Indiana 2022 Regular Session

Indiana House Bill HB1270 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	Introduced Version
3	3	HOUSE BILL No. 1270
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 16-18-2-251; IC 16-21; IC 27-1; IC 27-2-26.
7	7	Synopsis: Nonprofit hospital and insurer reporting. Requires a
8	8	nonprofit hospital with more than 100 beds to report annually specified
9	9	financial information to the state department of health. Requires a
10	10	nonprofit hospital and a health carrier to post and send certain
11	11	information at least 45 days before a public forum. Modifies
12	12	requirements concerning the: (1) date on which the public forum must
13	13	be held; (2) topics that must be discussed at a public forum; (3)
14	14	submission of questions and feedback at a public forum; and (4) use of
15	15	technology to allow attendance through real time audio and video
16	16	through the Internet. Requires the insurance commissioner to report to
17	17	the legislative council if the federal Transparency in Health Coverage
18	18	rule (federal rule) is repealed or enforcement is stopped. Requires
19	19	health payers to continue to post pricing information in compliance
20	20	with the federal rule after the federal rule is repealed or stopped.
21	21	Modifies the definition of "health payer" for purposes of the all payer
22	22	claims data base.
23	23	Effective: Upon passage; July 1, 2022.
24	24	Schaibley
25	25	January 10, 2022, read first time and referred to Committee on Public Health.
26	26	2022 IN 1270—LS 6860/DI 104 Introduced
27	27	Second Regular Session of the 122nd General Assembly (2022)
28	28	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
29	29	Constitution) is being amended, the text of the existing provision will appear in this style type,
30	30	additions will appear in this style type, and deletions will appear in this style type.
31	31	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
32	32	provision adopted), the text of the new provision will appear in this style type. Also, the
33	33	word NEW will appear in that style type in the introductory clause of each SECTION that adds
34	34	a new provision to the Indiana Code or the Indiana Constitution.
35	35	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
36	36	between statutes enacted by the 2021 Regular Session of the General Assembly.
37	37	HOUSE BILL No. 1270
38	38	A BILL FOR AN ACT to amend the Indiana Code concerning
39	39	health.
40	40	Be it enacted by the General Assembly of the State of Indiana:
41	41	1 SECTION 1. IC 16-18-2-251 IS AMENDED TO READ AS
42	42	2 FOLLOWS [EFFECTIVE JULY 1, 2022]: Sec. 251. "Nonprofit
43	43	3 hospital", for purposes of IC 16-21-6-3 and IC 16-21-9, has the
44	44	4 meaning set forth in IC 16-21-9-3.
45	45	5 SECTION 2. IC 16-21-6-3, AS AMENDED BY P.L.2-2007,
46	46	6 SECTION 190, IS AMENDED TO READ AS FOLLOWS
47	47	7 [EFFECTIVE JULY 1, 2022]: Sec. 3. (a) Each hospital shall file with
48	48	8 the state department a report for the preceding fiscal year within one
49	49	9 hundred twenty (120) days after the end of the hospital's fiscal year.
50	50	10 The state department shall grant an extension of the time to file the
51	51	11 report if the hospital shows good cause for the extension. The report
52	52	12 must contain the following:
53	53	13 (1) A copy of the hospital's balance sheet, including a statement
54	54	14 describing the hospital's total assets and total liabilities.
55	55	15 (2) A copy of the hospital's income statement.
56	56	16 (3) A statement of changes in financial position.
57	57	17 (4) A statement of changes in fund balance.
58	58	2022 IN 1270—LS 6860/DI 104 2
59	59	1 (5) Accountant notes pertaining to the report.
60	60	2 (6) A copy of the hospital's report required to be filed annually
61	61	3 under 42 U.S.C. 1395g, and other appropriate utilization and
62	62	4 financial reports required to be filed under federal statutory law.
63	63	5 (7) Net patient revenue.
64	64	6 (8) A statement including:
65	65	7 (A) Medicare gross revenue;
66	66	8 (B) Medicaid gross revenue;
67	67	9 (C) other revenue from state programs;
68	68	10 (D) revenue from local government programs;
69	69	11 (E) local tax support;
70	70	12 (F) charitable contributions;
71	71	13 (G) other third party payments;
72	72	14 (H) gross inpatient revenue;
73	73	15 (I) gross outpatient revenue;
74	74	16 (J) contractual allowance;
75	75	17 (K) any other deductions from revenue;
76	76	18 (L) charity care provided;
77	77	19 (M) itemization of bad debt expense; and
78	78	20 (N) an estimation of the unreimbursed cost of subsidized
79	79	21 health services.
