(E) The CMS-1450 form or its successor form.
(F) The UB-04 form or its successor form.
The forms or transaction may be modified as necessary to comply
with the federal Health Insurance Portability and Accountability
Act (HIPAA) (P.L. 104-191). or to redact a trade secret (as
defined in IC 24-2-3-2).
(3) Claims payments, electronic funds transfer, or remittance
advice notices provided by the third party administrator, managed
care organization, or prepaid health care delivery plan as ASC
X12N 835 files or a successor format. The files may be modified
only as necessary to comply with the federal Health Insurance
Portability and Accountability Act (HIPAA) (P.L. 104-191). or to
HEA 1003 — CC 1
33
redact a trade secret (as defined in IC 24-2-3-2). In the event that
paper claims are provided, the third party administrator, managed
care organization, or prepaid health care delivery plan shall
convert the paper claims to the ASC X12N 835 electronic format
or a successor format.
(4) Any fees charged to the plan sponsor, office of the secretary
of family and social services, or state personnel department
related to plan administration and claims processing, including
renegotiation fees, access fees, repricing fees, or enhanced review
fees.
(b) A third party administrator, managed care organization, or
prepaid health care delivery plan may not impose:
(1) fees for:
(A) requesting an audit under this section; or
(B) selecting an auditor other than an auditor designated by the
third party administrator, managed care organization, or
prepaid health care delivery plan; or
(2) conditions that would restrict a party's right to conduct an
audit under this section, including restrictions on the:
(A) time period of the audit;
(B) number of claims analyzed;
(C) type of analysis conducted;
(D) data elements used in the analysis; or
(E) selection of an auditor as long as the auditor:
(i) does not have a conflict of interest;
(ii) meets a threshold for liability insurance specified in the
contract between the parties;
(iii) does not work on a contingent fee basis; and
(iv) does not have a history of breaching nondisclosure
agreements.
(c) A third party administrator, managed care organization, or
prepaid health care delivery plan shall confirm receipt of a request for
an audit under this section to the plan sponsor, office of the secretary
of family and social services, or state personnel department not later
than ten (10) business days after the information is requested.
(d) Information provided in an audit under this section must be
provided in accordance with the federal Health Insurance Portability
and Accountability Act (HIPAA) (P.L. 104-191).
(e) A contract that is entered into, issued, amended, or renewed after
June 30, 2024, may not contain a provision that violates this section.
(f) A violation of this section is an unfair or deceptive act or practice
in the business of insurance under IC 27-4-1-4.
HEA 1003 — CC 1
34
(g) The department may also adopt rules under IC 4-22-2 to set forth
fines for a violation under this section.
SECTION 63. IC 27-8-5.7-12 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 12. (a) This section applies to a
policy of accident and sickness insurance that is issued, delivered,
amended, or renewed after June 30, 2025.
(b) An insurer may not deny a claim for reimbursement for a
covered service or item provided to an insured on the sole basis
that the referring provider is an out of network provider.
SECTION 64. IC 27-8-11-13.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 13.5. (a) As used in this section,
"physician" refers to an individual who:
(1) is licensed under IC 25-22.5;
(2) has been granted reciprocity by the medical licensing
board of Indiana under IC 25-1-21 before July 1, 2026; or
(3) is licensed in a state that has enacted the interstate medical
licensure compact.
(b) If a physician who is fully credentialed by an insurer:
(1) leaves the employment of an employer and becomes
employed with another employer in Indiana; or
(2) establishes or relocates a medical practice in Indiana;
the insurer shall provisionally credential the physician for the time
frame set forth in subsection (c).
(c) A physician under subsection (b) must be provisionally
credentialed:
(1) for sixty (60) days after the physician's separation from
employment or the establishment or relocation of the medical
practice; or
(2) until the physician is fully credentialed by the insurer;
whichever is earlier.
