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Indiana Senate Bill SB0147

Indiana 2025 Regular Session

Indiana Senate Bill SB0147 Compare Versions

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1-*SB0147.2*
2-Reprinted
3-February 14, 2025
1+*SB0147.1*
2+January 24, 2025
43 SENATE BILL No. 147
54 _____
6-DIGEST OF SB 147 (Updated February 13, 2025 3:47 pm - DI 154)
5+DIGEST OF SB 147 (Updated January 22, 2025 9:39 am - DI 140)
76 Citations Affected: IC 25-22.5; IC 27-1.
8-Synopsis: Physician referrals and reimbursement rates. Prohibits, in
9-accordance with the federal Stark Law (42 U.S.C. 1395nn), a referring
10-physician from receiving compensation or an incentive from a health
11-care entity or another physician, who is in the same health care network
12-as the referring physician, for referring a patient to the health care
13-entity or other physician. Provides that the attorney general may
14-investigate certain complaints. Provides that the attorney general may
15-cooperate with federal, state, and local law enforcement agencies in the
16-investigation of certain complaints. Provides that the attorney general
17-may take certain actions when conducting an investigation of certain
18-complaints. Requires the all payer claims data base to publish the
19-physician reimbursement rates as a separate line item for each contract
20-instead of in the aggregate.
7+Synopsis: Physician referrals and reimbursement rates. Prohibits a
8+referring physician from receiving compensation or an incentive from
9+a health care entity or another physician, who is in the same health care
10+network as the referring physician, for referring a patient to the health
11+care entity or other physician. Provides that the rules adopted by the
12+department of insurance regarding the all payer claims data base must
13+include a requirement that health payers report physician
14+reimbursement rates for each contract and specify a process for health
15+payers to report the physician reimbursement rates. Requires the all
16+payer claims data base to publish the physician reimbursement rates as
17+a separate line item for each contract instead of in the aggregate.
2118 Effective: July 1, 2025.
22-Busch, Charbonneau, Johnson T,
23-Randolph Lonnie M
19+Busch, Charbonneau, Johnson T
2420 January 8, 2025, read first time and referred to Committee on Health and Provider
2521 Services.
2622 January 23, 2025, reported favorably — Do Pass.
27-January 27, 2025, read second time, ordered engrossed. Engrossed.
28-February 4, 2025, returned to second reading.
29-February 13, 2025, re-read second time, amended, ordered engrossed.
30-SB 147—LS 6335/DI 154 Reprinted
31-February 14, 2025
23+SB 147—LS 6335/DI 154 January 24, 2025
3224 First Regular Session of the 124th General Assembly (2025)
3325 PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
3426 Constitution) is being amended, the text of the existing provision will appear in this style type,
3527 additions will appear in this style type, and deletions will appear in this style type.
3628 Additions: Whenever a new statutory provision is being enacted (or a new constitutional
3729 provision adopted), the text of the new provision will appear in this style type. Also, the
3830 word NEW will appear in that style type in the introductory clause of each SECTION that adds
3931 a new provision to the Indiana Code or the Indiana Constitution.
4032 Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
4133 between statutes enacted by the 2024 Regular Session of the General Assembly.
4234 SENATE BILL No. 147
4335 A BILL FOR AN ACT to amend the Indiana Code concerning
4436 insurance.
4537 Be it enacted by the General Assembly of the State of Indiana:
4638 1 SECTION 1. IC 25-22.5-11-3.5 IS ADDED TO THE INDIANA
4739 2 CODE AS A NEW SECTION TO READ AS FOLLOWS
48-3 [EFFECTIVE JULY 1, 2025]: Sec. 3.5. In accordance with the
49-4 federal Stark Law (42 U.S.C. 1395nn), a referring physician may
50-5 not receive compensation or an incentive from a health care entity
51-6 or another physician, who is in the same health care network as the
52-7 referring physician, for referring a patient to the health care entity
53-8 or other physician.
54-9 SECTION 2. IC 25-22.5-11-3.6 IS ADDED TO THE INDIANA
55-10 CODE AS A NEW SECTION TO READ AS FOLLOWS
56-11 [EFFECTIVE JULY 1, 2025]: Sec. 3.6. The attorney general may do
57-12 the following:
58-13 (1) Investigate complaints of violations of section 3.5 of this