80	80	22 (9) A statement itemizing donations.
81	81	23 (10) A statement describing the total cost of reimbursed and
82	82	24 unreimbursed research.
83	83	25 (11) A statement describing the total cost of reimbursed and
84	84	26 unreimbursed education separated into the following categories:
85	85	27 (A) Education of physicians, nurses, technicians, and other
86	86	28 medical professionals and health care providers.
87	87	29 (B) Scholarships and funding to medical schools, and other
88	88	30 postsecondary educational institutions for health professions
89	89	31 education.
90	90	32 (C) Education of patients concerning diseases and home care
91	91	33 in response to community needs.
92	92	34 (D) Community health education through informational
93	93	35 programs, publications, and outreach activities in response to
94	94	36 community needs.
95	95	37 (E) Other educational services resulting in education related
96	96	38 costs.
97	97	39 (b) The information in the report filed under subsection (a) must be
98	98	40 provided from reports or audits certified by an independent certified
99	99	41 public accountant or by the state board of accounts.
100	100	42 (c) In addition to the information required in subsection (a), a
101	101	2022 IN 1270—LS 6860/DI 104 3
102	102	1 nonprofit hospital that has more than one hundred (100) beds shall
103	103	2 submit the following as part of the report required by this section:
104	104	3 (1) Federal form 990, Schedule H, Part I, 7(a), financial
105	105	4 assistance at cost, worksheet 1 or other similar
106	106	5 documentation, or its successor form or schedule.
107	107	6 (2) Federal form 990, Schedule H, Part I, 7(b), Medicaid,
108	108	7 worksheet 3, column a, or its successor form or schedule.
109	109	8 (3) Federal form 990, Schedule H, Part I, 7(c), costs of other
110	110	9 means-tested government programs, worksheet 3, column b,
111	111	10 or its successor form or schedule.
112	112	11 (4) Federal form 990, Schedule H, Part I, 7(e), community
113	113	12 health improvement services and community benefit
114	114	13 operations, worksheet 4 or other similar documentation, or its
115	115	14 successor form or schedule.
116	116	15 (5) Federal form 990, Schedule H, Part I, 7(f), health
117	117	16 professions education, worksheet 5 or other similar
118	118	17 documentation, or its successor form or schedule.
119	119	18 (6) Federal form 990, Schedule H, Part I, 7(g), subsidized
120	120	19 health services, worksheet 6 or other similar documentation,
121	121	20 or its successor form or schedule.
122	122	21 (7) Federal form 990, Schedule H, Part I, 7(h), research,
123	123	22 worksheet 7 or other similar documentation, or its successor
124	124	23 form or schedule.
125	125	24 (8) Federal form 990, Schedule H, Part I, 7(i), cash and in kind
126	126	25 contributions for community benefit, worksheet 8, or its
127	127	26 successor form or schedule.
128	128	27 (9) Federal form 990, Schedule H, Part II, community
129	129	28 building activities, lines 1 through 9, or its successor form or
130	130	29 schedule, and including specific initiatives and related net
131	131	30 expenses for each line.
132	132	31 (10) Federal form 990, Schedule H, Part III, section A, bad
133	133	32 debt expense, lines 2 through 3, or its successor form or
134	134	33 schedule, and including calculations to support the data
135	135	34 entered.
136	136	35 (11) Federal form 990, Schedule H, Part III, section B,
137	137	36 Medicare, lines 5 through 7, or its successor form or schedule,
138	138	37 and including calculations to support the data entered.
139	139	38 The nonprofit hospital may redact information included in these
140	140	39 forms if the redaction is necessary to comply with the federal
141	141	40 Health Insurance Portability and Accountability Act (HIPAA)
142	142	41 (P.L. 104-191).