(d) Notwithstanding section 7(k) of this chapter, an insurer shall
reimburse a physician who is provisionally credentialed under this
section for services rendered while the physician was provisionally
credentialed at the rates determined by:
(1) the agreement between the physician's new employer and
the insurer under section 3 of this chapter; or
(2) if:
(A) the physician's new employer has not entered into an
agreement with the insurer under section 3 of this chapter;
or
HEA 1003 — CC 1
35
(B) the physician established or relocated a medical
practice;
the agreement between the physician and the insurer under
section 3 of this chapter that was in effect at the time of the
physician's separation from employment or the establishment
or relocation of the medical practice.
SECTION 65. IC 27-13-36.2-10 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 10. (a) This section applies to an
individual contract and a group contract that is entered into,
delivered, amended, or renewed after June 30, 2025.
(b) A health maintenance organization may not deny a claim for
reimbursement for a covered service or item provided to an
enrollee on the sole basis that the referring provider is an out of
network provider.
SECTION 66. IC 27-13-43-5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 5. (a) As used in this section,
"physician" refers to an individual who:
(1) is licensed under IC 25-22.5;
(2) has been granted reciprocity by the medical licensing
board of Indiana under IC 25-1-21 before July 1, 2026; or
(3) is licensed in a state that has enacted the interstate medical
licensure compact.
(b) If a physician who is fully credentialed by a health
maintenance organization:
(1) leaves the employment of an employer and becomes
employed with another employer in Indiana; or
(2) establishes or relocates a medical practice in Indiana;
the health maintenance organization shall provisionally credential
the physician for the time frame set forth in subsection (c).
(c) A physician under subsection (b) must be provisionally
credentialed:
(1) for sixty (60) days after the physician's separation from
employment or the establishment or relocation of the medical
practice; or
(2) until the physician is fully credentialed by the health
maintenance organization;
whichever is earlier.
(d) Notwithstanding section 2(j) of this chapter, a health
maintenance organization shall reimburse a physician who is
provisionally credentialed under this section for services rendered
HEA 1003 — CC 1
36
while the physician was provisionally credentialed at the rates
determined by:
(1) the agreement between the physician's new employer and
the health maintenance organization relating to terms and
conditions of reimbursement; or
(2) if:
(A) the physician's new employer has not entered into an
agreement with the health maintenance organization
relating to the terms and conditions of reimbursement; or
(B) the physician established or relocated a medical
practice;
the agreement between the physician and the health
maintenance organization relating to terms and conditions of
reimbursement that was in effect at the time of the physician's
separation from employment or the establishment or
relocation of the medical practice.
SECTION 67. IC 34-30-2.1-240, AS ADDED BY P.L.105-2022,
SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 240. IC 16-39-7-2 (Concerning medical care
providers for maintenance of x-ray film). images).
SECTION 68. [EFFECTIVE JULY 1, 2025] (a) The Indiana
department of health, in consultation with the office of technology
established by IC 4-13.1-2-1, shall study the feasibility of
developing and implementing standards for health providers
concerning the following:
(1) Medical record interoperability.
(2) Medical data security.
(3) Patient control over the access and use of the patient's
medical information, including the ability to opt out or
rescind authorization to share the patient's medical
information.
(4) Notification to individuals of any unauthorized access or
disclosure of the individual's medical information.
(5) Compliance with the federal Health Insurance Portability
and Accountability Act (HIPAA) concerning safety and
patient's information.
(b) Not later than November 1, 2025, the Indiana department of
health shall submit a report to the legislative council in an
electronic format under IC 5-14-6 concerning the study conducted
under subsection (a) and any findings or recommendations as a
result of the study.
(c) This SECTION expires December 31, 2025.
HEA 1003 — CC 1
37
SECTION 69. An emergency is declared for this act.
HEA 1003 — CC 1
Speaker of the House of Representatives
President of the Senate
President Pro Tempore
Governor of the State of Indiana
Date: Time:
HEA 1003 — CC 1Every fact on this page links to its source, starting with the official bill record.