Indiana 2023 Regular Session

Indiana House Bill HB1291 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. 1291
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 16-21-6-3; IC 27-8-5-1.5; IC 27-13-20-1.5.
7	7	Synopsis: Information about health care and health coverage. Amends
8	8	the law requiring a hospital to file an annual report with the Indiana
9	9	department of health: (1) to require that a hospital's report also be filed
10	10	with the all payer claims data base; and (2) to require a hospital to
11	11	include in the report additional information concerning the hospital's
12	12	medical loss ratio, the total funding received by the hospital under the
13	13	CARES Act, and other matters. Requires the insurance commissioner,
14	14	when deciding whether to approve a premium rate increase or decrease
15	15	for an accident and sickness insurance policy or an increase or decrease
16	16	in the rates to be used by a health maintenance organization (HMO), to
17	17	consider the median cost sharing for the affected insurance policy or
18	18	HMO contract, the benefits provided under the policy or contract, the
19	19	underlying costs of the health services covered by the policy or
20	20	contract, and other matters.
21	21	Effective: July 1, 2023.
22	22	Carbaugh
23	23	January 11, 2023, read first time and referred to Committee on Insurance.
24	24	2023 IN 1291—LS 6874/DI 55 Introduced
25	25	First Regular Session of the 123rd General Assembly (2023)
26	26	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
27	27	Constitution) is being amended, the text of the existing provision will appear in this style type,
28	28	additions will appear in this style type, and deletions will appear in this style type.
29	29	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
30	30	provision adopted), the text of the new provision will appear in this style type. Also, the
31	31	word NEW will appear in that style type in the introductory clause of each SECTION that adds
32	32	a new provision to the Indiana Code or the Indiana Constitution.
33	33	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
34	34	between statutes enacted by the 2022 Regular Session of the General Assembly.
35	35	HOUSE BILL No. 1291
36	36	A BILL FOR AN ACT to amend the Indiana Code concerning
37	37	insurance.
38	38	Be it enacted by the General Assembly of the State of Indiana:
39	39	1 SECTION 1. IC 16-21-6-3, AS AMENDED BY P.L.2-2007,
40	40	2 SECTION 190, IS AMENDED TO READ AS FOLLOWS
41	41	3 [EFFECTIVE JULY 1, 2023]: Sec. 3. (a) Each hospital shall file with
42	42	4 the state department and the all payer claims data base created
43	43	5 under IC 27-1-44.5 a report for the preceding fiscal year within one
44	44	6 hundred twenty (120) days after the end of the hospital's fiscal year.
45	45	7 The state department shall grant an extension of the time to file the
46	46	8 report if the hospital shows good cause for the extension. Subject to
47	47	9 subsection (d), the report must contain the following:
48	48	10 (1) A copy of the hospital's balance sheet, including a statement
49	49	11 describing the hospital's total assets and total liabilities.
50	50	12 (2) A copy of the hospital's income statement.
51	51	13 (3) A statement of changes in financial position.
52	52	14 (4) A statement of changes in fund balance.
53	53	15 (5) Accountant notes pertaining to the report.
54	54	16 (6) A copy of the hospital's report required to be filed annually
55	55	17 under 42 U.S.C. 1395g, and other appropriate utilization and
56	56	2023 IN 1291—LS 6874/DI 55 2
57	57	1 financial reports required to be filed under federal statutory law.
58	58	2 (7) Net patient revenue.
59	59	3 (8) A statement including:
60	60	4 (A) Medicare gross revenue;
61	61	5 (B) Medicaid gross revenue;
62	62	6 (C) other revenue from state programs;
63	63	7 (D) revenue from local government programs;
64	64	8 (E) local tax support;
65	65	9 (F) charitable contributions;
66	66	10 (G) other third party payments;
67	67	11 (H) gross inpatient revenue;
68	68	12 (I) gross outpatient revenue;
69	69	13 (J) contractual allowance;
70	70	14 (K) any other deductions from revenue;
71	71	15 (L) charity care provided;
72	72	16 (M) itemization of bad debt expense; and
73	73	17 (N) an estimation of the unreimbursed cost of subsidized
74	74	18 health services.
75	75	19 (9) A statement itemizing donations.
76	76	20 (10) A statement describing the total cost of reimbursed and
77	77	21 unreimbursed research.
78	78	22 (11) A statement describing the total cost of reimbursed and
79	79	23 unreimbursed education separated into the following categories:
80	80	24 (A) Education of physicians, nurses, technicians, and other
81	81	25 medical professionals and health care providers.
82	82	26 (B) Scholarships and funding to medical schools, and other
83	83	27 postsecondary educational institutions for health professions
84	84	28 education.