143	143	42 SECTION 3. IC 16-21-9-3.5, AS AMENDED BY P.L.199-2021,
144	144	2022 IN 1270—LS 6860/DI 104 4
145	145	1 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
146	146	2 UPON PASSAGE]: Sec. 3.5. (a) This section does not apply to the
147	147	3 following:
148	148	4 (1) A nonprofit critical access hospital that is not:
149	149	5 (A) part of a hospital system; or
150	150	6 (B) an affiliate of a hospital or hospital system.
151	151	7 (2) A hospital that is established and operated under IC 16-22 or
152	152	8 IC 16-23.
153	153	9 (b) Before December 31 November 15 of each year, a nonprofit
154	154	10 hospital shall hold a public forum in which the nonprofit hospital,
155	155	11 including the nonprofit hospital's board of directors, shall:
156	156	12 (1) obtain feedback from the community about the nonprofit
157	157	13 hospital's performance in the previous year;
158	158	14 (2) discuss the pricing of inpatient and outpatient health
159	159	15 services provided at:
160	160	16 (A) the nonprofit hospital; and
161	161	17 (B) affiliates of the nonprofit hospital; and
162	162	18 (3) discuss the contributions made by the nonprofit hospital to the
163	163	19 community, including uncompensated care, charitable
164	164	20 contributions, and any other charitable assistance programs.
165	165	21 (c) At least fourteen (14) forty-five (45) days before the forum held
166	166	22 under subsection (b), the nonprofit hospital shall post on the nonprofit
167	167	23 hospital's Internet web site the following:
168	168	24 (1) A printed notice that:
169	169	25 (A) is designed, lettered, and featured on the Internet web site
170	170	26 so as to be conspicuous to and readable by any individual with
171	171	27 normal vision who visits the Internet web site;
172	172	28 (B) states the date, time, and location of the public forum to be
173	173	29 held under subsection (b); and
174	174	30 (C) provides instructions that describe how members of the
175	175	31 community and the public can attend the public forum
176	176	32 through real time audio and video technology through the
177	177	33 Internet; and
178	178	34 (C) (D) states that the purpose of the public forum is to
179	179	35 provide members of the community with an opportunity to:
180	180	36 (i) comment on the nonprofit hospital's performance in the
181	181	previous year;37
182	182	38 (ii) discuss the pricing of inpatient and outpatient health
183	183	39 services provided at the nonprofit hospital and affiliates of
184	184	40 the nonprofit hospital; and
185	185	41 (iii) discuss the contributions made by the hospital to the
186	186	42 community, including uncompensated care, charitable
187	187	2022 IN 1270—LS 6860/DI 104 5
188	188	contributions, and any other charitable assistance programs.1
189	189	2 (2) The following information relating to the subjects to be
190	190	3 discussed at the public forum held under subsection (b):
191	191	4 (A) The nonprofit hospital's Indiana specific income statement
192	192	5 for the previous calendar year that is prepared according to
193	193	6 generally accepted accounting principles.
194	194	7 (B) Information concerning:
195	195	8 (i) the nonprofit hospital's pricing of health services in
196	196	9 comparison to the amounts of reimbursement for the health
197	197	10 services under the Medicare program;
198	198	11 (ii) the rationale for any pricing of health services by the
199	199	12 nonprofit hospital that is higher than the corresponding
200	200	13 reimbursement for the health services under the Medicare
201	201	14 program; and
202	202	15 (iii) any increase in the nonprofit hospital's pricing of health
203	203	16 services that occurred in the previous year.
204	204	17 (d) At the public forum held under this section, a nonprofit
205	205	18 hospital must allow members of the community to ask questions
206	206	19 and provide feedback during the public forum. A nonprofit
207	207	20 hospital may allow, but may not require, members of the
208	208	21 community to submit questions and feedback in advance of the
209	209	22 public forum.
210	210	23 (d) (e) The public forum requirement held under this section may
211	211	24 be held, either all or in part, must be accessible through an interactive
212	212	25 real time audio and video meeting that is accessible to the community
213	213	26 technology through the Internet. The technology must allow:
214	214	27 (1) members of the community to hear, see, and participate in
215	215	28 the public forum in real time; and
216	216	29 (2) the public to hear and see the public forum in real time.
217	217	30 (f) At least forty-five (45) days before the public forum held
218	218	31 under subsection (b), the nonprofit hospital shall send the printed
219	219	32 notice described in subsection (c)(1) to the state department.
