Indiana 2024 Regular Session

Indiana House Bill HB1327 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~HB1327.1~~
2		-	~~January 30, 2024~~
	1	+
	2	+	Introduced Version
3	3		HOUSE BILL No. 1327
4	4		_____
5		-	DIGEST OF HB 1327 (Updated January 30, 2024 12:26 pm - DI 147)
6		-	Citations Affected: IC 12-15; IC 16-18; IC 16-19; IC 25-22.5;
7		-	IC 27-1; IC 27-2; IC 27-4.
8		-	Synopsis: Health and insurance matters. Requires reporting of certain
9		-	ownership information by: (1) a hospital to the Indiana department of
10		-	health (state department); (2) a physician group practice to the
11		-	professional licensing agency; and (3) an insurer, a third party
12		-	administrator, and a pharmacy benefit manager to the department of
13		-	insurance. Requires the professional licensing agency and the
14		-	department of insurance to provide the ownership information to the
15		-	state department. Requires the state department to post the ownership
16		-	information on the state department's website. Sets forth penalties for
17		-	a violation of the ownership reporting requirements. Allows a contract
18		-	holder to request an audit of a pharmacy benefit manager at least two
19		-	times in a calendar year. Requires a contract with a third party
	5	+	DIGEST OF INTRODUCED BILL
	6	+	Citations Affected: IC 12-15-1-18.5; IC 16-18-2; IC 16-19-18;
	7	+	IC 27-1; IC 27-2-25.5; IC 27-4-1-4.
	8	+	Synopsis: Health and insurance matters. Requires a hospital, physician
	9	+	group practice, insurer, third party administrator, and pharmacy benefit
	10	+	manager to file with the Indiana department of health (department) a
	11	+	report that includes information regarding each person or entity that has
	12	+	an ownership interest, in whole or in part, or a controlling interest in
	13	+	the hospital, physician group practice, insurer, third party
	14	+	administrator, or pharmacy benefit manager. Requires the department
	15	+	to publicly post a searchable consolidated document on the
	16	+	department's website that contains the information. Sets forth penalties
	17	+	for a violation of the reporting requirements. Requires the department
	18	+	to submit an annual report of violations of the reporting requirements
	19	+	to certain members of the general assembly. Allows a contract holder
	20	+	to request an audit of a pharmacy benefit manager up to one time each
	21	+	quarter. Prohibits a third party administrator, health plan, or pharmacy
	22	+	benefit manager from charging a fee if the plan sponsor opts out of an
	23	+	additional offered service. Requires a contract with a third party
20	24		administrator, pharmacy benefit manager, or prepaid health care
21	25		delivery plan to provide that the plan sponsor has ownership of the
22	26		claims data. Allows a plan sponsor that contracts with a third party
23	27		administrator, the office of the secretary of family and social services
24	28		that contracts with a managed care organization to provide services to
25	29		a Medicaid recipient, or the state personnel department that contracts
26	30		with a prepaid health care delivery plan to provide group health
27		-	coverage for state employees to request an audit at least two times in
28		-	a calendar year. Provides that a violation of the requirements
29		-	concerning audits of a third party administrator, managed care
30		-	organization, or prepaid health care delivery plan is an unfair or
31		-	deceptive act or practice in the business of insurance and allows the
32		-	department of insurance to adopt rules to set forth fines for a violation.
	31	+	coverage for state employees to request an audit up to one time each
	32	+	quarter. Provides that a violation of the requirements concerning audits
	33	+	of a third party administrator, managed care organization, or prepaid
	34	+	(Continued next page)
33	35		Effective: Upon passage; July 1, 2024.
34		-	Schaibley, Barrett, McGuire,
35		-	Shackleford
	36	+	Schaibley, Barrett, McGuire
36	37		January 10, 2024, read first time and referred to Committee on Public Health.
37		-	January 30, 2024, amended, reported — Do Pass.
38		-	HB 1327—LS 6888/DI 141 January 30, 2024
	38	+	2024 IN 1327—LS 6888/DI 141 Digest Continued
	39	+	health care delivery plan is an unfair or deceptive act or practice in the
	40	+	business of insurance and allows the department of insurance to adopt
	41	+	rules to set forth fines for a violation.
	42	+	2024 IN 1327—LS 6888/DI 1412024 IN 1327—LS 6888/DI 141 Introduced
39	43		Second Regular Session of the 123rd General Assembly (2024)
40	44		PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
41	45		Constitution) is being amended, the text of the existing provision will appear in this style type,
42	46		additions will appear in this style type, and deletions will appear in this style type.
43	47		Additions: Whenever a new statutory provision is being enacted (or a new constitutional
44	48		provision adopted), the text of the new provision will appear in this style type. Also, the
45	49		word NEW will appear in that style type in the introductory clause of each SECTION that adds
46	50		a new provision to the Indiana Code or the Indiana Constitution.
47	51		Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
48	52		between statutes enacted by the 2023 Regular Session of the General Assembly.
49	53		HOUSE BILL No. 1327
50	54		A BILL FOR AN ACT to amend the Indiana Code concerning
51	55		insurance.
52	56		Be it enacted by the General Assembly of the State of Indiana:
53	57		1 SECTION 1. IC 12-15-1-18.5, AS ADDED BY P.L.203-2023,
54	58		2 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
55	59		3 UPON PASSAGE]: Sec. 18.5. (a) The payer affordability penalty fund
56	60		4 is established for the purpose of receiving fines collected under
57		-	5 IC 16-19-18-5, IC 16-21-6-3, ~~IC 25-22.5-18-5,~~ IC 27-~~1-4~~.5~~-7, and~~
58		-	6 ~~fines collected under IC 27-2-25.5~~ to be used for:
	61	+	5 IC 16-19-18-7, IC 16-21-6-3, and fines collected under IC 27-2-25.5
	62	+	6 to be used for:
59	63		7 (1) the state's share of the Medicaid program; and
60	64		8 (2) a study of hospitals that are impacted by changes made in the
61	65		9 disproportionate share hospital methodology payments set forth
62	66		10 in Section 203 of the federal Consolidated Appropriations Act of
63	67		11 2021.
64	68		12 The office of the secretary shall perform the study and provide the
65	69		13 results of the study described in subdivision (2) to the budget
66	70		14 committee.
67	71		15 (b) The fund shall be administered by the office of the secretary.
68		-	HB 1327—LS 6888/DI 141 2
	72	+	2024 IN 1327—LS 6888/DI 141 2
69	73		1 (c) The expenses of administering the fund shall be paid from
70	74		2 money in the fund.
71	75		3 (d) The treasurer of state shall invest the money in the fund not
72	76		4 currently needed to meet the obligations of the fund in the same
73	77		5 manner as other public money may be invested. Interest that accrues
74	78		6 from these investments shall be deposited in the fund.
75	79		7 (e) Money in the fund at the end of a state fiscal year does not revert
76	80		8 to the state general fund.
77	81		9 (f) Money in the fund is continually appropriated.
78	82		10 SECTION 2. IC 16-18-2-79.1 IS ADDED TO THE INDIANA
79	83		11 CODE AS A NEW SECTION TO READ AS FOLLOWS
80	84		12 [EFFECTIVE UPON PASSAGE]: Sec. 79.1. "Controlling", for
81	85		13 purposes of IC 16-19-18, has the meaning set forth in
82	86		14 IC 16-19-18-1.
83		-	15 SECTION 3. IC 16-18-2-282.3 IS ADDED TO THE INDIANA
84		-	16 CODE AS A NEW SECTION TO READ AS FOLLOWS
85		-	17 [EFFECTIVE UPON PASSAGE]: Sec. 282.3. "Physician group
86		-	18 practice", for purposes of IC 16-19-18, has the meaning set forth
87		-	19 in IC 16-19-18-2.
88		-	20 SECTION 4. IC 16-19-18 IS ADDED TO THE INDIANA CODE
89		-	21 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
90		-	22 UPON PASSAGE]:
91		-	23 Chapter 18. Disclosure of Ownership Information
92		-	24 Sec. 1. As used in this chapter, "controlling" has the meaning set
93		-	25 forth in IC 23-1-43-8.
94		-	26 Sec. 2. As used in this chapter, "physician group practice"
95		-	27 means a physician practice that:
96		-	28 (1) has at least one (1) physical location in Indiana; and
97		-	29 (2) includes as practitioners two (2) or more physicians
98		-	30 licensed under IC 25-22.5, regardless of the ownership
99		-	31 structure of the practice.
100		-	32 Sec. 3. (a) Before July 1, 2024, and each July 1 thereafter, each
101		-	33 hospital that does business in Indiana shall file with the state
102		-	34 department a report that includes the following information:
103		-	35 (1) The name of each person or entity that has:
104		-	36 (A) an ownership interest of at least five percent (5%);
105		-	37 (B) a controlling interest; or
106		-	38 (C) an interest as a private equity partner;
107		-	39 in the hospital.
108		-	40 (2) The business address of each person or entity identified
109		-	41 under subdivision (1). The business address must include a:
110		-	42 (A) building number;
111		-	HB 1327—LS 6888/DI 141 3
112		-	1 (B) street name;
113		-	2 (C) city name;
114		-	3 (D) zip code; and
115		-	4 (E) country name.
116		-	5 The business address may not include a post office box
117		-	6 number.
118		-	7 (3) The business website, if applicable, of each person or
119		-	8 entity identified under subdivision (1).
120		-	9 (4) Any of the following identification numbers, if applicable,
121		-	10 for a person or entity identified under subdivision (1):
122		-	11 (A) National provider identifier (NPI).
123		-	12 (B) Taxpayer identification number (TIN).
124		-	13 (C) Employer identification number (EIN).
125		-	14 (D) CMS certification number (CCN).
126		-	15 (E) National Association of Insurance Commissioners
127		-	16 (NAIC) identification number.
128		-	17 (F) A personal identification number associated with a
129		-	18 license issued by the department of insurance.
130		-	19 A report provided under this section may not include the
131		-	20 Social Security number of any individual.
132		-	21 (b) The state department may not charge a fee for a report
133		-	22 submitted under this section.
134		-	23 Sec. 4. (a) The state department shall cooperate with the Indiana
135		-	24 professional licensing agency and the department of insurance to
136		-	25 develop and implement a plan to:
137		-	26 (1) collect the information described in section 3 of this
138		-	27 chapter, IC 25-22.5-18-3, and IC 27-1-4.5-5; and
139		-	28 (2) make the information publicly available as set forth in this
140		-	29 section.
141		-	30 (b) Before December 1 of each year, the state department shall
142		-	31 publicly post the information:
143		-	32 (1) collected under section 3 of this chapter; and
144		-	33 (2) received from the:
145		-	34 (A) Indiana professional licensing agency under
146		-	35 IC 25-22.5-18-4; or
147		-	36 (B) department of insurance under IC 27-1-4.5-6;
148		-	37 on the state department's website.
149		-	38 Sec. 5. (a) The state department may assess a hospital that
150		-	39 violates section 3 of this chapter a fine of one thousand dollars
151		-	40 ($1,000) per day for which the report is past due.
152		-	41 (b) A fine under this section shall be deposited into the payer
153		-	42 affordability penalty fund established by IC 12-15-1-18.5.
154		-	HB 1327—LS 6888/DI 141 4
155		-	1 (c) The state department may waive a fine assessed under this
156		-	2 section.
157		-	3 (d) The state health commissioner may take action against a
158		-	4 hospital under IC 16-21-3 for repeated violations of section 3 of
159		-	5 this chapter.
160		-	6 Sec. 6. (a) Before December 1 of each year, the state department
161		-	7 shall submit to the legislative council an annual report of the:
162		-	8 (1) violations assessed; and
163		-	9 (2) fines waived;
164		-	10 under section 5 of this chapter in the previous calendar year.
165		-	11 (b) A report described in this section must be submitted in an
166		-	12 electronic format under IC 5-14-6.
167		-	13 Sec. 7. (a) Before July 1, 2024, the state department shall issue
168		-	14 a notice or bulletin on at least two (2) occasions to notify hospitals
169		-	15 of the reporting requirements set forth in this chapter.
170		-	16 (b) A notice or bulletin issued under this section must be posted
171		-	17 on the state department's website in a manner that is easily
172		-	18 accessible to hospitals.
173		-	19 SECTION 5. IC 25-22.5-18 IS ADDED TO THE INDIANA CODE
174		-	20 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
175		-	21 UPON PASSAGE]:
176		-	22 Chapter 18. Disclosure of Ownership Information
177		-	23 Sec. 1. As used in this chapter, "controlling" has the meaning set
178		-	24 forth in IC 23-1-43-8.
179		-	25 Sec. 2. As used in this chapter, "physician group practice"
180		-	26 means a physician practice that:
181		-	27 (1) has at least one (1) physical location in Indiana; and
182		-	28 (2) includes as practitioners two (2) or more physicians
183		-	29 licensed under this article, regardless of the ownership
184		-	30 structure of the practice.
185		-	31 Sec. 3. (a) Before July 1, 2024, and each July 1 thereafter, each
186		-	32 physician group practice that does business in Indiana shall file
187		-	33 with the agency a report that includes the following information:
188		-	34 (1) The name of each person or entity that has:
189		-	35 (A) an ownership interest of at least five percent (5%);
190		-	36 (B) a controlling interest; or
191		-	37 (C) an interest as a private equity partner;
192		-	38 in the physician group practice.
193		-	39 (2) The business address of each person or entity identified
194		-	40 under subdivision (1). The business address must include a:
195		-	41 (A) building number;
196		-	42 (B) street name;
197		-	HB 1327—LS 6888/DI 141 5
198		-	1 (C) city name;
199		-	2 (D) zip code; and
200		-	3 (E) country name.
201		-	4 The business address may not include a post office box
202		-	5 number.
203		-	6 (3) The business website, if applicable, of each person or
204		-	7 entity identified under subdivision (1).
205		-	8 (4) Any of the following identification numbers, if applicable,
206		-	9 for a person or entity identified under subdivision (1):
207		-	10 (A) National provider identifier (NPI).
208		-	11 (B) Taxpayer identification number (TIN).
209		-	12 (C) Employer identification number (EIN).
210		-	13 (D) CMS certification number (CCN).
211		-	14 (E) National Association of Insurance Commissioners
212		-	15 (NAIC) identification number.
213		-	16 (F) A personal identification number associated with a
214		-	17 license issued by the department of insurance.
215		-	18 A report provided under this section may not include the
216		-	19 Social Security number of any individual.
217		-	20 (b) The agency may not charge a fee for a report submitted
218		-	21 under this section.
219		-	22 Sec. 4. (a) The agency shall cooperate with the Indiana
220		-	23 department of health and the department of insurance to develop
221		-	24 and implement a plan to:
222		-	25 (1) collect the information described in section 3 of this
223		-	26 chapter, IC 16-19-18-3, and IC 27-1-4.5-5; and
224		-	27 (2) make the information publicly available as set forth in
225		-	28 IC 16-19-18-4.
