Indiana § 27-1-47-4 - Rules

§ 27-1-47-4. Rules

Sec. 4. The insurance commissioner may adopt rules under IC 4-22-2 to administer this chapter.

As added by P.L.196-2021, SEC.33.

IC 27-1-47.5Chapter 47.5. Oversight of Health Care Costs

27-1-47.5-1"Governmental hospital" 27-1-47.5-2"Independent hospital" 27-1-47.5-3"Indiana nonprofit hospital system" 27-1-47.5-4"Prices" 27-1-47.5-5Pricing; report 27-1-47.5-6Reporting requirements; records 27-1-47.5-7Calculating and comparing prices; review of data and resources 27-1-47.5-8Annual report 27-1-47.5-9Compliance with federal law

IC 27-1-47.5-1"Governmental hospital" Sec. 1. As used in this chapter, "governmental hospital" means an acute care hospital licensed under IC 16-21-2 that is governed by:

(1) IC 16-22-2;

(2) IC 16-22-8; or

(3) IC 16-23.

As added by P.L.203-2023, SEC.21.

IC 27-1-47.5-2"Independent hospital" Sec. 2. As used in this chapter, "independent hospital" means a private nonprofit acute care hospital licensed under IC 16-21-2 that meets the following criteria:

(1) Is either:

(A) not directly or indirectly owned or controlled by an entity that is headquartered outside of the county where the hospital is located; or

(B) owned or controlled by an entity that owns or operates hospitals on not more than three (3) acute care hospital licenses in Indiana. For purposes of this clause, a critical access hospital that meets the criteria under 42 CFR 485.601 et seq. does not count toward the number of acute care hospital licensed operated by an entity.

(2) Except as provided in subdivision (1)(B), does not directly or indirectly own another acute care hospital.

As added by P.L.203-2023, SEC.21.

IC 27-1-47.5-3"Indiana nonprofit hospital system" Sec. 3. (a) As used in this chapter, "Indiana nonprofit hospital system" means a hospital that:

(1) is organized as a nonprofit corporation or a charitable trust under Indiana law or the laws of any other state or country and that is:

(A) eligible for tax exempt bond financing; or

(B) exempt from state or local taxes;

(2) is licensed under IC 16-21-2;

(3) filed jointly one (1) hospital audited financial statement with the Indiana department of health in 2021; and

(4) has an annual patient service revenue of at least two billion dollars ($2,000,000,000) based on the hospital system's 2021 audited financial statement filed with the Indiana department of health. As used in this subdivision, "patient service revenue" includes similar terms, including net patient service revenue and patient care service revenue.

(b) The term does not apply to the following:

(1) A nonprofit hospital that is owned by a county.

(2) A critical access hospital that meets the criteria under 42 CFR 485.601 et seq.

(3) An independent hospital.

(4) A governmental hospital.

As added by P.L.203-2023, SEC.21.

IC 27-1-47.5-4"Prices" Sec. 4. As used in this chapter, "prices" means allowables that are paid for patient care services.

As added by P.L.203-2023, SEC.21.

IC 27-1-47.5-5Pricing; report Sec. 5. The department shall contract with a third party to do the following:

(1) Calculate an Indiana nonprofit hospital system's prices from the commercially insured market, categorized by:

(A) self-funded plan prices;

(B) fully-funded plan prices;

(C) the individual market prices; and

(D) the total combined prices of clauses (A) through (C);

expressed as a percentage of how much Medicare would have paid for the same services for the 2021 calendar year, the 2022 calendar year, and the 2023 calendar year.

(2) Not later than December 1, 2024, prepare a report of the findings in subdivision (1) and submit the report to the following:

(A) The department.

(B) The health care cost oversight task force established by IC 2-5-47.

(C) The budget committee for review.

As added by P.L.203-2023, SEC.21.

IC 27-1-47.5-6Reporting requirements; records Sec. 6. (a) Before March 1, 2024, and before March 1 of each subsequent year, an Indiana nonprofit hospital system shall submit the following:

(1) Information the department or the department's third party contractor determines is necessary to make the assessments required in this chapter.

(2) Standard charge information required to be made public by the federal Centers for Medicare and Medicaid Services for price transparency for each hospital facility within the Indiana nonprofit hospital system.

(b) Information required under this section shall be submitted to the department in a manner prescribed by the department.

(c) Except as provided in section 8 of this chapter, any records or documents disclosed to, received by, or generated by the department for purposes of this chapter are exempt from the requirements of IC 5-14-3.

As added by P.L.203-2023, SEC.21.

IC 27-1-47.5-7Calculating and comparing prices; review of data and resources Sec. 7. (a) The department shall contract with a third party to make the calculations required by this section. The third party contractor shall make the calculations described in subsection (b) concerning an Indiana nonprofit hospital system's prices from the commercially insured market, categorized by:

(1) self-funded plan prices;

(2) fully-funded plan prices;

(3) the individual market prices; and

(4) the total combined prices of subdivisions (1) through (3);

expressed as a percentage of how much Medicare would have paid for the same services.

(b) Before November 1, 2024, and before November 1 of each subsequent year, the department's third party contractor shall compare:

(1) hospital inpatient prices;

(2) hospital outpatient prices; and

(3) practitioner services prices;

calculated separately and combined in total as a percentage of Medicare for all patient care services provided to the commercially insured market. The third party contractor shall make these calculations for each Indiana nonprofit hospital within an Indiana nonprofit hospital system and for the Indiana nonprofit hospital system, expressed as a percentage of how much Medicare would have paid for the same services in comparison to what two hundred eighty-five percent (285%) of Medicare would have been for the same services.

(c) The department and the department's third party contractor shall review the data and resources submitted concerning prices in Indiana specific to each Indiana nonprofit hospital system.

As added by P.L.203-2023, SEC.21.

IC 27-1-47.5-8Annual report Sec. 8. Before December 1, 2024, and before December 1 of each subsequent year, the department shall submit a report of the third party contractor's findings in section 7 of this chapter in an electronic format under IC 5-14-6 to the health care cost oversight task force established by IC 2-5-47.

As added by P.L.203-2023, SEC.21.

IC 27-1-47.5-9Compliance with federal law Sec. 9. Information under this chapter must be provided in accordance with the federal Health Insurance Portability and Accountability Act,

As added by P.L.203-2023, SEC.21.

IC 27-1-48Chapter 48. Health Plan Notices

27-1-48-1"Covered individual" 27-1-48-2"CPT code" 27-1-48-3"Health care service" 27-1-48-4"Health plan" 27-1-48-5"Participating provider" 27-1-48-6"Prior authorization" 27-1-48-7Alternative method for claims submission 27-1-48-8Information required to be posted on health plan's website