Indiana 2024 Regular Session

Indiana Senate Bill SB0258 Compare Versions

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

Old	New	Differences
1	1
2	2	Introduced Version
3	3	SENATE BILL No. 258
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 25-22.5-11-3.5; IC 27-1-44.5.
7	7	Synopsis: Physician referrals and reimbursement rates. Prohibits a
8	8	referring physician from receiving compensation or an incentive from
9	9	a health care entity or another physician, who is in the same health care
10	10	network as the referring physician, for referring a patient to the health
11	11	care entity or other physician. Provides that the rules adopted by the
12	12	department of insurance regarding the all payer claims data base must
13	13	include a requirement that health payers report physician
14	14	reimbursement rates for each contract and specify a process for health
15	15	payers to report the physician reimbursement rates. Requires the all
16	16	payer claims data base to publish the physician reimbursement rates as
17	17	a separate line item for each contract instead of in the aggregate.
18	18	Effective: July 1, 2024.
19	19	Busch
20	20	January 16, 2024, read first time and referred to Committee on Health and Provider
21	21	Services.
22	22	2024 IN 258—LS 6861/DI 141 Introduced
23	23	Second Regular Session of the 123rd General Assembly (2024)
24	24	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
25	25	Constitution) is being amended, the text of the existing provision will appear in this style type,
26	26	additions will appear in this style type, and deletions will appear in this style type.
27	27	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
28	28	provision adopted), the text of the new provision will appear in this style type. Also, the
29	29	word NEW will appear in that style type in the introductory clause of each SECTION that adds
30	30	a new provision to the Indiana Code or the Indiana Constitution.
31	31	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
32	32	between statutes enacted by the 2023 Regular Session of the General Assembly.
33	33	SENATE BILL No. 258
34	34	A BILL FOR AN ACT to amend the Indiana Code concerning
35	35	insurance.
36	36	Be it enacted by the General Assembly of the State of Indiana:
37	37	1 SECTION 1. IC 25-22.5-11-3.5 IS ADDED TO THE INDIANA
38	38	2 CODE AS A NEW SECTION TO READ AS FOLLOWS
39	39	3 [EFFECTIVE JULY 1, 2024]: Sec. 3.5. A referring physician may
40	40	4 not receive compensation or an incentive from a health care entity
41	41	5 or another physician, who is in the same health care network as the
42	42	6 referring physician, for referring a patient to the health care entity
43	43	7 or other physician.
44	44	8 SECTION 2. IC 27-1-44.5-8, AS ADDED BY P.L.195-2021,
45	45	9 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
46	46	10 JULY 1, 2024]: Sec. 8. The data base must do the following:
47	47	11 (1) Provide an online, public web portal that is free to use and
48	48	12 allows the public to view the average negotiated charges by each
49	49	13 health carrier for specific health care services provided by an
50	50	14 individual health care provider, as well as the quality metrics for
51	51	15 facilities and providers for specific health care services. Facilities
52	52	16 and providers include hospitals, physician groups, ambulatory
53	53	17 outpatient surgical centers, physical therapy offices, imaging
54	54	2024 IN 258—LS 6861/DI 141 2
55	55	1 centers, laboratories, infusion clinics, pharmacies, and any other
56	56	2 location providing health care services.
57	57	3 (2) Be available to the public as a resource to insurers, consumers,
58	58	4 employers, providers, purchasers of health care, and state
59	59	5 agencies to allow for continuous review of health care utilization,
60	60	6 expenditures, and quality and safety performance in the state.
61	61	7 (3) Be available to state agencies and private entities in the state
62	62	8 that are engaged in efforts to improve health care, subject to rules
63	63	9 adopted by the department.
64	64	10 (4) Be presented to allow for comparisons of geographic,
65	65	11 demographic, and economic factors and institutional size.
66	66	12 (5) Present data in a consumer friendly manner.
67	67	13 (6) Publish data collected from health payers regarding
68	68	14 physician reimbursement rates as a separate line item for
69	69	15 each contract instead of in the aggregate.
70	70	16 SECTION 3. IC 27-1-44.5-11, AS AMENDED BY P.L.225-2023,
71	71	17 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
72	72	18 JULY 1, 2024]: Sec. 11. (a) Except as provided in subsection (c), the
73	73	19 department shall adopt rules under IC 4-22-2 to implement this chapter.
74	74	20 The rules must include a requirement that health payer data sources
75	75	21 submit necessary information to the administrator. Rules enacted under
76	76	22 this subsection must cover all health payer data sources as follows:
77	77	23 (1) The department shall adopt rules that apply to health payers
78	78	24 regulated under IC 27.
79	79	25 (2) The office of the secretary of family and social services shall
80	80	26 adopt rules that apply to health payers regulated under IC 12.
81	81	27 (b) The department shall adopt provisional rules under
82	82	28 IC 4-22-2-37.1 establishing a fee formula for data licensing and the
83	83	29 collection and release of claims data.
84	84	30 (c) The department may adopt rules under IC 4-22-2 concerning the:
85	85	31 (1) requirement that health payers submit required data under
86	86	32 section 5 of this chapter; and
87	87	33 (2) establishment of a fee formula for data licensing, collection,
88	88	34 and release of claims described in section 9 of this chapter.
89	89	35 (d) The rules adopted by the department under this section
90	90	36 must:
91	91	37 (1) include a requirement that health payers report physician
92	92	38 reimbursement rates for each contract, including contracts
93	93	39 with physician groups and individual physicians; and
94	94	40 (2) specify a process for health payers to report the data
95	95	41 described in subdivision (1).
96	96	42 (d) (e) The department may impose a civil penalty on a health payer
97	97	2024 IN 258—LS 6861/DI 141 3
98	98	1 that is required to submit information under this chapter and fails to
99	99	2 comply. A civil penalty collected under this section must be deposited
100	100	3 in the department of insurance fund created by IC 27-1-3-28.
101	101	2024 IN 258—LS 6861/DI 141