226		-	29 (b) Before September 1 of each year, the agency shall provide
227		-	30 the information collected under section 3 of this chapter to the
228		-	31 Indiana department of health.
229		-	32 Sec. 5. (a) The agency may assess a physician group practice
230		-	33 that:
231		-	34 (1) has more than five (5) physicians as practitioners in the
232		-	35 physician group practice; and
233		-	36 (2) violates section 3 of this chapter;
234		-	37 a fine of one thousand dollars ($1,000) per day for which the report
235		-	38 is past due.
236		-	39 (b) The agency may assess a physician group practice that:
237		-	40 (1) has five (5) physicians or less as practitioners in the
238		-	41 physician group practice; and
239		-	42 (2) violates section 3 of this chapter;
240		-	HB 1327—LS 6888/DI 141 6
241		-	1 a fine of one hundred dollars ($100) per day for which the report
242		-	2 is past due. A fine assessed under this subsection may not exceed
243		-	3 ten thousand dollars ($10,000) in a calendar year.
244		-	4 (c) A fine under this section shall be deposited into the payer
	87	+	15 SECTION 3. IC 16-18-2-190.9, AS ADDED BY P.L.203-2023,
	88	+	16 SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	89	+	17 UPON PASSAGE]: Sec. 190.9. (a) "Insurer", for purposes of
	90	+	18 IC 16-51-1, has the meaning set forth in IC 16-51-1-8.
	91	+	19 (b) "Insurer", for purposes of IC 16-19-18, has the meaning set
	92	+	20 forth in IC 16-19-18-2.
	93	+	21 SECTION 4. IC 16-18-2-281.2 IS ADDED TO THE INDIANA
	94	+	22 CODE AS A NEW SECTION TO READ AS FOLLOWS
	95	+	23 [EFFECTIVE UPON PASSAGE]: Sec. 281.2. "Pharmacy benefit
	96	+	24 manager", for purposes of IC 16-19-18, has the meaning set forth
	97	+	25 in IC 16-19-18-3.
	98	+	26 SECTION 5. IC 16-18-2-351.7 IS ADDED TO THE INDIANA
	99	+	27 CODE AS A NEW SECTION TO READ AS FOLLOWS
	100	+	28 [EFFECTIVE UPON PASSAGE]: Sec. 351.7. "Third party
	101	+	29 administrator", for purposes of IC 16-19-18, has the meaning set
	102	+	30 forth in IC 16-19-18-4.
	103	+	31 SECTION 6. IC 16-19-18 IS ADDED TO THE INDIANA CODE
	104	+	32 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
	105	+	33 UPON PASSAGE]:
	106	+	34 Chapter 18. Disclosure of Ownership or Controlling Interest
	107	+	35 Sec. 1. As used in this chapter, "controlling" has the meaning set
	108	+	36 forth in IC 23-1-43-8.
	109	+	37 Sec. 2. As used in this chapter, "insurer" includes the following:
	110	+	38 (1) An insurer (as defined in IC 27-1-2-3(x)) that issues a
	111	+	39 policy of accident and sickness insurance (as defined in
	112	+	40 IC 27-8-5-1(a)).
	113	+	41 (2) A health maintenance organization (as defined in
	114	+	42 IC 27-13-1-19) that provides coverage for basic health care
	115	+	2024 IN 1327—LS 6888/DI 141 3
	116	+	1 services (as defined in IC 27-13-1-4).
	117	+	2 (3) A managed care organization (as defined in
	118	+	3 IC 12-7-2-126.9) that provides services to a Medicaid
	119	+	4 recipient.
	120	+	5 (4) A prepaid health care delivery plan under IC 5-10-8-7(c)
	121	+	6 that provides group health coverage for state employees.
	122	+	7 Sec. 3. As used in this chapter, "pharmacy benefit manager" has
	123	+	8 the meaning set forth in IC 27-1-24.5-12.
	124	+	9 Sec. 4. As used in this chapter, "third party administrator"
	125	+	10 means an individual or entity that performs administrative services
	126	+	11 for an insurer or a self-funded health benefit plan, including:
	127	+	12 (1) a self-funded health benefit plan that complies with the
	128	+	13 federal Employee Retirement Income Security Act (ERISA)
	129	+	14 of 1974 (29 U.S.C. 1001 et seq.); and
	130	+	15 (2) a self-insurance program established under IC 5-10-8-7(b).
	131	+	16 Sec. 5. Before July 1, 2024, and each July 1 thereafter, each
	132	+	17 hospital, physician group practice, insurer, third party
	133	+	18 administrator, and pharmacy benefit manager shall file with the
	134	+	19 state department a report that includes the following information:
	135	+	20 (1) The name of each person or entity that has:
	136	+	21 (A) an ownership interest, in whole or in part; or
	137	+	22 (B) a controlling interest;
	138	+	23 in the hospital, physician group practice, insurer, third party
	139	+	24 administrator, or pharmacy benefit manager.
	140	+	25 (2) The mailing address of each person or entity identified
	141	+	26 under subdivision (1). The mailing address must include a:
	142	+	27 (A) building number;
	143	+	28 (B) street name;
	144	+	29 (C) city name;
	145	+	30 (D) zip code; and
	146	+	31 (E) country name.
	147	+	32 The mailing address may not include a post office box
	148	+	33 number.
	149	+	34 (3) The website, if applicable, of each person or entity
	150	+	35 identified under subdivision (1).
	151	+	36 Sec. 6. (a) Before September 1, 2024, the state department shall
	152	+	37 publicly post a searchable consolidated document on the state
	153	+	38 department's website that contains the information collected under
	154	+	39 section 5 of this chapter.
	155	+	40 (b) The state department shall update the document under
	156	+	41 subsection (a) before September 1 of each year.
	157	+	42 Sec. 7. (a) The state department may assess a hospital, physician
	158	+	2024 IN 1327—LS 6888/DI 141 4
	159	+	1 group practice, insurer, third party administrator, or pharmacy
	160	+	2 benefit manager that violates section 5 of this chapter a fine of one
	161	+	3 thousand dollars ($1,000) per day for which the report is past due.
	162	+	4 (b) A fine under this section shall be deposited into the payer
245	163		5 affordability penalty fund established by IC 12-15-1-18.5.
246		-	6 (d) The agency may waive a fine assessed under this section.
247		-	7 (e) The board may take disciplinary action against a licensee for
248		-	8 repeated violations of section 3 of this chapter.
249		-	9 Sec. 6. (a) Before December 1 of each year, the agency shall
250		-	10 submit to the legislative council an annual report of the:
251		-	11 (1) violations assessed; and
252		-	12 (2) fines waived;
253		-	13 under section 5 of this chapter in the previous calendar year.
254		-	14 (b) A report described in this section must be submitted in an
255		-	15 electronic format under IC 5-14-6.
256		-	16 Sec. 7. (a) Before July 1, 2024, the agency shall issue a notice or
257		-	17 bulletin on at least two (2) occasions to notify physician group
258		-	18 practices of the reporting requirements set forth in this chapter.
259		-	19 (b) A notice or bulletin issued under this section must be posted
260		-	20 on the agency's website in a manner that is easily accessible to
261		-	21 physician group practices.
262		-	22 SECTION 6. IC 27-1-4.5 IS ADDED TO THE INDIANA CODE
263		-	23 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
264		-	24 UPON PASSAGE]:
265		-	25 Chapter 4.5. Disclosure of Ownership Information
266		-	26 Sec. 1. As used in this chapter, "controlling" has the meaning set
267		-	27 forth in IC 23-1-43-8.
268		-	28 Sec. 2. As used in this chapter, "insurer" includes the following:
269		-	29 (1) An insurer (as defined in IC 27-1-2-3(x)) that issues a
270		-	30 policy of accident and sickness insurance (as defined in
271		-	31 IC 27-8-5-1(a)). However, the term does not include the
272		-	32 coverages described in IC 27-8-5-2.5(a).
273		-	33 (2) A health maintenance organization (as defined in
274		-	34 IC 27-13-1-19) that provides coverage for basic health care
275		-	35 services (as defined in IC 27-13-1-4).
276		-	36 (3) A managed care organization (as defined in
277		-	37 IC 12-7-2-126.9) that provides services to a Medicaid
278		-	38 recipient.
279		-	39 (4) A prepaid health care delivery plan under IC 5-10-8-7(c)
280		-	40 that provides group health coverage for state employees.
281		-	41 Sec. 3. As used in this chapter, "pharmacy benefit manager" has
282		-	42 the meaning set forth in IC 27-1-24.5-12.
283		-	HB 1327—LS 6888/DI 141 7
284		-	1 Sec. 4. As used in this chapter, "third party administrator"
285		-	2 means an individual or entity that performs administrative services
286		-	3 for an insurer or a self-funded health benefit plan, including:
287		-	4 (1) a self-funded health benefit plan that complies with the
288		-	5 federal Employee Retirement Income Security Act (ERISA)
289		-	6 of 1974 (29 U.S.C. 1001 et seq.); and
290		-	7 (2) a self-insurance program established under IC 5-10-8-7(b).
291		-	8 Sec. 5. (a) Before July 1, 2024, and each July 1 thereafter, each
292		-	9 insurer, third party administrator, and pharmacy benefit manager
293		-	10 that does business in Indiana shall file with the department a
294		-	11 report that includes the following information:
295		-	12 (1) The name of each person or entity that has:
296		-	13 (A) an ownership interest of at least five percent (5%);
297		-	14 (B) a controlling interest; or
298		-	15 (C) an interest as a private equity partner;
299		-	16 in the insurer, third party administrator, or pharmacy benefit
300		-	17 manager.
301		-	18 (2) The business address of each person or entity identified
302		-	19 under subdivision (1). The business address must include a:
303		-	20 (A) building number;
304		-	21 (B) street name;
305		-	22 (C) city name;
306		-	23 (D) zip code; and
307		-	24 (E) country name.
308		-	25 The business address may not include a post office box
309		-	26 number.
310		-	27 (3) The business website, if applicable, of each person or
311		-	28 entity identified under subdivision (1).
312		-	29 (4) Any of the following identification numbers, if applicable,
313		-	30 for a person or entity identified under subdivision (1):
314		-	31 (A) National provider identifier (NPI).
315		-	32 (B) Taxpayer identification number (TIN).
316		-	33 (C) Employer identification number (EIN).
317		-	34 (D) CMS certification number (CCN).
318		-	35 (E) National Association of Insurance Commissioners
319		-	36 (NAIC) identification number.
320		-	37 (F) A personal identification number associated with a
321		-	38 license issued by the department of insurance.
322		-	39 A report provided under this section may not include the
323		-	40 Social Security number of any individual.
324		-	41 (b) The department may not charge a fee for a report submitted
325		-	42 under this section.
326		-	HB 1327—LS 6888/DI 141 8
327		-	1 Sec. 6. (a) The department shall cooperate with the Indiana
328		-	2 department of health and the Indiana professional licensing agency
329		-	3 to develop and implement a plan to:
330		-	4 (1) collect the information described in section 5 of this
331		-	5 chapter, IC 16-19-18-3, and IC 25-22.5-18-3; and
332		-	6 (2) make the information publicly available as set forth in
333		-	7 IC 16-19-18-4.
334		-	8 (b) Before September 1 of each year, the department shall
335		-	9 provide the information collected under section 5 of this chapter to
336		-	10 the Indiana department of health.
337		-	11 Sec. 7. (a) The department may assess:
338		-	12 (1) an insurer;
339		-	13 (2) a third party administrator; or
340		-	14 (3) a pharmacy benefit manager;
341		-	15 that violates section 5 of this chapter a fine of one thousand dollars
342		-	16 ($1,000) per day for which the report is past due.
343		-	17 (b) A fine under this section shall be deposited into the payer
344		-	18 affordability penalty fund established by IC 12-15-1-18.5.
345		-	19 (c) The department may waive a fine assessed under this section.
346		-	20 (d) The department may take disciplinary action against:
347		-	21 (1) an insurer;
348		-	22 (2) a third party administrator; or
349		-	23 (3) a pharmacy benefit manager;
350		-	24 that is licensed under this title for repeated violations of section 5
351		-	25 of this chapter.
352		-	26 Sec. 8. (a) Before December 1 of each year, the department shall
353		-	27 submit to the legislative council an annual report of the:
354		-	28 (1) violations assessed; and
355		-	29 (2) fines waived;
356		-	30 under section 7 of this chapter in the previous calendar year.
357		-	31 (b) A report described in this section must be submitted in an
358		-	32 electronic format under IC 5-14-6.
359		-	33 Sec. 9. (a) Before July 1, 2024, the department shall issue a
360		-	34 notice or bulletin on at least two (2) occasions to notify insurers,
361		-	35 third party administrators, and pharmacy benefit managers of the
362		-	36 reporting requirements set forth in this chapter.
363		-	37 (b) A notice or bulletin issued under this section must be posted
364		-	38 on the department's website in a manner that is easily accessible to
365		-	39 insurers, third party administrators, and pharmacy benefit
366		-	40 managers.
	164	+	6 (c) The state health commissioner may take action against a
	165	+	7 hospital under IC 16-21-3 for repeated violations of section 5 of
	166	+	8 this chapter.
	167	+	9 (d) The state department shall refer repeated violations of
	168	+	10 section 5 of this chapter for review and possible disciplinary action
	169	+	11 to the:
	170	+	12 (1) medical licensing board for repeated violations committed
	171	+	13 by a physician group practice; or
	172	+	14 (2) department of insurance for repeated violations
	173	+	15 committed by an insurer, a third party administrator, or a
	174	+	16 pharmacy benefit manager.
	175	+	17 Sec. 8. (a) Before September 1 of each year, the state
	176	+	18 department shall submit an annual report of the violations assessed
	177	+	19 by the state department under section 7 of this chapter in the
	178	+	20 previous calendar year to the following:
	179	+	21 (1) The speaker of the house of representatives.
	180	+	22 (2) The president pro tempore of the senate.
	181	+	23 (3) The chairperson of the house of representatives insurance
	182	+	24 committee.
	183	+	25 (4) The ranking minority member of the house of
	184	+	26 representatives insurance committee.
	185	+	27 (5) The chairperson of the senate insurance and financial
	186	+	28 institutions committee.
	187	+	29 (6) The ranking minority member of the senate insurance and
	188	+	30 financial institutions committee.
	189	+	31 (7) The chairperson of the house of representatives public
	190	+	32 health committee.
	191	+	33 (8) The ranking minority member of the house of
	192	+	34 representatives public health committee.
	193	+	35 (9) The chairperson of the senate health and provider services
	194	+	36 committee.