85	85	29 (C) Education of patients concerning diseases and home care
86	86	30 in response to community needs.
87	87	31 (D) Community health education through informational
88	88	32 programs, publications, and outreach activities in response to
89	89	33 community needs.
90	90	34 (E) Other educational services resulting in education related
91	91	35 costs.
92	92	36 (12) A statement of the hospital's medical loss ratio expressed
93	93	37 as the median total reimbursement for all health
94	94	38 reimbursement claims received, plus health quality expenses,
95	95	39 divided by the total operational income minus applicable taxes
96	96	40 (except for taxes paid on investment income).
97	97	41 (13) A statement of the total median reimbursement received
98	98	42 by the hospital for drugs designated under Section 340B of the
99	99	2023 IN 1291—LS 6874/DI 55 3
100	100	1 Public Health Service Act (42 U.S.C. 256b), expressed as a
101	101	2 ratio of the median costs paid for those drugs in the
102	102	3 aggregate.
103	103	4 (14) A statement of the total funding received by the hospital
104	104	5 under the Coronavirus, Aid, Relief, and Economic Security
105	105	6 (CARES) Act (P.L. 116-136), from the earliest remittance
106	106	7 until the end of the funding. Reporting under this subdivision
107	107	8 is not required after the last calendar year in which the
108	108	9 hospital receives CARES Act funding.
109	109	10 (15) A statement of the total annual charge master ratio for
110	110	11 services rendered by the hospital to the median cost for total
111	111	12 health care services rendered by the hospital in the reporting
112	112	13 year.
113	113	14 (16) A statement of the total median reimbursement to total
114	114	15 cost ratio of specialty drugs infused in a hospital clinic in a
115	115	16 patient setting or outpatient setting.
116	116	17 (b) The information in the report filed under subsection (a) must be
117	117	18 provided from reports or audits certified by an independent certified
118	118	19 public accountant or by the state board of accounts.
119	119	20 (c) The information contained in a hospital's report under
120	120	21 subsection (a)(8)(L) must express:
121	121	22 (1) the charity care provided by the hospital as a valuation of
122	122	23 the total charge master rate for services in the aggregate; and
123	123	24 (2) the care reimbursement that the hospital would have
124	124	25 received if the charity care had been reimbursed, expressed as
125	125	26 the median reimbursement.
126	126	27 (d) A hospital is not required to include the information
127	127	28 described in subsection (a)(12) through (a)(16) in a report filed
128	128	29 under this section if the hospital:
129	129	30 (1) meets the conditions set forth in 42 U.S.C. 1395i–4(e) to be
130	130	31 designated by the Centers for Medicare and Medicaid
131	131	32 Services as a critical access hospital; or
132	132	33 (2) is a county hospital subject to IC 16-22.
133	133	34 SECTION 2. IC 27-8-5-1.5, AS AMENDED BY P.L.124-2018,
134	134	35 SECTION 76, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
135	135	36 JULY 1, 2023]: Sec. 1.5. (a) This section applies to a policy of accident
136	136	37 and sickness insurance issued on an individual, a group, a franchise, or
137	137	38 a blanket basis, including a policy issued by an assessment company or
138	138	39 a fraternal benefit society.
139	139	40 (b) As used in this section, "commissioner" refers to the insurance
140	140	41 commissioner appointed under IC 27-1-1-2.
141	141	42 (c) As used in this section, "grossly inadequate filing" means a
142	142	2023 IN 1291—LS 6874/DI 55 4
143	143	1 policy form filing:
144	144	2 (1) that fails to provide key information, including state specific
145	145	3 information, regarding a product, policy, or rate; or
146	146	4 (2) that demonstrates an insufficient understanding of applicable
147	147	5 legal requirements.
148	148	6 (d) As used in this section, "policy form" means a policy, a contract,
149	149	7 a certificate, a rider, an endorsement, an evidence of coverage, or any
150	150	8 amendment that is required by law to be filed with the commissioner
151	151	9 for approval before use in Indiana.
152	152	10 (e) As used in this section, "type of insurance" refers to a type of
153	153	11 coverage listed on the National Association of Insurance
154	154	12 Commissioners Uniform Life, Accident and Health, Annuity and Credit
155	155	13 Product Coding Matrix under the heading "Continuing Care Retirement
156	156	14 Communities", "Health", "Long Term Care", or "Medicare
157	157	15 Supplement".
158	158	16 (f) Each person having a role in the filing process described in
159	159	17 subsection (i) shall act in good faith and with due diligence in the
160	160	18 performance of the person's duties.