220	220	33 SECTION 4. IC 27-1-44.3 IS ADDED TO THE INDIANA CODE
221	221	34 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
222	222	35 UPON PASSAGE]:
223	223	36 Chapter 44.3. Transparency in Health Coverage
224	224	37 Sec. 1. (a) As used in this chapter, "health payer" refers to the
225	225	38 following:
226	226	39 (1) An insurer that issues an individual or group policy of
227	227	40 accident and sickness insurance (as defined in IC 27-8-5-1).
228	228	41 (2) A health maintenance organization (as defined in
229	229	42 IC 27-13-1-19) for purposes of individual contracts and group
230	230	2022 IN 1270—LS 6860/DI 104 6
231	231	1 contracts.
232	232	2 (3) A pharmacy benefit manager (as defined in
233	233	3 IC 27-1-24.5-12).
234	234	4 (4) An administrator (as defined in IC 27-1-25-1).
235	235	5 (b) The term does not include an insurer that issues a policy of
236	236	6 accident and sickness insurance for purposes of the following types
237	237	7 of coverage:
238	238	8 (1) Accident only, credit, dental, vision, Medicare supplement,
239	239	9 long term care, or disability income insurance.
240	240	10 (2) Coverage issued as a supplement to liability insurance.
241	241	11 (3) Automobile medical payment insurance.
242	242	12 (4) A specified disease policy.
243	243	13 (5) A policy that provides indemnity benefits not based on any
244	244	14 expense incurred requirements, including a plan that provides
245	245	15 coverage for:
246	246	16 (A) hospital confinement, critical illness, or intensive care;
247	247	17 or
248	248	18 (B) gaps for deductibles or copayments.
249	249	19 (6) Worker's compensation or similar insurance.
250	250	20 (7) A student health plan.
251	251	21 (8) A supplemental plan that always pays in addition to other
252	252	22 coverage.
253	253	23 (9) An employer sponsored health benefit plan that is:
254	254	24 (A) provided to individuals who are eligible for Medicare;
255	255	25 and
256	256	26 (B) not marketed as, or held out to be, a Medicare
257	257	27 supplement policy.
258	258	28 Sec. 2. If:
259	259	29 (1) the federal Transparency in Health Coverage rule (85 FR
260	260	30 72158) is repealed; or
261	261	31 (2) federal enforcement of the federal Transparency in Health
262	262	32 Coverage rule is stopped;
263	263	33 the insurance commissioner appointed under IC 27-1-1-2 shall
264	264	34 notify the legislative council in an electronic format under
265	265	35 IC 5-14-6 of the occurrence referred to in subdivision (1) or (2).
266	266	36 Sec. 3. (a) This section takes effect when the legislative council
267	267	37 receives a notification from the insurance commissioner under
268	268	38 section 2 of this chapter. A health payer shall post pricing
269	269	39 information in compliance with the federal Transparency in Health
270	270	40 Coverage rule, as published at 85 FR 72158 and in effect on
271	271	41 January 11, 2021.
272	272	42 (b) The insurance commissioner may adopt rules under
273	273	2022 IN 1270—LS 6860/DI 104 7
274	274	1 IC 4-22-2 necessary to implement this section.
275	275	2 SECTION 5. IC 27-1-44.5-2, AS AMENDED BY P.L.195-2021,
276	276	3 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
277	277	4 UPON PASSAGE]: Sec. 2. As used in this chapter, "health payer"
278	278	5 includes the following:
279	279	6 (1) Medicare.
280	280	7 (2) Medicaid or a managed care organization (as defined in
281	281	8 IC 12-7-2-126.9) that has contracted with Medicaid to provide
282	282	9 services to a Medicaid recipient.
283	283	10 (3) An insurer that issues a policy of accident and sickness
284	284	11 insurance (as defined in IC 27-8-5-1), except for the following
285	285	12 types of coverage:
286	286	13 (A) Accident only, credit, dental, vision, Medicare
287	287	14 supplement, long term care, or disability income insurance.
288	288	15 (B) Coverage issued as a supplement to liability insurance.
289	289	16 (C) Automobile medical payment insurance.
290	290	17 (D) A specified disease policy.
291	291	18 (E) A policy that provides indemnity benefits not based on any
292	292	19 expense incurred requirements, including a plan that provides
293	293	20 coverage for:
294	294	21 (i) hospital confinement, critical illness, or intensive care; or
295	295	22 (ii) gaps for deductibles or copayments.