	195	+	37 (10) The ranking minority member of the senate health and
	196	+	38 provider services committee.
	197	+	39 (b) A report described in this section must be submitted in an
	198	+	40 electronic format under IC 5-14-6.
367	199		41 SECTION 7. IC 27-1-24.5-0.7 IS ADDED TO THE INDIANA
368	200		42 CODE AS A NEW SECTION TO READ AS FOLLOWS
369		-	HB 1327—LS 6888/DI 141 9
	201	+	2024 IN 1327—LS 6888/DI 141 5
370	202		1 [EFFECTIVE JULY 1, 2024]: Sec. 0.7. As used in this chapter,
371	203		2 "contract holder" means:
372	204		3 (1) an individual or entity that offers health insurance
373		-	4 coverage to its employees or members through a ~~self-funded~~
374		-	5 health benefit plan, including a self-funded ~~health benefit plan~~
375		-	6 that complies with the federal Employee ~~Retirement Income~~
376		-	7 Security Act (ERISA) of 1974 (29 U.S.C. ~~1001 et seq.);~~
377		-	8 (2) ~~a health plan~~; or
378		-	9 (3) ~~Medicaid or~~ a ~~managed care organization (as defined in~~
379		-	10 ~~IC 12-7-2-126.9~~) ~~that provides services to~~ a ~~Medicaid~~
380		-	11 ~~recipient;~~
381		-	12 ~~that contracts with a pharmacy benefit manager to provide~~
382		-	13 ~~services.~~
383		-	14 ~~SECTION 8~~. ~~IC 27-1-24.5-25, AS AMENDED BY P.L.32-2021,~~
384		-	15 SECTION ~~81,~~ IS ~~AMENDED~~ TO ~~READ AS FOLLOWS [EFFECTIVE~~
385		-	16 ~~JULY 1, 2024]: Sec. 25. (a)~~ A ~~party that has contracted with a~~
386		-	17 ~~pharmacy benefit manager to provide services contract holder may~~,
387		-	18 ~~at least one (1) time two (2) times in a calendar year, request~~ an ~~audit~~
388		-	19 ~~of compliance with the contract.~~ ~~If requested by the contract holder,~~
389		-	20 ~~the audit may shall include full disclosure~~ of ~~the following:~~
390		-	21 (1~~) Rebate amounts secured on prescription drugs~~, ~~whether~~
391		-	22 ~~product specific or general rebates~~, ~~that were provided by a~~
392		-	23 ~~pharmaceutical manufacturer~~. ~~The information provided under~~
393		-	24 ~~this subdivision must identify the prescription drugs by~~
394		-	25 ~~therapeutic category.~~ ~~and~~
395		-	26 ~~(2) Pharmaceutical and device claims received~~ by the
396		-	27 ~~pharmacy benefit manager on any~~ of the following:
397		-	28 (A) ~~The CMS-1500~~ ~~form or its successor form.~~
398		-	29 ~~(B) The HCFA-1500 form~~ or ~~its successor form.~~
399		-	30 ~~(C)~~ The ~~HIPAA X12 837P electronic claims transaction for~~
400		-	31 ~~professional services,~~ ~~or its successor transaction.~~
401		-	32 (D) The ~~HIPAA X12 837I institutional form or its~~
402		-	33 ~~successor form.~~
403		-	34 (E) The ~~CMS-1450 form or its successor form.~~
404		-	35 (F) The ~~UB-04 form or its successor form.~~
405		-	36 The ~~forms or transaction may be modified only as necessary~~
406		-	37 ~~to comply with~~ the ~~federal Health Insurance Portability and~~
407		-	38 ~~Accountability Act (HIPAA) (P.L. 104-191).~~
408		-	39 ~~(3) Pharmaceutical and device~~ claims ~~payments or~~ electronic
409		-	40 ~~funds transfer or remittance advice notices provided by the~~
410		-	41 ~~pharmacy benefit manager as ASC X12N 835 files~~ or a
411		-	42 ~~successor format.~~ The ~~files may be modified only as necessary~~
412		-	HB 1327—LS 6888/DI 141 10
413		-	1 ~~to comply with~~ the ~~federal Health Insurance Portability and~~
414		-	2 ~~Accountability Act (HIPAA) (P.L. 104-191)~~. In the event that
415		-	3 ~~paper~~ claims are provided, the pharmacy benefit manager
416		-	4 ~~shall~~ convert the paper claims to the ASC X12N 835 electronic
417		-	5 format ~~or a successor format~~.
	205	+	4 coverage to its employees or members through a health plan
	206	+	5 or a self-funded health benefit plan, including a self-funded
	207	+	6 health benefit plan that complies with the federal Employee
	208	+	7 Retirement Income Security Act (ERISA) of 1974 (29 U.S.C.
	209	+	8 1001 et seq.);
	210	+	9 (2) a health plan; or
	211	+	10 (3) Medicaid or a managed care organization (as defined in
	212	+	11 IC 12-7-2-126.9) that provides services to a Medicaid
	213	+	12 recipient;
	214	+	13 that contracts with a pharmacy benefit manager to provide
	215	+	14 services.
	216	+	15 SECTION 8. IC 27-1-24.5-4.3 IS ADDED TO THE INDIANA
	217	+	16 CODE AS A NEW SECTION TO READ AS FOLLOWS
	218	+	17 [EFFECTIVE JULY 1, 2024]: Sec. 4.3. As used in this chapter,
	219	+	18 "group purchasing organization" means an organization that
	220	+	19 negotiates drug prices, rebates, fees, discounts, or other services on
	221	+	20 behalf of a pharmacy benefit manager.
	222	+	21 SECTION 9. IC 27-1-24.5-25, AS AMENDED BY P.L.32-2021,
	223	+	22 SECTION 81, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	224	+	23 JULY 1, 2024]: Sec. 25. (a) A party that has contracted with a
	225	+	24 pharmacy benefit manager to provide services contract holder may,
	226	+	25 at least up to one (1) time in a calendar year, each quarter, request an
	227	+	26 audit of compliance with the contract. If requested by the contract
	228	+	27 holder, the audit may shall include full disclosure of the following:
	229	+	28 (1) Rebate amounts secured on prescription drugs, whether
	230	+	29 product specific or general rebates, that were provided by a
	231	+	30 pharmaceutical manufacturer. The information provided under
	232	+	31 this subdivision must identify the prescription drugs by:
	233	+	32 (A) the national drug code number with the prescription
	234	+	33 drug name; or
	235	+	34 (B) the individual prescription drug name. and
	236	+	35 (2) Pharmaceutical and device claims received by the
	237	+	36 pharmacy benefit manager as ASC X12N 837 files. The files
	238	+	37 must be unmodified copies of the files. In the event that paper
	239	+	38 claims are received, the pharmacy benefit manager shall
	240	+	39 convert the paper claims to the ASC X12N 837 electronic
	241	+	40 format.
	242	+	41 (3) Pharmaceutical and device claims payments or electronic
	243	+	42 funds transfer or remittance advice notices provided by the
	244	+	2024 IN 1327—LS 6888/DI 141 6
	245	+	1 pharmacy benefit manager as ASC X12N 835 files. The files
	246	+	2 must be unmodified copies of the files. In the event that paper
	247	+	3 claims are provided, the pharmacy benefit manager shall
	248	+	4 convert the paper claims to the ASC X12N 835 electronic
	249	+	5 format.
418	250		6 (4) Any other revenue and fees derived by the pharmacy benefit
419	251		7 manager from the contract, including all direct and indirect
420	252		8 remuneration from pharmaceutical manufacturers regardless
421	253		9 of whether the remuneration is classified as a rebate, fee, or
422	254		10 another term.
423	255		11 (b) A contract pharmacy benefit manager may not contain
424	256		12 provisions that impose:
425		-	13 (1) unreasonable fees for:
426		-	14 (A) requesting an audit under this section; or
427		-	15 (B) selecting an auditor other than an auditor designated
428		-	16 by the pharmacy benefit manager;
429		-	17 (2) conditions that would severely restrict a party's contract
430		-	18 holder's right to conduct an audit under this subsection, section,
431		-	19 including restrictions on the:
432		-	20 (A) time period of the audit;
433		-	21 (B) number of claims analyzed;
434		-	22 (C) type of analysis conducted;
435		-	23 (D) data elements used in the analysis; or
436		-	24 (E) selection of an auditor as long as the auditor is a
437		-	25 professional with contract auditing experience.
438		-	26 (b) (c) A pharmacy benefit manager shall disclose, upon request
439		-	27 from a party that has contracted with a pharmacy benefit manager,
440		-	28 contract holder, to the party contract holder the actual amounts
441		-	29 directly or indirectly paid by the pharmacy benefit manager to the
442		-	30 pharmacist or any pharmacy for the drug or for pharmacist services
443		-	31 related to the drug.
444		-	32 (c) (d) A pharmacy benefit manager shall provide notice to a party
445		-	33 contract holder contracting with the pharmacy benefit manager of any
446		-	34 consideration, including direct or indirect remuneration, that the
447		-	35 pharmacy benefit manager receives from a pharmacy pharmaceutical
448		-	36 manufacturer or group purchasing organization for any name brand
449		-	37 dispensing of a prescription when a generic or biologically similar
450		-	38 product is available for the prescription. formulary placement or any
451		-	39 other reason.
452		-	40 (d) (e) The commissioner may establish a procedure to release
453		-	41 information from an audit performed by the department to a party
454		-	42 contract holder that has requested an audit under this section in a
455		-	HB 1327—LS 6888/DI 141 11
456		-	1 manner that does not violate confidential or proprietary information
457		-	2 laws.
458		-	3 (e) (f) Any provision of A contract that is entered into, issued,
459		-	4 amended, or renewed after June 30, 2020, 2024, may not contain a
460		-	5 provision that violates this section. is unenforceable.
461		-	6 (g) A pharmacy benefit manager shall:
462		-	7 (1) obtain any information requested in an audit under this
463		-	8 section from a group purchasing organization or other
464		-	9 partner entity of the pharmacy benefit manager; and
465		-	10 (2) provide any information requested in an audit under this
466		-	11 section to the contract holder not later than twenty (20)
467		-	12 business days after the information is requested.
468		-	13 (h) Information provided in an audit under this section must be
	257	+	13 (1) unreasonable fees for an audit conducted under this
	258	+	14 section; or
	259	+	15 (2) conditions that would severely restrict a party's contract
	260	+	16 holder's right to conduct an audit under this subsection, section,
	261	+	17 including restrictions on the:
	262	+	18 (A) time period of the audit;
	263	+	19 (B) number of claims analyzed;
	264	+	20 (C) type of analysis conducted;
	265	+	21 (D) data elements used in the analysis; or
	266	+	22 (E) selection of an auditor.
	267	+	23 (b) (c) A pharmacy benefit manager shall disclose, upon request
	268	+	24 from a party that has contracted with a pharmacy benefit manager,
	269	+	25 contract holder, to the party contract holder the actual amounts
	270	+	26 directly or indirectly paid by the pharmacy benefit manager to the
	271	+	27 pharmacist or any pharmacy for the drug or for pharmacist services
	272	+	28 related to the drug.
	273	+	29 (c) (d) A pharmacy benefit manager shall provide notice to a party
	274	+	30 contract holder contracting with the pharmacy benefit manager of any
	275	+	31 consideration, including direct or indirect remuneration, that the
	276	+	32 pharmacy benefit manager receives from a pharmacy pharmaceutical
	277	+	33 manufacturer or group purchasing organization for any name brand
	278	+	34 dispensing of a prescription when a generic or biologically similar
	279	+	35 product is available for the prescription. formulary placement or any
	280	+	36 other reason.
	281	+	37 (d) (e) The commissioner may establish a procedure to release
	282	+	38 information from an audit performed by the department to a party
	283	+	39 contract holder that has requested an audit under this section in a
	284	+	40 manner that does not violate confidential or proprietary information
	285	+	41 laws.
	286	+	42 (e) (f) Any provision of A contract that is entered into, issued,
	287	+	2024 IN 1327—LS 6888/DI 141 7
	288	+	1 amended, or renewed after June 30, 2020, 2024, may not contain a
	289	+	2 provision that violates this section. is unenforceable.
	290	+	3 (g) A pharmacy benefit manager shall:
	291	+	4 (1) obtain any information requested in an audit under this
	292	+	5 section from a group purchasing organization or other
	293	+	6 partner entity of the pharmacy benefit manager; and
	294	+	7 (2) provide any information requested in an audit under this
	295	+	8 section to the contract holder not later than fifteen (15)
	296	+	9 business days after the information is requested.
	297	+	10 (h) Information provided in an audit under this section must be
	298	+	11 provided in accordance with the federal Health Insurance
	299	+	12 Portability and Accountability Act (HIPAA) (P.L. 104-191).
	300	+	13 SECTION 10. IC 27-1-42.5 IS ADDED TO THE INDIANA CODE
	301	+	14 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
	302	+	15 JULY 1, 2024]:
	303	+	16 Chapter 42.5. Prohibition on Fees for Additional Services
	304	+	17 Sec. 1. This chapter applies to a contract entered into, issued,
	305	+	18 amended, or renewed after June 30, 2024.
	306	+	19 Sec. 2. As used in this chapter, "health plan" means the
	307	+	20 following:
	308	+	21 (1) A policy of accident and sickness insurance (as defined in
	309	+	22 IC 27-8-5-1). However, the term does not include the
	310	+	23 coverages described in IC 27-8-5-2.5(a).
	311	+	24 (2) A contract with a health maintenance organization (as
	312	+	25 defined in IC 27-13-1-19) that provides coverage for basic
	313	+	26 health care services (as defined in IC 27-13-1-4).
	314	+	27 (3) A prepaid health care delivery plan under IC 5-10-8-7(c)
	315	+	28 to provide group health coverage for state employees.
	316	+	29 Sec. 3. As used in this chapter, "pharmacy benefit manager" has
	317	+	30 the meaning set forth in IC 27-1-24.5-12.
	318	+	31 Sec. 4. As used in this chapter, "plan sponsor" means an
	319	+	32 individual or entity that offers health insurance coverage to its
	320	+	33 employees or members through a health plan or a self-funded
	321	+	34 health benefit plan, including:
	322	+	35 (1) a self-funded health benefit plan that complies with the
	323	+	36 federal Employee Retirement Income Security Act (ERISA)
	324	+	37 of 1974 (29 U.S.C. 1001 et seq.); and
	325	+	38 (2) a self-insurance program established under IC 5-10-8-7(b).
	326	+	39 Sec. 5. As used in this chapter, "third party administrator"
	327	+	40 means an individual or entity that performs administrative services
	328	+	41 for a health plan or a self-funded health benefit plan, including:
	329	+	42 (1) a self-funded health benefit plan that complies with the
	330	+	2024 IN 1327—LS 6888/DI 141 8
	331	+	1 federal Employee Retirement Income Security Act (ERISA)
	332	+	2 of 1974 (29 U.S.C. 1001 et seq.); and
	333	+	3 (2) a self-insurance program established under IC 5-10-8-7(b).