161	161	19 (g) A policy form, including a policy form of a policy, contract,
162	162	20 certificate, rider, endorsement, evidence of coverage, or amendment
163	163	21 that is issued through a health benefit exchange (as defined in
164	164	22 IC 27-19-2-8), may not be issued or delivered in Indiana unless the
165	165	23 policy form has been filed with and approved by the commissioner.
166	166	24 (h) The commissioner shall do the following:
167	167	25 (1) Create a document containing a list of all product filing
168	168	26 requirements for each type of insurance, with appropriate
169	169	27 citations to the law, administrative rule, or bulletin that specifies
170	170	28 the requirement, including the citation for the type of insurance
171	171	29 to which the requirement applies.
172	172	30 (2) Make the document described in subdivision (1) available on
173	173	31 the department of insurance Internet site.
174	174	32 (3) Update the document described in subdivision (1) at least
175	175	33 annually and not more than thirty (30) days following any change
176	176	34 in a filing requirement.
177	177	35 (i) The filing process is as follows:
178	178	36 (1) A filer shall submit a policy form filing that:
179	179	37 (A) includes a copy of the document described in subsection
180	180	38 (h);
181	181	39 (B) indicates the location within the policy form or supplement
182	182	40 that relates to each requirement contained in the document
183	183	41 described in subsection (h); and
184	184	42 (C) certifies that the policy form meets all requirements of
185	185	2023 IN 1291—LS 6874/DI 55 5
186	186	1 state law.
187	187	2 (2) The commissioner shall review a policy form filing and, not
188	188	3 more than thirty (30) days after the commissioner receives the
189	189	4 filing under subdivision (1):
190	190	5 (A) approve the filing; or
191	191	6 (B) provide written notice of a determination:
192	192	7 (i) that deficiencies exist in the filing; or
193	193	8 (ii) that the commissioner disapproves the filing.
194	194	9 A written notice provided by the commissioner under clause (B)
195	195	10 must be based only on the requirements set forth in the document
196	196	11 described in subsection (h) and must cite the specific
197	197	12 requirements not met by the filing. A written notice provided by
198	198	13 the commissioner under clause (B)(i) must state the reasons for
199	199	14 the commissioner's determination in sufficient detail to enable the
200	200	15 filer to bring the policy form into compliance with the
201	201	16 requirements not met by the filing.
202	202	17 (3) A filer may resubmit a policy form that:
203	203	18 (A) was determined deficient under subdivision (2) and has
204	204	19 been amended to correct the deficiencies; or
205	205	20 (B) was disapproved under subdivision (2) and has been
206	206	21 revised.
207	207	22 A policy form resubmitted under this subdivision must meet the
208	208	23 requirements set forth as described in subdivision (1) and must be
209	209	24 resubmitted not more than thirty (30) days after the filer receives
210	210	25 the commissioner's written notice of deficiency or disapproval. If
211	211	26 a policy form is not resubmitted within thirty (30) days after
212	212	27 receipt of the written notice, the commissioner's determination
213	213	28 regarding the policy form is final.
214	214	29 (4) The commissioner shall review a policy form filing
215	215	30 resubmitted under subdivision (3) and, not more than thirty (30)
216	216	31 days after the commissioner receives the resubmission:
217	217	32 (A) approve the resubmitted policy form; or
218	218	33 (B) provide written notice that the commissioner disapproves
219	219	34 the resubmitted policy form.
220	220	35 A written notice of disapproval provided by the commissioner
221	221	36 under clause (B) must be based only on the requirements set forth
222	222	37 in the document described in subsection (h), must cite the specific
223	223	38 requirements not met by the filing, and must state the reasons for
224	224	39 the commissioner's determination in detail. The commissioner's
225	225	40 approval or disapproval of a resubmitted policy form under this
226	226	41 subdivision is final, except that the commissioner may allow the
227	227	42 filer to resubmit a further revised policy form if the filer, in the
228	228	2023 IN 1291—LS 6874/DI 55 6
229	229	1 filer's resubmission under subdivision (3), introduced new
230	230	2 provisions or materially modified a substantive provision of the
231	231	3 policy form. If the commissioner allows a filer to resubmit a
232	232	4 further revised policy form under this subdivision, the filer must
233	233	5 resubmit the further revised policy form not more than thirty (30)
234	234	6 days after the filer receives notice under clause (B), and the
235	235	7 commissioner shall issue a final determination on the further
236	236	8 revised policy form not more than thirty (30) days after the
237	237	9 commissioner receives the further revised policy form.