296	296	23 (F) Worker's compensation or similar insurance.
297	297	24 (G) A student health plan.
298	298	25 (H) A supplemental plan that always pays in addition to other
299	299	26 coverage.
300	300	27 (I) An employer sponsored health benefit plan that is:
301	301	28 (i) provided to individuals who are eligible for Medicare;
302	302	29 and
303	303	30 (ii) not marketed as, or held out to be, a Medicare
304	304	31 supplement policy.
305	305	32 (4) A health maintenance organization (as defined in
306	306	33 IC 27-13-1-19).
307	307	34 (5) A pharmacy benefit manager (as defined in IC 27-1-24.5-12).
308	308	35 (6) An administrator (as defined in IC 27-1-25-1).
309	309	36 (7) Any other person identified by the commissioner for
310	310	37 participation in the data base described in this chapter.
311	311	38 SECTION 6. IC 27-2-26-2, AS ADDED BY P.L.151-2021,
312	312	39 SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
313	313	40 UPON PASSAGE]: Sec. 2. (a) Before December 31 November 15 of
314	314	41 each year, a health carrier shall hold a public forum in which the health
315	315	42 carrier shall:
316	316	2022 IN 1270—LS 6860/DI 104 8
317	317	1 (1) obtain feedback from the community about the health carrier's
318	318	2 performance in the previous year; and
319	319	3 (2) discuss the premiums (as defined in IC 27-1-2-3(w)) charged
320	320	4 by the health carrier.
321	321	5 (b) The public forum required under subsection (a) may be held
322	322	6 under this section either all or in part, must be accessible through an
323	323	7 interactive real time audio and video meeting that is accessible to the
324	324	8 community through the Internet. The technology must allow:
325	325	9 (1) members of the community to hear, see, and participate in
326	326	10 the public forum in real time; and
327	327	11 (2) the public to hear and see the public forum in real time.
328	328	12 (c) At the public forum held under this section, a health carrier
329	329	13 must allow members of the community to ask questions and
330	330	14 provide feedback during the public forum. A health carrier may
331	331	15 allow, but may not require, members of the community to submit
332	332	16 questions and feedback in advance of the public forum.
333	333	17 SECTION 7. IC 27-2-26-3, AS ADDED BY P.L.151-2021,
334	334	18 SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
335	335	19 UPON PASSAGE]: Sec. 3. At least fourteen (14) forty-five (45) days
336	336	20 before the public forum required by this chapter is held, the health
337	337	21 carrier shall post on the health carrier's Internet web site the following:
338	338	22 (1) A printed notice that:
339	339	23 (A) is designed, lettered, and featured on the Internet web site
340	340	24 in a manner that is conspicuous to and readable by any
341	341	25 individual with normal vision who visits the Internet web site;
342	342	26 (B) states the date, time, and location of the public forum; and
343	343	27 (C) provides instructions that describe how members of the
344	344	28 community and the public can attend the public forum
345	345	29 through real time audio and video technology through the
346	346	30 Internet; and
347	347	31 (C) (D) states that the purpose of the public forum is to
348	348	32 provide members of the community with an opportunity to:
349	349	33 (i) comment on the health carrier's performance in the
350	350	34 previous year; and
351	351	35 (ii) discuss the premiums (as defined in IC 27-1-2-3(w))
352	352	36 charged by the health carrier.
353	353	37 (2) The following information concerning the subjects to be
354	354	38 discussed at the public forum:
355	355	39 (A) The health carrier's Indiana based profits, if the health
356	356	40 carrier is publicly traded.
357	357	41 (B) The premiums (as defined in IC 27-1-2-3(w)) charged by
358	358	42 the health carrier.
359	359	2022 IN 1270—LS 6860/DI 104 9
360	360	1 (C) The health carrier's strategy to lower health care costs.
361	361	2 (D) Any increase in the health carrier's premiums, on average
362	362	3 statewide, that occurred in the previous year for each health
363	363	4 carrier.
364	364	5 (E) Annual audited financial reports, if required under
365	365	6 IC 27-1-3.5-6 and if the health carrier is publicly traded.
366	366	7 SECTION 8. An emergency is declared for this act.
367	367	2022 IN 1270—LS 6860/DI 104