	334	+	4 Sec. 6. A:
	335	+	5 (1) third party administrator;
	336	+	6 (2) health plan; or
	337	+	7 (3) pharmacy benefit manager;
	338	+	8 may not charge a fee if the plan sponsor opts out of an additional
	339	+	9 service offered by the third party administrator, health plan, or
	340	+	10 pharmacy benefit manager.
	341	+	11 SECTION 11. IC 27-2-25.5-0.5 IS ADDED TO THE INDIANA
	342	+	12 CODE AS A NEW SECTION TO READ AS FOLLOWS
	343	+	13 [EFFECTIVE JULY 1, 2024]: Sec. 0.5. As used in this chapter, "plan
	344	+	14 sponsor" means an individual or entity that offers health insurance
	345	+	15 coverage to its employees or members through a self-funded health
	346	+	16 benefit plan, including:
	347	+	17 (1) a self-funded health benefit plan that complies with the
	348	+	18 federal Employee Retirement Income Security Act (ERISA)
	349	+	19 of 1974 (29 U.S.C. 1001 et seq.); and
	350	+	20 (2) a self-insurance program established under IC 5-10-8-7(b).
	351	+	21 SECTION 12. IC 27-2-25.5-0.7 IS ADDED TO THE INDIANA
	352	+	22 CODE AS A NEW SECTION TO READ AS FOLLOWS
	353	+	23 [EFFECTIVE JULY 1, 2024]: Sec. 0.7. As used in sections 3 and 4 of
	354	+	24 this chapter, "third party administrator" means an individual or
	355	+	25 entity that performs administrative services for a self-funded
	356	+	26 health benefit plan, including:
	357	+	27 (1) a self-funded health benefit plan that complies with the
	358	+	28 federal Employee Retirement Income Security Act (ERISA)
	359	+	29 of 1974 (29 U.S.C. 1001 et seq.); and
	360	+	30 (2) a self-insurance program established under IC 5-10-8-7(b).
	361	+	31 SECTION 13. IC 27-2-25.5-3 IS ADDED TO THE INDIANA
	362	+	32 CODE AS A NEW SECTION TO READ AS FOLLOWS
	363	+	33 [EFFECTIVE JULY 1, 2024]: Sec. 3. (a) This section applies to a
	364	+	34 contract entered into, issued, amended, or renewed after June 30,
	365	+	35 2024.
	366	+	36 (b) A contract between:
	367	+	37 (1) a:
	368	+	38 (A) third party administrator;
	369	+	39 (B) pharmacy benefit manager (as defined in
	370	+	40 IC 27-1-24.5-12); or
	371	+	41 (C) prepaid health care delivery plan under IC 5-10-8-7(c)
	372	+	42 to provide group health coverage for state employees; and
	373	+	2024 IN 1327—LS 6888/DI 141 9
	374	+	1 (2) a plan sponsor;
	375	+	2 must provide that the plan sponsor owns the claims data relating
	376	+	3 to the contract.
	377	+	4 SECTION 14. IC 27-2-25.5-4 IS ADDED TO THE INDIANA
	378	+	5 CODE AS A NEW SECTION TO READ AS FOLLOWS
	379	+	6 [EFFECTIVE JULY 1, 2024]: Sec. 4. (a) A plan sponsor that
	380	+	7 contracts with a third party administrator, the office of the
	381	+	8 secretary of family and social services that contracts with a
	382	+	9 managed care organization (as defined in IC 12-7-2-126.9) to
	383	+	10 provide services to a Medicaid recipient, or the state personnel
	384	+	11 department that contracts with a prepaid health care delivery plan
	385	+	12 under IC 5-10-8-7(c) to provide group health coverage for state
	386	+	13 employees may, up to one (1) time each quarter, request an audit
	387	+	14 of compliance with the contract. If requested by the plan sponsor,
	388	+	15 office of the secretary of family and social services, or state
	389	+	16 personnel department, the audit shall include full disclosure of the
	390	+	17 following:
	391	+	18 (1) Claims data described in section 1 of this chapter.
	392	+	19 (2) Claims received by the third party administrator,
	393	+	20 managed care organization, or prepaid health care delivery
	394	+	21 plan as ASC X12N 837 files. The files must be unmodified
	395	+	22 copies of the files. In the event that paper claims are received,
	396	+	23 the third party administrator, managed care organization, or
	397	+	24 prepaid health care delivery plan shall convert the paper
	398	+	25 claims to the ASC X12N 837 electronic format.
	399	+	26 (3) Claims payments, electronic funds transfer, or remittance
	400	+	27 advice notices provided by the third party administrator,
	401	+	28 managed care organization, or prepaid health care delivery
	402	+	29 plan as ASC X12N 835 files. The files must be unmodified
	403	+	30 copies of the files. In the event that paper claims are provided,
	404	+	31 the third party administrator, managed care organization, or
	405	+	32 prepaid health care delivery plan shall convert the paper
	406	+	33 claims to the ASC X12N 835 electronic format.
	407	+	34 (4) Any fees charged to the plan sponsor, office of the
	408	+	35 secretary of family and social services, or state personnel
	409	+	36 department related to plan administration and claims
	410	+	37 processing, including renegotiation fees, access fees, repricing
	411	+	38 fees, or enhanced review fees.
	412	+	39 (b) A third party administrator, managed care organization, or
	413	+	40 prepaid health care delivery plan may not impose:
	414	+	41 (1) fees for an audit conducted under this section; or
	415	+	42 (2) conditions that would restrict a party's right to conduct an
	416	+	2024 IN 1327—LS 6888/DI 141 10
	417	+	1 audit under this section, including restrictions on the:
	418	+	2 (A) time period of the audit;
	419	+	3 (B) number of claims analyzed;
	420	+	4 (C) type of analysis conducted;
	421	+	5 (D) data elements used in the analysis; or
	422	+	6 (E) selection of an auditor.
	423	+	7 (c) A third party administrator, managed care organization, or
	424	+	8 prepaid health care delivery plan shall provide any information
	425	+	9 requested in an audit under this section to the plan sponsor, office
	426	+	10 of the secretary of family and social services, or state personnel
	427	+	11 department not later than fifteen (15) business days after the
	428	+	12 information is requested.
	429	+	13 (d) Information provided in an audit under this section must be
469	430		14 provided in accordance with the federal Health Insurance
470	431		15 Portability and Accountability Act (HIPAA) (P.L. 104-191).
471		-	16 SECTION 9. IC 27-2-25.5-0.5 IS ADDED TO THE INDIANA
472		-	17 CODE AS A NEW SECTION TO READ AS FOLLOWS
473		-	18 [EFFECTIVE JULY 1, 2024]: Sec. 0.5. As used in this chapter, "plan
474		-	19 sponsor" means an individual or entity that offers health insurance
475		-	20 coverage to its employees or members through a self-funded health
476		-	21 benefit plan, including:
477		-	22 (1) a self-funded health benefit plan that complies with the
478		-	23 federal Employee Retirement Income Security Act (ERISA)
479		-	24 of 1974 (29 U.S.C. 1001 et seq.); and
480		-	25 (2) a self-insurance program established under IC 5-10-8-7(b).
481		-	26 SECTION 10. IC 27-2-25.5-0.7 IS ADDED TO THE INDIANA
482		-	27 CODE AS A NEW SECTION TO READ AS FOLLOWS
483		-	28 [EFFECTIVE JULY 1, 2024]: Sec. 0.7. As used in sections 3 and 4 of
484		-	29 this chapter, "third party administrator" means an individual or
485		-	30 entity that performs administrative services for a self-funded
486		-	31 health benefit plan, including:
487		-	32 (1) a self-funded health benefit plan that complies with the
488		-	33 federal Employee Retirement Income Security Act (ERISA)
489		-	34 of 1974 (29 U.S.C. 1001 et seq.); and
490		-	35 (2) a self-insurance program established under IC 5-10-8-7(b).
491		-	36 SECTION 11. IC 27-2-25.5-3 IS ADDED TO THE INDIANA
492		-	37 CODE AS A NEW SECTION TO READ AS FOLLOWS
493		-	38 [EFFECTIVE JULY 1, 2024]: Sec. 3. (a) This section applies to a
494		-	39 contract entered into, issued, amended, or renewed after June 30,
495		-	40 2024.
496		-	41 (b) A contract between:
497		-	42 (1) a:
498		-	HB 1327—LS 6888/DI 141 12
499		-	1 (A) third party administrator;
500		-	2 (B) pharmacy benefit manager (as defined in
501		-	3 IC 27-1-24.5-12); or
502		-	4 (C) prepaid health care delivery plan under IC 5-10-8-7(c)
503		-	5 to provide group health coverage for state employees; and
504		-	6 (2) a plan sponsor;
505		-	7 must provide that the plan sponsor owns the claims data relating
506		-	8 to the contract.
507		-	9 (c) Any claims data provided under this section must be
508		-	10 provided in accordance with the federal Health Insurance
509		-	11 Portability and Accountability Act (HIPAA) (P.L. 104-191).
510		-	12 SECTION 12. IC 27-2-25.5-4 IS ADDED TO THE INDIANA
511		-	13 CODE AS A NEW SECTION TO READ AS FOLLOWS
512		-	14 [EFFECTIVE JULY 1, 2024]: Sec. 4. (a) A plan sponsor that
513		-	15 contracts with a third party administrator, the office of the
514		-	16 secretary of family and social services that contracts with a
515		-	17 managed care organization (as defined in IC 12-7-2-126.9) to
516		-	18 provide services to a Medicaid recipient, or the state personnel
517		-	19 department that contracts with a prepaid health care delivery plan
518		-	20 under IC 5-10-8-7(c) to provide group health coverage for state
519		-	21 employees may, at least two (2) times in a calendar year, request an
520		-	22 audit of compliance with the contract. If requested by the plan
521		-	23 sponsor, office of the secretary of family and social services, or
522		-	24 state personnel department, the audit shall include full disclosure
523		-	25 of the following:
524		-	26 (1) Claims data described in section 1 of this chapter.
525		-	27 (2) Claims received by the third party administrator,
526		-	28 managed care organization, or prepaid health care delivery
527		-	29 plan on any of the following:
528		-	30 (A) The CMS-1500 form or its successor form.
529		-	31 (B) The HCFA-1500 form or its successor form.
530		-	32 (C) The HIPAA X12 837P electronic claims transaction for
531		-	33 professional services, or its successor transaction.
532		-	34 (D) The HIPAA X12 837I institutional form or its
533		-	35 successor form.
534		-	36 (E) The CMS-1450 form or its successor form.
535		-	37 (F) The UB-04 form or its successor form.
536		-	38 The forms or transaction may be modified only as necessary
537		-	39 to comply with the federal Health Insurance Portability and
538		-	40 Accountability Act (HIPAA) (P.L. 104-191).
539		-	41 (3) Claims payments, electronic funds transfer, or remittance
540		-	42 advice notices provided by the third party administrator,
541		-	HB 1327—LS 6888/DI 141 13
542		-	1 managed care organization, or prepaid health care delivery
543		-	2 plan as ASC X12N 835 files or a successor format. The files
544		-	3 may be modified only as necessary to comply with the federal
545		-	4 Health Insurance Portability and Accountability Act (HIPAA)
546		-	5 (P.L. 104-191). In the event that paper claims are provided,
547		-	6 the third party administrator, managed care organization, or
548		-	7 prepaid health care delivery plan shall convert the paper
549		-	8 claims to the ASC X12N 835 electronic format or a successor
550		-	9 format.
551		-	10 (4) Any fees charged to the plan sponsor, office of the
552		-	11 secretary of family and social services, or state personnel
553		-	12 department related to plan administration and claims
554		-	13 processing, including renegotiation fees, access fees, repricing
555		-	14 fees, or enhanced review fees.
556		-	15 (b) A third party administrator, managed care organization, or
557		-	16 prepaid health care delivery plan may not impose:
558		-	17 (1) fees for:
559		-	18 (A) requesting an audit under this section; or
560		-	19 (B) selecting an auditor other than an auditor designated
561		-	20 by the third party administrator, managed care
562		-	21 organization, or prepaid health care delivery plan; or
563		-	22 (2) conditions that would restrict a party's right to conduct an
564		-	23 audit under this section, including restrictions on the:
565		-	24 (A) time period of the audit;
566		-	25 (B) number of claims analyzed;
567		-	26 (C) type of analysis conducted;
568		-	27 (D) data elements used in the analysis; or
569		-	28 (E) selection of an auditor, as long as the auditor is a
570		-	29 professional with contract auditing experience.
571		-	30 (c) A third party administrator, managed care organization, or
572		-	31 prepaid health care delivery plan shall provide any information
573		-	32 requested in an audit under this section to the plan sponsor, office
574		-	33 of the secretary of family and social services, or state personnel
575		-	34 department not later than twenty (20) business days after the
576		-	35 information is requested.
577		-	36 (d) Information provided in an audit under this section must be
578		-	37 provided in accordance with the federal Health Insurance
579		-	38 Portability and Accountability Act (HIPAA) (P.L. 104-191).
580		-	39 (e) A contract that is entered into, issued, amended, or renewed
581		-	40 after June 30, 2024, may not contain a provision that violates this
582		-	41 section.
583		-	42 (f) A violation of this section is an unfair or deceptive act or
584		-	HB 1327—LS 6888/DI 141 14
585		-	1 practice in the business of insurance under IC 27-4-1-4.
586		-	2 (g) The department may also adopt rules under IC 4-22-2 to set
587		-	3 forth fines for a violation under this section.
588		-	4 SECTION 13. IC 27-4-1-4, AS AMENDED BY P.L.56-2023,
589		-	5 SECTION 244, IS AMENDED TO READ AS FOLLOWS
590		-	6 [EFFECTIVE JULY 1, 2024]: Sec. 4. (a) The following are hereby
591		-	7 defined as unfair methods of competition and unfair and deceptive acts
592		-	8 and practices in the business of insurance:
593		-	9 (1) Making, issuing, circulating, or causing to be made, issued, or
594		-	10 circulated, any estimate, illustration, circular, or statement:
595		-	11 (A) misrepresenting the terms of any policy issued or to be
596		-	12 issued or the benefits or advantages promised thereby or the
597		-	13 dividends or share of the surplus to be received thereon;
598		-	14 (B) making any false or misleading statement as to the
599		-	15 dividends or share of surplus previously paid on similar
600		-	16 policies;
601		-	17 (C) making any misleading representation or any
602		-	18 misrepresentation as to the financial condition of any insurer,
603		-	19 or as to the legal reserve system upon which any life insurer
604		-	20 operates;
605		-	21 (D) using any name or title of any policy or class of policies
606		-	22 misrepresenting the true nature thereof; or
607		-	23 (E) making any misrepresentation to any policyholder insured
608		-	24 in any company for the purpose of inducing or tending to
609		-	25 induce such policyholder to lapse, forfeit, or surrender the
610		-	26 policyholder's insurance.