238	238	10 (5) If the commissioner disapproves a policy form filing under
239	239	11 this subsection, the commissioner shall notify the filer, in writing,
240	240	12 of the filer's right to a hearing as described in subsection (m). (r).
241	241	13 A disapproved policy form filing may not be used for a policy of
242	242	14 accident and sickness insurance unless the disapproval is
243	243	15 overturned in a hearing conducted under this subsection.
244	244	16 (6) If the commissioner does not take any action on a policy form
245	245	17 that is filed or resubmitted under this subsection in accordance
246	246	18 with any applicable period specified in subdivision (2), (3), or (4),
247	247	19 the policy form filing is considered to be approved.
248	248	20 (j) Except as provided in this subsection, the commissioner may not
249	249	21 disapprove a policy form resubmitted under subsection (i)(3) or (i)(4)
250	250	22 for a reason other than a reason specified in the original notice of
251	251	23 determination under subsection (i)(2)(B). The commissioner may
252	252	24 disapprove a resubmitted policy form for a reason other than a reason
253	253	25 specified in the original notice of determination under subsection (i)(2)
254	254	26 if:
255	255	27 (1) the filer has introduced a new provision in the resubmission;
256	256	28 (2) the filer has materially modified a substantive provision of the
257	257	29 policy form in the resubmission;
258	258	30 (3) there has been a change in requirements applying to the policy
259	259	31 form; or
260	260	32 (4) there has been reviewer error and the written disapproval fails
261	261	33 to state a specific requirement with which the policy form does
262	262	34 not comply.
263	263	35 (k) The commissioner may return a grossly inadequate filing to the
264	264	36 filer without triggering a deadline set forth in this section.
265	265	37 (l) The commissioner may disapprove a policy form if:
266	266	38 (1) the benefits provided under the policy form are not reasonable
267	267	39 in relation to the premium charged; or
268	268	40 (2) the policy form contains provisions that are unjust, unfair,
269	269	41 inequitable, misleading, or deceptive, or that encourage
270	270	42 misrepresentation of the policy.
271	271	2023 IN 1291—LS 6874/DI 55 7
272	272	1 (m) Before approving or disapproving a premium rate increase
273	273	2 or decrease, the commissioner shall consider the following:
274	274	3 (1) The products affected, by line of business.
275	275	4 (2) The number of covered lives affected.
276	276	5 (3) Whether the product is open or closed to new members in
277	277	6 the product block.
278	278	7 (4) Applicable median cost sharing for the product, as allowed
279	279	8 by state or federal law.
280	280	9 (5) The benefits provided and the underlying costs of the
281	281	10 health services rendered.
282	282	11 (6) The implementation date of the increase or decrease.
283	283	12 (7) The overall percent premium rate increase or decrease
284	284	13 that is requested.
285	285	14 (8) The actual percent premium rate increase or decrease to
286	286	15 be approved.
287	287	16 (9) Incurred claims paid each year for the past three (3) years,
288	288	17 if applicable.
289	289	18 (10) Earned premiums for each of the past three (3) years, if
290	290	19 applicable.
291	291	20 (11) Projected medical cost trends in the geographic service
292	292	21 region, if the product for which a rate increase or decrease is
293	293	22 requested is not a product offered statewide.
294	294	23 (12) If applicable, historical rebates paid to the policyholder
295	295	24 from the most recent health plan year under the federal
296	296	25 Patient Protection and Affordable Care Act (P.L. 111-148), as
297	297	26 amended by the federal Health Care and Education
298	298	27 Reconciliation Act of 2010 (P.L. 111-152).
299	299	28 (13) The median cost sharing amount for an individual
300	300	29 covered by the product, or the actuarial value information as
301	301	30 required under the Patient Protection and Affordable Care
302	302	31 Act, if applicable.
303	303	32 (n) The commissioner shall not approve a new product unless
304	304	33 the commissioner has, at a minimum, considered the matters set
305	305	34 forth in subsection (m)(1) through (m)(13).
306	306	35 (o) The information compiled, prepared, and considered by the
307	307	36 commissioner under subsection (m)(1) through (m)(13) is subject
308	308	37 to the requirements of IC 5-14-3. However, the commissioner's
309	309	38 approval of a new product or a rate increase or decrease may take
310	310	39 effect before the information compiled, prepared, and considered
311	311	40 by the commissioner under subsection (m)(1) through (m)(13) is
312	312	41 made accessible to the public under IC 5-14-3.
313	313	42 (p) When considering whether to approve a premium rate
314	314	2023 IN 1291—LS 6874/DI 55 8
315	315	1 increase, the commissioner shall consider whether the current rate
316	316	2 is appropriate for achieving the insurer's target loss ratio.