611		-	27 (2) Making, publishing, disseminating, circulating, or placing
612		-	28 before the public, or causing, directly or indirectly, to be made,
613		-	29 published, disseminated, circulated, or placed before the public,
614		-	30 in a newspaper, magazine, or other publication, or in the form of
615		-	31 a notice, circular, pamphlet, letter, or poster, or over any radio or
616		-	32 television station, or in any other way, an advertisement,
617		-	33 announcement, or statement containing any assertion,
618		-	34 representation, or statement with respect to any person in the
619		-	35 conduct of the person's insurance business, which is untrue,
620		-	36 deceptive, or misleading.
621		-	37 (3) Making, publishing, disseminating, or circulating, directly or
622		-	38 indirectly, or aiding, abetting, or encouraging the making,
623		-	39 publishing, disseminating, or circulating of any oral or written
624		-	40 statement or any pamphlet, circular, article, or literature which is
625		-	41 false, or maliciously critical of or derogatory to the financial
626		-	42 condition of an insurer, and which is calculated to injure any
627		-	HB 1327—LS 6888/DI 141 15
628		-	1 person engaged in the business of insurance.
629		-	2 (4) Entering into any agreement to commit, or individually or by
630		-	3 a concerted action committing any act of boycott, coercion, or
631		-	4 intimidation resulting or tending to result in unreasonable
632		-	5 restraint of, or a monopoly in, the business of insurance.
633		-	6 (5) Filing with any supervisory or other public official, or making,
634		-	7 publishing, disseminating, circulating, or delivering to any person,
635		-	8 or placing before the public, or causing directly or indirectly, to
636		-	9 be made, published, disseminated, circulated, delivered to any
637		-	10 person, or placed before the public, any false statement of
638		-	11 financial condition of an insurer with intent to deceive. Making
639		-	12 any false entry in any book, report, or statement of any insurer
640		-	13 with intent to deceive any agent or examiner lawfully appointed
641		-	14 to examine into its condition or into any of its affairs, or any
642		-	15 public official to which such insurer is required by law to report,
643		-	16 or which has authority by law to examine into its condition or into
644		-	17 any of its affairs, or, with like intent, willfully omitting to make a
645		-	18 true entry of any material fact pertaining to the business of such
646		-	19 insurer in any book, report, or statement of such insurer.
647		-	20 (6) Issuing or delivering or permitting agents, officers, or
648		-	21 employees to issue or deliver, agency company stock or other
649		-	22 capital stock, or benefit certificates or shares in any common law
650		-	23 corporation, or securities or any special or advisory board
651		-	24 contracts or other contracts of any kind promising returns and
652		-	25 profits as an inducement to insurance.
653		-	26 (7) Making or permitting any of the following:
654		-	27 (A) Unfair discrimination between individuals of the same
655		-	28 class and equal expectation of life in the rates or assessments
656		-	29 charged for any contract of life insurance or of life annuity or
657		-	30 in the dividends or other benefits payable thereon, or in any
658		-	31 other of the terms and conditions of such contract. However,
659		-	32 in determining the class, consideration may be given to the
660		-	33 nature of the risk, plan of insurance, the actual or expected
661		-	34 expense of conducting the business, or any other relevant
662		-	35 factor.
663		-	36 (B) Unfair discrimination between individuals of the same
664		-	37 class involving essentially the same hazards in the amount of
665		-	38 premium, policy fees, assessments, or rates charged or made
666		-	39 for any policy or contract of accident or health insurance or in
667		-	40 the benefits payable thereunder, or in any of the terms or
668		-	41 conditions of such contract, or in any other manner whatever.
669		-	42 However, in determining the class, consideration may be given
670		-	HB 1327—LS 6888/DI 141 16
671		-	1 to the nature of the risk, the plan of insurance, the actual or
672		-	2 expected expense of conducting the business, or any other
673		-	3 relevant factor.
674		-	4 (C) Excessive or inadequate charges for premiums, policy
675		-	5 fees, assessments, or rates, or making or permitting any unfair
676		-	6 discrimination between persons of the same class involving
677		-	7 essentially the same hazards, in the amount of premiums,
678		-	8 policy fees, assessments, or rates charged or made for:
679		-	9 (i) policies or contracts of reinsurance or joint reinsurance,
680		-	10 or abstract and title insurance;
681		-	11 (ii) policies or contracts of insurance against loss or damage
682		-	12 to aircraft, or against liability arising out of the ownership,
683		-	13 maintenance, or use of any aircraft, or of vessels or craft,
684		-	14 their cargoes, marine builders' risks, marine protection and
685		-	15 indemnity, or other risks commonly insured under marine,
686		-	16 as distinguished from inland marine, insurance; or
687		-	17 (iii) policies or contracts of any other kind or kinds of
688		-	18 insurance whatsoever.
689		-	19 However, nothing contained in clause (C) shall be construed to
690		-	20 apply to any of the kinds of insurance referred to in clauses (A)
691		-	21 and (B) nor to reinsurance in relation to such kinds of insurance.
692		-	22 Nothing in clause (A), (B), or (C) shall be construed as making or
693		-	23 permitting any excessive, inadequate, or unfairly discriminatory
694		-	24 charge or rate or any charge or rate determined by the department
695		-	25 or commissioner to meet the requirements of any other insurance
696		-	26 rate regulatory law of this state.
697		-	27 (8) Except as otherwise expressly provided by IC 27-1-47 or
698		-	28 another law, knowingly permitting or offering to make or making
699		-	29 any contract or policy of insurance of any kind or kinds
700		-	30 whatsoever, including but not in limitation, life annuities, or
701		-	31 agreement as to such contract or policy other than as plainly
702		-	32 expressed in such contract or policy issued thereon, or paying or
703		-	33 allowing, or giving or offering to pay, allow, or give, directly or
704		-	34 indirectly, as inducement to such insurance, or annuity, any rebate
705		-	35 of premiums payable on the contract, or any special favor or
706		-	36 advantage in the dividends, savings, or other benefits thereon, or
707		-	37 any valuable consideration or inducement whatever not specified
708		-	38 in the contract or policy; or giving, or selling, or purchasing or
709		-	39 offering to give, sell, or purchase as inducement to such insurance
710		-	40 or annuity or in connection therewith, any stocks, bonds, or other
711		-	41 securities of any insurance company or other corporation,
712		-	42 association, limited liability company, or partnership, or any
713		-	HB 1327—LS 6888/DI 141 17
714		-	1 dividends, savings, or profits accrued thereon, or anything of
715		-	2 value whatsoever not specified in the contract. Nothing in this
716		-	3 subdivision and subdivision (7) shall be construed as including
717		-	4 within the definition of discrimination or rebates any of the
718		-	5 following practices:
719		-	6 (A) Paying bonuses to policyholders or otherwise abating their
720		-	7 premiums in whole or in part out of surplus accumulated from
721		-	8 nonparticipating insurance, so long as any such bonuses or
722		-	9 abatement of premiums are fair and equitable to policyholders
723		-	10 and for the best interests of the company and its policyholders.
724		-	11 (B) In the case of life insurance policies issued on the
725		-	12 industrial debit plan, making allowance to policyholders who
726		-	13 have continuously for a specified period made premium
727		-	14 payments directly to an office of the insurer in an amount
728		-	15 which fairly represents the saving in collection expense.
729		-	16 (C) Readjustment of the rate of premium for a group insurance
730		-	17 policy based on the loss or expense experience thereunder, at
731		-	18 the end of the first year or of any subsequent year of insurance
732		-	19 thereunder, which may be made retroactive only for such
733		-	20 policy year.
734		-	21 (D) Paying by an insurer or insurance producer thereof duly
735		-	22 licensed as such under the laws of this state of money,
736		-	23 commission, or brokerage, or giving or allowing by an insurer
737		-	24 or such licensed insurance producer thereof anything of value,
738		-	25 for or on account of the solicitation or negotiation of policies
739		-	26 or other contracts of any kind or kinds, to a broker, an
740		-	27 insurance producer, or a solicitor duly licensed under the laws
741		-	28 of this state, but such broker, insurance producer, or solicitor
742		-	29 receiving such consideration shall not pay, give, or allow
743		-	30 credit for such consideration as received in whole or in part,
744		-	31 directly or indirectly, to the insured by way of rebate.
745		-	32 (9) Requiring, as a condition precedent to loaning money upon the
746		-	33 security of a mortgage upon real property, that the owner of the
747		-	34 property to whom the money is to be loaned negotiate any policy
748		-	35 of insurance covering such real property through a particular
749		-	36 insurance producer or broker or brokers. However, this
750		-	37 subdivision shall not prevent the exercise by any lender of the
751		-	38 lender's right to approve or disapprove of the insurance company
752		-	39 selected by the borrower to underwrite the insurance.
753		-	40 (10) Entering into any contract, combination in the form of a trust
754		-	41 or otherwise, or conspiracy in restraint of commerce in the
755		-	42 business of insurance.
756		-	HB 1327—LS 6888/DI 141 18
757		-	1 (11) Monopolizing or attempting to monopolize or combining or
758		-	2 conspiring with any other person or persons to monopolize any
759		-	3 part of commerce in the business of insurance. However,
760		-	4 participation as a member, director, or officer in the activities of
761		-	5 any nonprofit organization of insurance producers or other
762		-	6 workers in the insurance business shall not be interpreted, in
763		-	7 itself, to constitute a combination in restraint of trade or as
764		-	8 combining to create a monopoly as provided in this subdivision
765		-	9 and subdivision (10). The enumeration in this chapter of specific
766		-	10 unfair methods of competition and unfair or deceptive acts and
767		-	11 practices in the business of insurance is not exclusive or
768		-	12 restrictive or intended to limit the powers of the commissioner or
769		-	13 department or of any court of review under section 8 of this
770		-	14 chapter.
771		-	15 (12) Requiring as a condition precedent to the sale of real or
772		-	16 personal property under any contract of sale, conditional sales
773		-	17 contract, or other similar instrument or upon the security of a
774		-	18 chattel mortgage, that the buyer of such property negotiate any
775		-	19 policy of insurance covering such property through a particular
776		-	20 insurance company, insurance producer, or broker or brokers.
777		-	21 However, this subdivision shall not prevent the exercise by any
778		-	22 seller of such property or the one making a loan thereon of the
779		-	23 right to approve or disapprove of the insurance company selected
780		-	24 by the buyer to underwrite the insurance.
781		-	25 (13) Issuing, offering, or participating in a plan to issue or offer,
782		-	26 any policy or certificate of insurance of any kind or character as
783		-	27 an inducement to the purchase of any property, real, personal, or
784		-	28 mixed, or services of any kind, where a charge to the insured is
785		-	29 not made for and on account of such policy or certificate of
786		-	30 insurance. However, this subdivision shall not apply to any of the
787		-	31 following:
788		-	32 (A) Insurance issued to credit unions or members of credit
789		-	33 unions in connection with the purchase of shares in such credit
790		-	34 unions.
791		-	35 (B) Insurance employed as a means of guaranteeing the
792		-	36 performance of goods and designed to benefit the purchasers
793		-	37 or users of such goods.
794		-	38 (C) Title insurance.
795		-	39 (D) Insurance written in connection with an indebtedness and
796		-	40 intended as a means of repaying such indebtedness in the
797		-	41 event of the death or disability of the insured.
798		-	42 (E) Insurance provided by or through motorists service clubs
799		-	HB 1327—LS 6888/DI 141 19
800		-	1 or associations.
801		-	2 (F) Insurance that is provided to the purchaser or holder of an
802		-	3 air transportation ticket and that:
803		-	4 (i) insures against death or nonfatal injury that occurs during
804		-	5 the flight to which the ticket relates;
805		-	6 (ii) insures against personal injury or property damage that
806		-	7 occurs during travel to or from the airport in a common
807		-	8 carrier immediately before or after the flight;
808		-	9 (iii) insures against baggage loss during the flight to which
809		-	10 the ticket relates; or
810		-	11 (iv) insures against a flight cancellation to which the ticket
811		-	12 relates.
812		-	13 (14) Refusing, because of the for-profit status of a hospital or
813		-	14 medical facility, to make payments otherwise required to be made
814		-	15 under a contract or policy of insurance for charges incurred by an
815		-	16 insured in such a for-profit hospital or other for-profit medical
816		-	17 facility licensed by the Indiana department of health.
817		-	18 (15) Refusing to insure an individual, refusing to continue to issue
818		-	19 insurance to an individual, limiting the amount, extent, or kind of
819		-	20 coverage available to an individual, or charging an individual a
820		-	21 different rate for the same coverage, solely because of that
821		-	22 individual's blindness or partial blindness, except where the
822		-	23 refusal, limitation, or rate differential is based on sound actuarial
823		-	24 principles or is related to actual or reasonably anticipated
824		-	25 experience.
825		-	26 (16) Committing or performing, with such frequency as to
826		-	27 indicate a general practice, unfair claim settlement practices (as
827		-	28 defined in section 4.5 of this chapter).
828		-	29 (17) Between policy renewal dates, unilaterally canceling an
829		-	30 individual's coverage under an individual or group health
830		-	31 insurance policy solely because of the individual's medical or
831		-	32 physical condition.
832		-	33 (18) Using a policy form or rider that would permit a cancellation
833		-	34 of coverage as described in subdivision (17).
834		-	35 (19) Violating IC 27-1-22-25, IC 27-1-22-26, or IC 27-1-22-26.1
835		-	36 concerning motor vehicle insurance rates.
836		-	37 (20) Violating IC 27-8-21-2 concerning advertisements referring
837		-	38 to interest rate guarantees.
838		-	39 (21) Violating IC 27-8-24.3 concerning insurance and health plan
839		-	40 coverage for victims of abuse.
840		-	41 (22) Violating IC 27-8-26 concerning genetic screening or testing.
841		-	42 (23) Violating IC 27-1-15.6-3(b) concerning licensure of
842		-	HB 1327—LS 6888/DI 141 20
843		-	1 insurance producers.
844		-	2 (24) Violating IC 27-1-38 concerning depository institutions.
845		-	3 (25) Violating IC 27-8-28-17(c) or IC 27-13-10-8(c) concerning
846		-	4 the resolution of an appealed grievance decision.
847		-	5 (26) Violating IC 27-8-5-2.5(e) through IC 27-8-5-2.5(j) (expired
848		-	6 July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1,
849		-	7 2007, and repealed).
850		-	8 (27) Violating IC 27-2-21 concerning use of credit information.
851		-	9 (28) Violating IC 27-4-9-3 concerning recommendations to
852		-	10 consumers.
853		-	11 (29) Engaging in dishonest or predatory insurance practices in
854		-	12 marketing or sales of insurance to members of the United States
855		-	13 Armed Forces as:
856		-	14 (A) described in the federal Military Personnel Financial
857		-	15 Services Protection Act, P.L.109-290; or
858		-	16 (B) defined in rules adopted under subsection (b).
859		-	17 (30) Violating IC 27-8-19.8-20.1 concerning stranger originated
860		-	18 life insurance.
861		-	19 (31) Violating IC 27-2-22 concerning retained asset accounts.
862		-	20 (32) Violating IC 27-8-5-29 concerning health plans offered
863		-	21 through a health benefit exchange (as defined in IC 27-19-2-8).
864		-	22 (33) Violating a requirement of the federal Patient Protection and
865		-	23 Affordable Care Act (P.L. 111-148), as amended by the federal
866		-	24 Health Care and Education Reconciliation Act of 2010 (P.L.
867		-	25 111-152), that is enforceable by the state.
868		-	26 (34) After June 30, 2015, violating IC 27-2-23 concerning
869		-	27 unclaimed life insurance, annuity, or retained asset account
870		-	28 benefits.
871		-	29 (35) Willfully violating IC 27-1-12-46 concerning a life insurance
872		-	30 policy or certificate described in IC 27-1-12-46(a).
873		-	31 (36) Violating IC 27-1-37-7 concerning prohibiting the disclosure
874		-	32 of health care service claims data.
875		-	33 (37) Violating IC 27-4-10-10 concerning virtual claims payments.
876		-	34 (38) Violating IC 27-1-24.5 concerning pharmacy benefit
877		-	35 managers.
878		-	36 (39) Violating IC 27-7-17-16 or IC 27-7-17-17 concerning the
879		-	37 marketing of travel insurance policies.
880		-	38 (40) Violating IC 27-2-25.5-4 concerning audits of a third
881		-	39 party administrator, managed care organization, or prepaid
882		-	40 health care delivery plan.
883		-	41 (b) Except with respect to federal insurance programs under
884		-	42 Subchapter III of Chapter 19 of Title 38 of the United States Code, the
885		-	HB 1327—LS 6888/DI 141 21
886		-	1 commissioner may, consistent with the federal Military Personnel
887		-	2 Financial Services Protection Act (10 U.S.C. 992 note), adopt rules
888		-	3 under IC 4-22-2 to:
889		-	4 (1) define; and
890		-	5 (2) while the members are on a United States military installation
891		-	6 or elsewhere in Indiana, protect members of the United States
892		-	7 Armed Forces from;
893		-	8 dishonest or predatory insurance practices.
894		-	9 SECTION 14. An emergency is declared for this act.
895		-	HB 1327—LS 6888/DI 141 22
896		-	COMMITTEE REPORT
897		-	Mr. Speaker: Your Committee on Public Health, to which was
898		-	referred House Bill 1327, has had the same under consideration and
899		-	begs leave to report the same back to the House with the
900		-	recommendation that said bill be amended as follows:
901		-	Page 1, line 5, delete "IC 16-19-18-7," and insert "IC 16-19-18-5,".
902		-	Page 1, line 5, after "IC 16-21-6-3," insert "IC 25-22.5-18-5,
903		-	IC 27-1-4.5-7,".
904		-	Page 2, delete lines 15 through 30, begin a new paragraph and
905		-	insert:
906		-	"SECTION 3. IC 16-18-2-282.3 IS ADDED TO THE INDIANA
907		-	CODE AS A NEW SECTION TO READ AS FOLLOWS
908		-	[EFFECTIVE UPON PASSAGE]: Sec. 282.3. "Physician group
909		-	practice", for purposes of IC 16-19-18, has the meaning set forth
910		-	in IC 16-19-18-2.".
911		-	Page 2, line 34, delete "or Controlling Interest" and insert
912		-	"Information".
913		-	Page 2, delete lines 37 through 42.
914		-	Delete page 3.
915		-	Page 4, delete lines 1 through 3, begin a new paragraph and insert:
916		-	"Sec. 2. As used in this chapter, "physician group practice"
917		-	means a physician practice that:
918		-	(1) has at least one (1) physical location in Indiana; and
919		-	(2) includes as practitioners two (2) or more physicians
920		-	licensed under IC 25-22.5, regardless of the ownership
921		-	structure of the practice.
922		-	Sec. 3. (a) Before July 1, 2024, and each July 1 thereafter, each
923		-	hospital that does business in Indiana shall file with the state
924		-	department a report that includes the following information:
925		-	(1) The name of each person or entity that has:
926		-	(A) an ownership interest of at least five percent (5%);
927		-	(B) a controlling interest; or
928		-	(C) an interest as a private equity partner;
929		-	in the hospital.
930		-	(2) The business address of each person or entity identified
931		-	under subdivision (1). The business address must include a:
932		-	(A) building number;
933		-	(B) street name;
934		-	(C) city name;
935		-	(D) zip code; and
936		-	(E) country name.
937		-	The business address may not include a post office box
938		-	HB 1327—LS 6888/DI 141 23
939		-	number.
940		-	(3) The business website, if applicable, of each person or
941		-	entity identified under subdivision (1).
942		-	(4) Any of the following identification numbers, if applicable,
943		-	for a person or entity identified under subdivision (1):
944		-	(A) National provider identifier (NPI).
945		-	(B) Taxpayer identification number (TIN).
946		-	(C) Employer identification number (EIN).
947		-	(D) CMS certification number (CCN).
948		-	(E) National Association of Insurance Commissioners
949		-	(NAIC) identification number.
950		-	(F) A personal identification number associated with a
951		-	license issued by the department of insurance.
952		-	A report provided under this section may not include the
953		-	Social Security number of any individual.
954		-	(b) The state department may not charge a fee for a report
955		-	submitted under this section.
956		-	Sec. 4. (a) The state department shall cooperate with the Indiana
957		-	professional licensing agency and the department of insurance to
958		-	develop and implement a plan to:
959		-	(1) collect the information described in section 3 of this
960		-	chapter, IC 25-22.5-18-3, and IC 27-1-4.5-5; and
961		-	(2) make the information publicly available as set forth in this
962		-	section.
963		-	(b) Before December 1 of each year, the state department shall
964		-	publicly post the information:
965		-	(1) collected under section 3 of this chapter; and
966		-	(2) received from the:
967		-	(A) Indiana professional licensing agency under
968		-	IC 25-22.5-18-4; or
969		-	(B) department of insurance under IC 27-1-4.5-6;
970		-	on the state department's website.
971		-	Sec. 5. (a) The state department may assess a hospital that
972		-	violates section 3 of this chapter a fine of one thousand dollars
973		-	($1,000) per day for which the report is past due.".
974		-	Page 4, between lines 5 and 6, begin a new paragraph and insert:
975		-	"(c) The state department may waive a fine assessed under this
976		-	section.".
977		-	Page 4, line 6, delete "(c)" and insert "(d)".
978		-	Page 4, line 7, delete "5" and insert "3".
979		-	Page 4, delete lines 9 through 40, begin a new paragraph and insert:
980		-	"Sec. 6. (a) Before December 1 of each year, the state
981		-	HB 1327—LS 6888/DI 141 24
982		-	department shall submit to the legislative council an annual report
983		-	of the:
984		-	(1) violations assessed; and
985		-	(2) fines waived;
986		-	under section 5 of this chapter in the previous calendar year.
987		-	(b) A report described in this section must be submitted in an
988		-	electronic format under IC 5-14-6.
989		-	Sec. 7. (a) Before July 1, 2024, the state department shall issue
990		-	a notice or bulletin on at least two (2) occasions to notify hospitals
991		-	of the reporting requirements set forth in this chapter.
992		-	(b) A notice or bulletin issued under this section must be posted
993		-	on the state department's website in a manner that is easily
994		-	accessible to hospitals.
995		-	SECTION 5. IC 25-22.5-18 IS ADDED TO THE INDIANA CODE
996		-	AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
997		-	UPON PASSAGE]:
998		-	Chapter 18. Disclosure of Ownership Information
999		-	Sec. 1. As used in this chapter, "controlling" has the meaning set
1000		-	forth in IC 23-1-43-8.
1001		-	Sec. 2. As used in this chapter, "physician group practice"
1002		-	means a physician practice that:
1003		-	(1) has at least one (1) physical location in Indiana; and
1004		-	(2) includes as practitioners two (2) or more physicians
1005		-	licensed under this article, regardless of the ownership
1006		-	structure of the practice.
1007		-	Sec. 3. (a) Before July 1, 2024, and each July 1 thereafter, each
1008		-	physician group practice that does business in Indiana shall file
1009		-	with the agency a report that includes the following information:
1010		-	(1) The name of each person or entity that has:
1011		-	(A) an ownership interest of at least five percent (5%);
1012		-	(B) a controlling interest; or
1013		-	(C) an interest as a private equity partner;
1014		-	in the physician group practice.
1015		-	(2) The business address of each person or entity identified
1016		-	under subdivision (1). The business address must include a:
1017		-	(A) building number;
1018		-	(B) street name;
1019		-	(C) city name;
1020		-	(D) zip code; and
1021		-	(E) country name.
1022		-	The business address may not include a post office box
1023		-	number.
1024		-	HB 1327—LS 6888/DI 141 25
1025		-	(3) The business website, if applicable, of each person or
1026		-	entity identified under subdivision (1).
1027		-	(4) Any of the following identification numbers, if applicable,
1028		-	for a person or entity identified under subdivision (1):
1029		-	(A) National provider identifier (NPI).
1030		-	(B) Taxpayer identification number (TIN).
1031		-	(C) Employer identification number (EIN).
1032		-	(D) CMS certification number (CCN).
1033		-	(E) National Association of Insurance Commissioners
1034		-	(NAIC) identification number.
1035		-	(F) A personal identification number associated with a
1036		-	license issued by the department of insurance.
1037		-	A report provided under this section may not include the
1038		-	Social Security number of any individual.
1039		-	(b) The agency may not charge a fee for a report submitted
1040		-	under this section.
1041		-	Sec. 4. (a) The agency shall cooperate with the Indiana
1042		-	department of health and the department of insurance to develop
1043		-	and implement a plan to:
1044		-	(1) collect the information described in section 3 of this
1045		-	chapter, IC 16-19-18-3, and IC 27-1-4.5-5; and
1046		-	(2) make the information publicly available as set forth in
1047		-	IC 16-19-18-4.
1048		-	(b) Before September 1 of each year, the agency shall provide
1049		-	the information collected under section 3 of this chapter to the
1050		-	Indiana department of health.
1051		-	Sec. 5. (a) The agency may assess a physician group practice
1052		-	that:
1053		-	(1) has more than five (5) physicians as practitioners in the
1054		-	physician group practice; and
1055		-	(2) violates section 3 of this chapter;
1056		-	a fine of one thousand dollars ($1,000) per day for which the report
1057		-	is past due.
1058		-	(b) The agency may assess a physician group practice that:
1059		-	(1) has five (5) physicians or less as practitioners in the
1060		-	physician group practice; and
1061		-	(2) violates section 3 of this chapter;
1062		-	a fine of one hundred dollars ($100) per day for which the report
1063		-	is past due. A fine assessed under this subsection may not exceed
1064		-	ten thousand dollars ($10,000) in a calendar year.
1065		-	(c) A fine under this section shall be deposited into the payer
1066		-	affordability penalty fund established by IC 12-15-1-18.5.
1067		-	HB 1327—LS 6888/DI 141 26
1068		-	(d) The agency may waive a fine assessed under this section.
1069		-	(e) The board may take disciplinary action against a licensee for
1070		-	repeated violations of section 3 of this chapter.
1071		-	Sec. 6. (a) Before December 1 of each year, the agency shall
1072		-	submit to the legislative council an annual report of the:
1073		-	(1) violations assessed; and
1074		-	(2) fines waived;
1075		-	under section 5 of this chapter in the previous calendar year.
1076		-	(b) A report described in this section must be submitted in an
1077		-	electronic format under IC 5-14-6.
1078		-	Sec. 7. (a) Before July 1, 2024, the agency shall issue a notice or
1079		-	bulletin on at least two (2) occasions to notify physician group
1080		-	practices of the reporting requirements set forth in this chapter.
1081		-	(b) A notice or bulletin issued under this section must be posted
1082		-	on the agency's website in a manner that is easily accessible to
1083		-	physician group practices.
1084		-	SECTION 6. IC 27-1-4.5 IS ADDED TO THE INDIANA CODE
1085		-	AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
1086		-	UPON PASSAGE]:
1087		-	Chapter 4.5. Disclosure of Ownership Information
1088		-	Sec. 1. As used in this chapter, "controlling" has the meaning set
1089		-	forth in IC 23-1-43-8.
1090		-	Sec. 2. As used in this chapter, "insurer" includes the following:
1091		-	(1) An insurer (as defined in IC 27-1-2-3(x)) that issues a
1092		-	policy of accident and sickness insurance (as defined in
1093		-	IC 27-8-5-1(a)). However, the term does not include the
1094		-	coverages described in IC 27-8-5-2.5(a).
1095		-	(2) A health maintenance organization (as defined in
1096		-	IC 27-13-1-19) that provides coverage for basic health care
1097		-	services (as defined in IC 27-13-1-4).
1098		-	(3) A managed care organization (as defined in
1099		-	IC 12-7-2-126.9) that provides services to a Medicaid
1100		-	recipient.
1101		-	(4) A prepaid health care delivery plan under IC 5-10-8-7(c)
1102		-	that provides group health coverage for state employees.
1103		-	Sec. 3. As used in this chapter, "pharmacy benefit manager" has
1104		-	the meaning set forth in IC 27-1-24.5-12.
1105		-	Sec. 4. As used in this chapter, "third party administrator"
1106		-	means an individual or entity that performs administrative services
1107		-	for an insurer or a self-funded health benefit plan, including:
1108		-	(1) a self-funded health benefit plan that complies with the
1109		-	federal Employee Retirement Income Security Act (ERISA)
1110		-	HB 1327—LS 6888/DI 141 27
1111		-	of 1974 (29 U.S.C. 1001 et seq.); and
1112		-	(2) a self-insurance program established under IC 5-10-8-7(b).
1113		-	Sec. 5. (a) Before July 1, 2024, and each July 1 thereafter, each
1114		-	insurer, third party administrator, and pharmacy benefit manager
1115		-	that does business in Indiana shall file with the department a
1116		-	report that includes the following information:
1117		-	(1) The name of each person or entity that has:
1118		-	(A) an ownership interest of at least five percent (5%);
1119		-	(B) a controlling interest; or
1120		-	(C) an interest as a private equity partner;
1121		-	in the insurer, third party administrator, or pharmacy benefit
1122		-	manager.