317	317	3 (q) To the extent authorized by the Patient Protection and
318	318	4 Affordable Care Act and other federal law, the commissioner,
319	319	5 under this section, may:
320	320	6 (1) consider network adequacy;
321	321	7 (2) conduct form review to ensure:
322	322	8 (A) minimum essential health benefits; and
323	323	9 (B) nondiscriminatory benefit design;
324	324	10 (3) perform accreditation confirmation; and
325	325	11 (4) confirm quality measures.
326	326	12 (m) (r) Upon disapproval of a filing under this section, the
327	327	13 commissioner shall provide written notice to the filer or insurer of the
328	328	14 right to a hearing within twenty (20) days of a request for a hearing.
329	329	15 (n) (s) Unless a policy form approved under this chapter contains a
330	330	16 material error or omission, the commissioner may not:
331	331	17 (1) retroactively disapprove the policy form; or
332	332	18 (2) examine the filer of the policy form during a routine or
333	333	19 targeted market conduct examination for compliance with a policy
334	334	20 form filing requirement that was not in existence at the time the
335	335	21 policy form was filed.
336	336	22 SECTION 3. IC 27-13-20-1.5 IS ADDED TO THE INDIANA
337	337	23 CODE AS A NEW SECTION TO READ AS FOLLOWS
338	338	24 [EFFECTIVE JULY 1, 2023]: Sec. 1.5. (a) Before approving or
339	339	25 disapproving an increase or decrease in the rates to be used by a
340	340	26 health maintenance organization, the commissioner shall review
341	341	27 the following:
342	342	28 (1) The products affected, by line of business.
343	343	29 (2) The number of covered lives affected.
344	344	30 (3) Whether the product is open or closed to new members in
345	345	31 the product block.
346	346	32 (4) Applicable median cost sharing for the product, as allowed
347	347	33 by state or federal law.
348	348	34 (5) The benefits provided and the underlying costs of the
349	349	35 health services rendered.
350	350	36 (6) The implementation date of the increase or decrease.
351	351	37 (7) The overall percent premium rate increase or decrease
352	352	38 that is requested.
353	353	39 (8) The actual percent premium rate increase or decrease to
354	354	40 be approved.
355	355	41 (9) Incurred claims paid each year for the past three (3) years,
356	356	42 if applicable.
357	357	2023 IN 1291—LS 6874/DI 55 9
358	358	1 (10) Earned premiums for each of the past three (3) years, if
359	359	2 applicable.
360	360	3 (11) Projected medical cost trends in the geographic service
361	361	4 region, if the product for which a rate increase or decrease is
362	362	5 requested is not a product offered statewide.
363	363	6 (12) If applicable, historical rebates paid to the enrollee from
364	364	7 the most recent health plan year under the federal Patient
365	365	8 Protection and Affordable Care Act (P.L. 111-148), as
366	366	9 amended by the federal Health Care and Education
367	367	10 Reconciliation Act of 2010 (P.L. 111-152).
368	368	11 (13) The median cost sharing amount for a member enrolled
369	369	12 in the product, or the actuarial value information as required
370	370	13 under the Patient Protection and Affordable Care Act, if
371	371	14 applicable.
372	372	15 (b) The commissioner shall not approve a rate increase or
373	373	16 decrease for an existing product unless the commissioner has, at a
374	374	17 minimum, considered the matters set forth in subsection (a)(1)
375	375	18 through (a)(13).
376	376	19 (c) The information compiled, prepared, and considered by the
377	377	20 commissioner under subsection (a)(1) through (a)(13) is subject to
378	378	21 the requirements of IC 5-14-3. However, the commissioner's
379	379	22 approval of a rate increase or decrease may take effect before the
380	380	23 information compiled, prepared, and considered by the
381	381	24 commissioner under subsection (a)(1) through (a)(13) is made
382	382	25 accessible to the public under IC 5-14-3.
383	383	26 (d) When considering whether to approve a premium rate
384	384	27 increase, the commissioner shall consider whether the current rate
385	385	28 is appropriate for achieving the target loss ratio of the health
386	386	29 maintenance organization.
387	387	30 (e) To the extent authorized by the Patient Protection and
388	388	31 Affordable Care Act and other federal law, the commissioner,
389	389	32 under this section, may:
390	390	33 (1) consider network adequacy;
391	391	34 (2) conduct form review to ensure:
392	392	35 (A) minimum essential health benefits; and
393	393	36 (B) nondiscriminatory benefit design;
394	394	37 (3) perform accreditation confirmation; and
395	395	38 (4) confirm quality measures.
396	396	2023 IN 1291—LS 6874/DI 55