1123		-	(2) The business address of each person or entity identified
1124		-	under subdivision (1). The business address must include a:
1125		-	(A) building number;
1126		-	(B) street name;
1127		-	(C) city name;
1128		-	(D) zip code; and
1129		-	(E) country name.
1130		-	The business address may not include a post office box
1131		-	number.
1132		-	(3) The business website, if applicable, of each person or
1133		-	entity identified under subdivision (1).
1134		-	(4) Any of the following identification numbers, if applicable,
1135		-	for a person or entity identified under subdivision (1):
1136		-	(A) National provider identifier (NPI).
1137		-	(B) Taxpayer identification number (TIN).
1138		-	(C) Employer identification number (EIN).
1139		-	(D) CMS certification number (CCN).
1140		-	(E) National Association of Insurance Commissioners
1141		-	(NAIC) identification number.
1142		-	(F) A personal identification number associated with a
1143		-	license issued by the department of insurance.
1144		-	A report provided under this section may not include the
1145		-	Social Security number of any individual.
1146		-	(b) The department may not charge a fee for a report submitted
1147		-	under this section.
1148		-	Sec. 6. (a) The department shall cooperate with the Indiana
1149		-	department of health and the Indiana professional licensing agency
1150		-	to develop and implement a plan to:
1151		-	(1) collect the information described in section 5 of this
1152		-	chapter, IC 16-19-18-3, and IC 25-22.5-18-3; and
1153		-	HB 1327—LS 6888/DI 141 28
1154		-	(2) make the information publicly available as set forth in
1155		-	IC 16-19-18-4.
1156		-	(b) Before September 1 of each year, the department shall
1157		-	provide the information collected under section 5 of this chapter to
1158		-	the Indiana department of health.
1159		-	Sec. 7. (a) The department may assess:
1160		-	(1) an insurer;
1161		-	(2) a third party administrator; or
1162		-	(3) a pharmacy benefit manager;
1163		-	that violates section 5 of this chapter a fine of one thousand dollars
1164		-	($1,000) per day for which the report is past due.
1165		-	(b) A fine under this section shall be deposited into the payer
1166		-	affordability penalty fund established by IC 12-15-1-18.5.
1167		-	(c) The department may waive a fine assessed under this section.
1168		-	(d) The department may take disciplinary action against:
1169		-	(1) an insurer;
1170		-	(2) a third party administrator; or
1171		-	(3) a pharmacy benefit manager;
1172		-	that is licensed under this title for repeated violations of section 5
1173		-	of this chapter.
1174		-	Sec. 8. (a) Before December 1 of each year, the department shall
1175		-	submit to the legislative council an annual report of the:
1176		-	(1) violations assessed; and
1177		-	(2) fines waived;
1178		-	under section 7 of this chapter in the previous calendar year.
1179		-	(b) A report described in this section must be submitted in an
1180		-	electronic format under IC 5-14-6.
1181		-	Sec. 9. (a) Before July 1, 2024, the department shall issue a
1182		-	notice or bulletin on at least two (2) occasions to notify insurers,
1183		-	third party administrators, and pharmacy benefit managers of the
1184		-	reporting requirements set forth in this chapter.
1185		-	(b) A notice or bulletin issued under this section must be posted
1186		-	on the department's website in a manner that is easily accessible to
1187		-	insurers, third party administrators, and pharmacy benefit
1188		-	managers.".
1189		-	Page 5, line 4, delete "a health plan".
1190		-	Page 5, line 5, delete "or".
1191		-	Page 5, delete lines 15 through 20.
1192		-	Page 5, line 25, reset in roman "at least".
1193		-	Page 5, line 25, delete "up to".
1194		-	Page 5, line 25, strike "one (1) time" and insert "two (2) times".
1195		-	Page 5, line 25, reset in roman "in a calendar year,".
1196		-	HB 1327—LS 6888/DI 141 29
1197		-	Page 5, line 25, delete "each quarter,".
1198		-	Page 5, delete lines 28 through 42, begin a new line block indented
1199		-	and insert:
1200		-	"(1) Rebate amounts secured on prescription drugs, whether
1201		-	product specific or general rebates, that were provided by a
1202		-	pharmaceutical manufacturer. The information provided under
1203		-	this subdivision must identify the prescription drugs by
1204		-	therapeutic category. and
1205		-	(2) Pharmaceutical and device claims received by the
1206		-	pharmacy benefit manager on any of the following:
1207		-	(A) The CMS-1500 form or its successor form.
1208		-	(B) The HCFA-1500 form or its successor form.
1209		-	(C) The HIPAA X12 837P electronic claims transaction for
1210		-	professional services, or its successor transaction.
1211		-	(D) The HIPAA X12 837I institutional form or its
1212		-	successor form.
1213		-	(E) The CMS-1450 form or its successor form.
1214		-	(F) The UB-04 form or its successor form.
1215		-	The forms or transaction may be modified only as necessary
1216		-	to comply with the federal Health Insurance Portability and
1217		-	Accountability Act (HIPAA) (P.L. 104-191).
1218		-	(3) Pharmaceutical and device claims payments or electronic
1219		-	funds transfer or remittance advice notices provided by the
1220		-	pharmacy benefit manager as ASC X12N 835 files or a
1221		-	successor format. The files may be modified only as necessary
1222		-	to comply with the federal Health Insurance Portability and
1223		-	Accountability Act (HIPAA) (P.L. 104-191). In the event that
1224		-	paper claims are provided, the pharmacy benefit manager
1225		-	shall convert the paper claims to the ASC X12N 835 electronic
1226		-	format or a successor format.
1227		-	(4) Any other revenue and fees derived by the pharmacy benefit
1228		-	manager from the contract, including all direct and indirect
1229		-	remuneration from pharmaceutical manufacturers regardless
1230		-	of whether the remuneration is classified as a rebate, fee, or
1231		-	another term.
1232		-	(b) A contract pharmacy benefit manager may not contain
1233		-	provisions that impose:
1234		-	(1) unreasonable fees for:
1235		-	(A) requesting an audit under this section; or
1236		-	(B) selecting an auditor other than an auditor designated
1237		-	by the pharmacy benefit manager;
1238		-	(2) conditions that would severely restrict a party's contract
1239		-	HB 1327—LS 6888/DI 141 30
1240		-	holder's right to conduct an audit under this subsection, section,
1241		-	including restrictions on the:
1242		-	(A) time period of the audit;
1243		-	(B) number of claims analyzed;
1244		-	(C) type of analysis conducted;
1245		-	(D) data elements used in the analysis; or
1246		-	(E) selection of an auditor as long as the auditor is a
1247		-	professional with contract auditing experience.".
1248		-	Page 6, delete lines 1 through 22.
1249		-	Page 7, line 8, delete "fifteen (15)" and insert "twenty (20)".
1250		-	Page 7, delete lines 13 through 42.
1251		-	Page 8, delete lines 1 through 10.
1252		-	Page 9, between lines 3 and 4, begin a new paragraph and insert:
1253		-	"(c) Any claims data provided under this section must be
1254		-	provided in accordance with the federal Health Insurance
1255		-	Portability and Accountability Act (HIPAA) (P.L. 104-191).".
1256		-	Page 9, line 13, delete "up to one (1) time each quarter," and insert
1257		-	"at least two (2) times in a calendar year,".
1258		-	Page 9, delete lines 19 through 33, begin a new line block indented
1259		-	and insert:
1260		-	"(2) Claims received by the third party administrator,
1261		-	managed care organization, or prepaid health care delivery
1262		-	plan on any of the following:
1263		-	(A) The CMS-1500 form or its successor form.
1264		-	(B) The HCFA-1500 form or its successor form.
1265		-	(C) The HIPAA X12 837P electronic claims transaction for
1266		-	professional services, or its successor transaction.
1267		-	(D) The HIPAA X12 837I institutional form or its
1268		-	successor form.
1269		-	(E) The CMS-1450 form or its successor form.
1270		-	(F) The UB-04 form or its successor form.
1271		-	The forms or transaction may be modified only as necessary
1272		-	to comply with the federal Health Insurance Portability and
1273		-	Accountability Act (HIPAA) (P.L. 104-191).
1274		-	(3) Claims payments, electronic funds transfer, or remittance
1275		-	advice notices provided by the third party administrator,
1276		-	managed care organization, or prepaid health care delivery
1277		-	plan as ASC X12N 835 files or a successor format. The files
1278		-	may be modified only as necessary to comply with the federal
1279		-	Health Insurance Portability and Accountability Act (HIPAA)
1280		-	(P.L. 104-191). In the event that paper claims are provided,
1281		-	the third party administrator, managed care organization, or
1282		-	HB 1327—LS 6888/DI 141 31
1283		-	prepaid health care delivery plan shall convert the paper
1284		-	claims to the ASC X12N 835 electronic format or a successor
1285		-	format.".
1286		-	Page 9, line 41, delete "for an audit conducted under this section;
1287		-	or" and insert "for:
1288		-	(A) requesting an audit under this section; or
1289		-	(B) selecting an auditor other than an auditor designated
1290		-	by the third party administrator, managed care
1291		-	organization, or prepaid health care delivery plan; or".
1292		-	Page 10, line 6, delete "auditor." and insert "auditor, as long as the
1293		-	auditor is a professional with contract auditing experience.".
1294		-	Page 10, line 11, delete "fifteen (15)" and insert "twenty (20)".
1295		-	Renumber all SECTIONS consecutively.
1296		-	and when so amended that said bill do pass.
1297		-	(Reference is to HB 1327 as introduced.)
1298		-	BARRETT
1299		-	Committee Vote: yeas 10, nays 0.
1300		-	HB 1327—LS 6888/DI 141
	432	+	16 (e) A contract that is entered into, issued, amended, or renewed
	433	+	17 after June 30, 2024, may not contain a provision that violates this
	434	+	18 section.
	435	+	19 (f) A violation of this section is an unfair or deceptive act or
	436	+	20 practice in the business of insurance under IC 27-4-1-4.
	437	+	21 (g) The department may also adopt rules under IC 4-22-2 to set
	438	+	22 forth fines for a violation under this section.
	439	+	23 SECTION 15. IC 27-4-1-4, AS AMENDED BY P.L.56-2023,
	440	+	24 SECTION 244, IS AMENDED TO READ AS FOLLOWS
	441	+	25 [EFFECTIVE JULY 1, 2024]: Sec. 4. (a) The following are hereby
	442	+	26 defined as unfair methods of competition and unfair and deceptive acts
	443	+	27 and practices in the business of insurance:
	444	+	28 (1) Making, issuing, circulating, or causing to be made, issued, or
	445	+	29 circulated, any estimate, illustration, circular, or statement:
	446	+	30 (A) misrepresenting the terms of any policy issued or to be
	447	+	31 issued or the benefits or advantages promised thereby or the
	448	+	32 dividends or share of the surplus to be received thereon;
	449	+	33 (B) making any false or misleading statement as to the
	450	+	34 dividends or share of surplus previously paid on similar
	451	+	35 policies;
	452	+	36 (C) making any misleading representation or any
	453	+	37 misrepresentation as to the financial condition of any insurer,
	454	+	38 or as to the legal reserve system upon which any life insurer
	455	+	39 operates;
	456	+	40 (D) using any name or title of any policy or class of policies
	457	+	41 misrepresenting the true nature thereof; or
	458	+	42 (E) making any misrepresentation to any policyholder insured
	459	+	2024 IN 1327—LS 6888/DI 141 11
	460	+	1 in any company for the purpose of inducing or tending to
	461	+	2 induce such policyholder to lapse, forfeit, or surrender the
	462	+	3 policyholder's insurance.
	463	+	4 (2) Making, publishing, disseminating, circulating, or placing
	464	+	5 before the public, or causing, directly or indirectly, to be made,
	465	+	6 published, disseminated, circulated, or placed before the public,
	466	+	7 in a newspaper, magazine, or other publication, or in the form of
	467	+	8 a notice, circular, pamphlet, letter, or poster, or over any radio or
	468	+	9 television station, or in any other way, an advertisement,
	469	+	10 announcement, or statement containing any assertion,
	470	+	11 representation, or statement with respect to any person in the
	471	+	12 conduct of the person's insurance business, which is untrue,
	472	+	13 deceptive, or misleading.
	473	+	14 (3) Making, publishing, disseminating, or circulating, directly or
	474	+	15 indirectly, or aiding, abetting, or encouraging the making,
	475	+	16 publishing, disseminating, or circulating of any oral or written
	476	+	17 statement or any pamphlet, circular, article, or literature which is
	477	+	18 false, or maliciously critical of or derogatory to the financial
	478	+	19 condition of an insurer, and which is calculated to injure any
	479	+	20 person engaged in the business of insurance.
	480	+	21 (4) Entering into any agreement to commit, or individually or by
	481	+	22 a concerted action committing any act of boycott, coercion, or
	482	+	23 intimidation resulting or tending to result in unreasonable
	483	+	24 restraint of, or a monopoly in, the business of insurance.
	484	+	25 (5) Filing with any supervisory or other public official, or making,
	485	+	26 publishing, disseminating, circulating, or delivering to any person,
	486	+	27 or placing before the public, or causing directly or indirectly, to
	487	+	28 be made, published, disseminated, circulated, delivered to any
	488	+	29 person, or placed before the public, any false statement of
	489	+	30 financial condition of an insurer with intent to deceive. Making
	490	+	31 any false entry in any book, report, or statement of any insurer
	491	+	32 with intent to deceive any agent or examiner lawfully appointed
	492	+	33 to examine into its condition or into any of its affairs, or any
	493	+	34 public official to which such insurer is required by law to report,
	494	+	35 or which has authority by law to examine into its condition or into
	495	+	36 any of its affairs, or, with like intent, willfully omitting to make a
	496	+	37 true entry of any material fact pertaining to the business of such
	497	+	38 insurer in any book, report, or statement of such insurer.
	498	+	39 (6) Issuing or delivering or permitting agents, officers, or
	499	+	40 employees to issue or deliver, agency company stock or other
	500	+	41 capital stock, or benefit certificates or shares in any common law
	501	+	42 corporation, or securities or any special or advisory board
	502	+	2024 IN 1327—LS 6888/DI 141 12
	503	+	1 contracts or other contracts of any kind promising returns and
	504	+	2 profits as an inducement to insurance.
	505	+	3 (7) Making or permitting any of the following:
	506	+	4 (A) Unfair discrimination between individuals of the same
	507	+	5 class and equal expectation of life in the rates or assessments
	508	+	6 charged for any contract of life insurance or of life annuity or
	509	+	7 in the dividends or other benefits payable thereon, or in any
	510	+	8 other of the terms and conditions of such contract. However,
	511	+	9 in determining the class, consideration may be given to the
	512	+	10 nature of the risk, plan of insurance, the actual or expected
	513	+	11 expense of conducting the business, or any other relevant
	514	+	12 factor.
	515	+	13 (B) Unfair discrimination between individuals of the same
	516	+	14 class involving essentially the same hazards in the amount of
	517	+	15 premium, policy fees, assessments, or rates charged or made
	518	+	16 for any policy or contract of accident or health insurance or in
	519	+	17 the benefits payable thereunder, or in any of the terms or
	520	+	18 conditions of such contract, or in any other manner whatever.
	521	+	19 However, in determining the class, consideration may be given
	522	+	20 to the nature of the risk, the plan of insurance, the actual or
	523	+	21 expected expense of conducting the business, or any other
	524	+	22 relevant factor.
	525	+	23 (C) Excessive or inadequate charges for premiums, policy
	526	+	24 fees, assessments, or rates, or making or permitting any unfair
	527	+	25 discrimination between persons of the same class involving
	528	+	26 essentially the same hazards, in the amount of premiums,
	529	+	27 policy fees, assessments, or rates charged or made for:
	530	+	28 (i) policies or contracts of reinsurance or joint reinsurance,
	531	+	29 or abstract and title insurance;
	532	+	30 (ii) policies or contracts of insurance against loss or damage
	533	+	31 to aircraft, or against liability arising out of the ownership,
	534	+	32 maintenance, or use of any aircraft, or of vessels or craft,
	535	+	33 their cargoes, marine builders' risks, marine protection and
	536	+	34 indemnity, or other risks commonly insured under marine,
	537	+	35 as distinguished from inland marine, insurance; or
	538	+	36 (iii) policies or contracts of any other kind or kinds of
	539	+	37 insurance whatsoever.
	540	+	38 However, nothing contained in clause (C) shall be construed to
	541	+	39 apply to any of the kinds of insurance referred to in clauses (A)
	542	+	40 and (B) nor to reinsurance in relation to such kinds of insurance.
	543	+	41 Nothing in clause (A), (B), or (C) shall be construed as making or
	544	+	42 permitting any excessive, inadequate, or unfairly discriminatory
	545	+	2024 IN 1327—LS 6888/DI 141 13
	546	+	1 charge or rate or any charge or rate determined by the department
	547	+	2 or commissioner to meet the requirements of any other insurance
	548	+	3 rate regulatory law of this state.
	549	+	4 (8) Except as otherwise expressly provided by IC 27-1-47 or
	550	+	5 another law, knowingly permitting or offering to make or making
	551	+	6 any contract or policy of insurance of any kind or kinds
	552	+	7 whatsoever, including but not in limitation, life annuities, or
	553	+	8 agreement as to such contract or policy other than as plainly
	554	+	9 expressed in such contract or policy issued thereon, or paying or
	555	+	10 allowing, or giving or offering to pay, allow, or give, directly or
	556	+	11 indirectly, as inducement to such insurance, or annuity, any rebate
	557	+	12 of premiums payable on the contract, or any special favor or
	558	+	13 advantage in the dividends, savings, or other benefits thereon, or
	559	+	14 any valuable consideration or inducement whatever not specified
	560	+	15 in the contract or policy; or giving, or selling, or purchasing or
	561	+	16 offering to give, sell, or purchase as inducement to such insurance
	562	+	17 or annuity or in connection therewith, any stocks, bonds, or other
	563	+	18 securities of any insurance company or other corporation,
	564	+	19 association, limited liability company, or partnership, or any
	565	+	20 dividends, savings, or profits accrued thereon, or anything of
	566	+	21 value whatsoever not specified in the contract. Nothing in this
	567	+	22 subdivision and subdivision (7) shall be construed as including
	568	+	23 within the definition of discrimination or rebates any of the
	569	+	24 following practices:
	570	+	25 (A) Paying bonuses to policyholders or otherwise abating their
	571	+	26 premiums in whole or in part out of surplus accumulated from
	572	+	27 nonparticipating insurance, so long as any such bonuses or
	573	+	28 abatement of premiums are fair and equitable to policyholders
	574	+	29 and for the best interests of the company and its policyholders.
	575	+	30 (B) In the case of life insurance policies issued on the
	576	+	31 industrial debit plan, making allowance to policyholders who
	577	+	32 have continuously for a specified period made premium
	578	+	33 payments directly to an office of the insurer in an amount
	579	+	34 which fairly represents the saving in collection expense.
	580	+	35 (C) Readjustment of the rate of premium for a group insurance
	581	+	36 policy based on the loss or expense experience thereunder, at
	582	+	37 the end of the first year or of any subsequent year of insurance
	583	+	38 thereunder, which may be made retroactive only for such
	584	+	39 policy year.
	585	+	40 (D) Paying by an insurer or insurance producer thereof duly
	586	+	41 licensed as such under the laws of this state of money,
	587	+	42 commission, or brokerage, or giving or allowing by an insurer
	588	+	2024 IN 1327—LS 6888/DI 141 14
	589	+	1 or such licensed insurance producer thereof anything of value,
	590	+	2 for or on account of the solicitation or negotiation of policies
	591	+	3 or other contracts of any kind or kinds, to a broker, an
	592	+	4 insurance producer, or a solicitor duly licensed under the laws
	593	+	5 of this state, but such broker, insurance producer, or solicitor
	594	+	6 receiving such consideration shall not pay, give, or allow
	595	+	7 credit for such consideration as received in whole or in part,
	596	+	8 directly or indirectly, to the insured by way of rebate.
	597	+	9 (9) Requiring, as a condition precedent to loaning money upon the
	598	+	10 security of a mortgage upon real property, that the owner of the
	599	+	11 property to whom the money is to be loaned negotiate any policy
	600	+	12 of insurance covering such real property through a particular
	601	+	13 insurance producer or broker or brokers. However, this
	602	+	14 subdivision shall not prevent the exercise by any lender of the
	603	+	15 lender's right to approve or disapprove of the insurance company
	604	+	16 selected by the borrower to underwrite the insurance.
	605	+	17 (10) Entering into any contract, combination in the form of a trust
	606	+	18 or otherwise, or conspiracy in restraint of commerce in the
	607	+	19 business of insurance.
	608	+	20 (11) Monopolizing or attempting to monopolize or combining or
	609	+	21 conspiring with any other person or persons to monopolize any
	610	+	22 part of commerce in the business of insurance. However,
	611	+	23 participation as a member, director, or officer in the activities of
	612	+	24 any nonprofit organization of insurance producers or other
	613	+	25 workers in the insurance business shall not be interpreted, in
	614	+	26 itself, to constitute a combination in restraint of trade or as
	615	+	27 combining to create a monopoly as provided in this subdivision
	616	+	28 and subdivision (10). The enumeration in this chapter of specific
	617	+	29 unfair methods of competition and unfair or deceptive acts and
	618	+	30 practices in the business of insurance is not exclusive or
	619	+	31 restrictive or intended to limit the powers of the commissioner or
	620	+	32 department or of any court of review under section 8 of this
	621	+	33 chapter.
	622	+	34 (12) Requiring as a condition precedent to the sale of real or
	623	+	35 personal property under any contract of sale, conditional sales
	624	+	36 contract, or other similar instrument or upon the security of a
	625	+	37 chattel mortgage, that the buyer of such property negotiate any
	626	+	38 policy of insurance covering such property through a particular
	627	+	39 insurance company, insurance producer, or broker or brokers.
	628	+	40 However, this subdivision shall not prevent the exercise by any
	629	+	41 seller of such property or the one making a loan thereon of the
	630	+	42 right to approve or disapprove of the insurance company selected
	631	+	2024 IN 1327—LS 6888/DI 141 15
	632	+	1 by the buyer to underwrite the insurance.
	633	+	2 (13) Issuing, offering, or participating in a plan to issue or offer,
	634	+	3 any policy or certificate of insurance of any kind or character as
	635	+	4 an inducement to the purchase of any property, real, personal, or
	636	+	5 mixed, or services of any kind, where a charge to the insured is
	637	+	6 not made for and on account of such policy or certificate of
	638	+	7 insurance. However, this subdivision shall not apply to any of the
	639	+	8 following:
	640	+	9 (A) Insurance issued to credit unions or members of credit
	641	+	10 unions in connection with the purchase of shares in such credit
	642	+	11 unions.
	643	+	12 (B) Insurance employed as a means of guaranteeing the
	644	+	13 performance of goods and designed to benefit the purchasers
	645	+	14 or users of such goods.
	646	+	15 (C) Title insurance.
	647	+	16 (D) Insurance written in connection with an indebtedness and
	648	+	17 intended as a means of repaying such indebtedness in the
	649	+	18 event of the death or disability of the insured.
	650	+	19 (E) Insurance provided by or through motorists service clubs
	651	+	20 or associations.
	652	+	21 (F) Insurance that is provided to the purchaser or holder of an
	653	+	22 air transportation ticket and that:
	654	+	23 (i) insures against death or nonfatal injury that occurs during
	655	+	24 the flight to which the ticket relates;
	656	+	25 (ii) insures against personal injury or property damage that
	657	+	26 occurs during travel to or from the airport in a common
	658	+	27 carrier immediately before or after the flight;
	659	+	28 (iii) insures against baggage loss during the flight to which
	660	+	29 the ticket relates; or
	661	+	30 (iv) insures against a flight cancellation to which the ticket
	662	+	31 relates.
	663	+	32 (14) Refusing, because of the for-profit status of a hospital or
	664	+	33 medical facility, to make payments otherwise required to be made
	665	+	34 under a contract or policy of insurance for charges incurred by an
	666	+	35 insured in such a for-profit hospital or other for-profit medical
	667	+	36 facility licensed by the Indiana department of health.
	668	+	37 (15) Refusing to insure an individual, refusing to continue to issue
	669	+	38 insurance to an individual, limiting the amount, extent, or kind of
	670	+	39 coverage available to an individual, or charging an individual a
	671	+	40 different rate for the same coverage, solely because of that
	672	+	41 individual's blindness or partial blindness, except where the
	673	+	42 refusal, limitation, or rate differential is based on sound actuarial
	674	+	2024 IN 1327—LS 6888/DI 141 16
	675	+	1 principles or is related to actual or reasonably anticipated
	676	+	2 experience.
	677	+	3 (16) Committing or performing, with such frequency as to
	678	+	4 indicate a general practice, unfair claim settlement practices (as
	679	+	5 defined in section 4.5 of this chapter).
	680	+	6 (17) Between policy renewal dates, unilaterally canceling an
	681	+	7 individual's coverage under an individual or group health
	682	+	8 insurance policy solely because of the individual's medical or
	683	+	9 physical condition.
	684	+	10 (18) Using a policy form or rider that would permit a cancellation
	685	+	11 of coverage as described in subdivision (17).
	686	+	12 (19) Violating IC 27-1-22-25, IC 27-1-22-26, or IC 27-1-22-26.1
	687	+	13 concerning motor vehicle insurance rates.
	688	+	14 (20) Violating IC 27-8-21-2 concerning advertisements referring
	689	+	15 to interest rate guarantees.
	690	+	16 (21) Violating IC 27-8-24.3 concerning insurance and health plan
	691	+	17 coverage for victims of abuse.
	692	+	18 (22) Violating IC 27-8-26 concerning genetic screening or testing.
	693	+	19 (23) Violating IC 27-1-15.6-3(b) concerning licensure of
	694	+	20 insurance producers.
	695	+	21 (24) Violating IC 27-1-38 concerning depository institutions.
	696	+	22 (25) Violating IC 27-8-28-17(c) or IC 27-13-10-8(c) concerning
	697	+	23 the resolution of an appealed grievance decision.
	698	+	24 (26) Violating IC 27-8-5-2.5(e) through IC 27-8-5-2.5(j) (expired
	699	+	25 July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1,
	700	+	26 2007, and repealed).
	701	+	27 (27) Violating IC 27-2-21 concerning use of credit information.
	702	+	28 (28) Violating IC 27-4-9-3 concerning recommendations to
	703	+	29 consumers.
	704	+	30 (29) Engaging in dishonest or predatory insurance practices in
	705	+	31 marketing or sales of insurance to members of the United States
	706	+	32 Armed Forces as:
	707	+	33 (A) described in the federal Military Personnel Financial
	708	+	34 Services Protection Act, P.L.109-290; or
	709	+	35 (B) defined in rules adopted under subsection (b).
	710	+	36 (30) Violating IC 27-8-19.8-20.1 concerning stranger originated
	711	+	37 life insurance.
	712	+	38 (31) Violating IC 27-2-22 concerning retained asset accounts.
	713	+	39 (32) Violating IC 27-8-5-29 concerning health plans offered
	714	+	40 through a health benefit exchange (as defined in IC 27-19-2-8).
	715	+	41 (33) Violating a requirement of the federal Patient Protection and
	716	+	42 Affordable Care Act (P.L. 111-148), as amended by the federal
	717	+	2024 IN 1327—LS 6888/DI 141 17
	718	+	1 Health Care and Education Reconciliation Act of 2010 (P.L.
	719	+	2 111-152), that is enforceable by the state.
	720	+	3 (34) After June 30, 2015, violating IC 27-2-23 concerning
	721	+	4 unclaimed life insurance, annuity, or retained asset account
	722	+	5 benefits.
	723	+	6 (35) Willfully violating IC 27-1-12-46 concerning a life insurance
	724	+	7 policy or certificate described in IC 27-1-12-46(a).
	725	+	8 (36) Violating IC 27-1-37-7 concerning prohibiting the disclosure
	726	+	9 of health care service claims data.
	727	+	10 (37) Violating IC 27-4-10-10 concerning virtual claims payments.
	728	+	11 (38) Violating IC 27-1-24.5 concerning pharmacy benefit
	729	+	12 managers.
	730	+	13 (39) Violating IC 27-7-17-16 or IC 27-7-17-17 concerning the
	731	+	14 marketing of travel insurance policies.
	732	+	15 (40) Violating IC 27-2-25.5-4 concerning audits of a third
	733	+	16 party administrator, managed care organization, or prepaid
	734	+	17 health care delivery plan.
	735	+	18 (b) Except with respect to federal insurance programs under
	736	+	19 Subchapter III of Chapter 19 of Title 38 of the United States Code, the
	737	+	20 commissioner may, consistent with the federal Military Personnel
	738	+	21 Financial Services Protection Act (10 U.S.C. 992 note), adopt rules
	739	+	22 under IC 4-22-2 to:
	740	+	23 (1) define; and
	741	+	24 (2) while the members are on a United States military installation
	742	+	25 or elsewhere in Indiana, protect members of the United States
	743	+	26 Armed Forces from;
	744	+	27 dishonest or predatory insurance practices.
	745	+	28 SECTION 16. An emergency is declared for this act.
	746	+	2024 IN 1327—LS 6888/DI 141