59-14 chapter or the federal Stark Law (42 U.S.C. 1395nn).
60-15 (2) Cooperate with federal, state, and local law enforcement
61-16 agencies in the investigation of a violation of section 3.5 of this
62-17 chapter or the federal Stark Law (42 U.S.C. 1395nn). To the
40+3 [EFFECTIVE JULY 1, 2025]: Sec. 3.5. A referring physician may
41+4 not receive compensation or an incentive from a health care entity
42+5 or another physician, who is in the same health care network as the
43+6 referring physician, for referring a patient to the health care entity
44+7 or other physician.
45+8 SECTION 2. IC 27-1-44.5-8, AS ADDED BY P.L.195-2021,
46+9 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
47+10 JULY 1, 2025]: Sec. 8. The data base must do the following:
48+11 (1) Provide an online, public web portal that is free to use and
49+12 allows the public to view the average negotiated charges by each
50+13 health carrier for specific health care services provided by an
51+14 individual health care provider, as well as the quality metrics for
52+15 facilities and providers for specific health care services. Facilities
53+16 and providers include hospitals, physician groups, ambulatory
54+17 outpatient surgical centers, physical therapy offices, imaging
6355 SB 147—LS 6335/DI 154 2
64-1 extent authorized by federal law, the attorney general may
65-2 enforce compliance with section 3.5 of this chapter or the
66-3 federal Stark Law (42 U.S.C. 1395nn) or refer suspected
67-4 violations of section 3.5 of this chapter or the federal Stark
68-5 Law (42 U.S.C. 1395nn) to the appropriate federal regulatory
69-6 agencies.
70-7 SECTION 3. IC 25-22.5-11-3.7 IS ADDED TO THE INDIANA
71-8 CODE AS A NEW SECTION TO READ AS FOLLOWS
72-9 [EFFECTIVE JULY 1, 2025]: Sec. 3.7. The attorney general may do
73-10 any of the following when conducting an investigation under
74-11 section 3.6 of this chapter:
75-12 (1) Issue and serve a subpoena for the production of records,
76-13 including records stored in electronic data processing systems,
77-14 books, papers, and documents, for inspection by the attorney
78-15 general or an investigator.
79-16 (2) Issue and serve a subpoena for the appearance of a person
80-17 to provide testimony under oath.
81-18 (3) Apply to a court with jurisdiction to enforce a subpoena
82-19 described in subdivision (1) or (2).
83-20 SECTION 4. IC 27-1-44.5-8, AS ADDED BY P.L.195-2021,
84-21 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
85-22 JULY 1, 2025]: Sec. 8. The data base must do the following:
86-23 (1) Provide an online, public web portal that is free to use and
87-24 allows the public to view the average negotiated charges by each
88-25 health carrier for specific health care services provided by an
89-26 individual health care provider, as well as the quality metrics for
90-27 facilities and providers for specific health care services. Facilities
91-28 and providers include hospitals, physician groups, ambulatory
92-29 outpatient surgical centers, physical therapy offices, imaging
93-30 centers, laboratories, infusion clinics, pharmacies, and any other
94-31 location providing health care services.
95-32 (2) Be available to the public as a resource to insurers, consumers,
96-33 employers, providers, purchasers of health care, and state
97-34 agencies to allow for continuous review of health care utilization,
98-35 expenditures, and quality and safety performance in the state.
99-36 (3) Be available to state agencies and private entities in the state
100-37 that are engaged in efforts to improve health care, subject to rules
101-38 adopted by the department.
102-39 (4) Be presented to allow for comparisons of geographic,
103-40 demographic, and economic factors and institutional size.
104-41 (5) Present data in a consumer friendly manner.
105-42 (6) Publish data collected from health payers regarding
56+1 centers, laboratories, infusion clinics, pharmacies, and any other
57+2 location providing health care services.
58+3 (2) Be available to the public as a resource to insurers, consumers,
59+4 employers, providers, purchasers of health care, and state
60+5 agencies to allow for continuous review of health care utilization,
61+6 expenditures, and quality and safety performance in the state.
62+7 (3) Be available to state agencies and private entities in the state
63+8 that are engaged in efforts to improve health care, subject to rules
64+9 adopted by the department.
65+10 (4) Be presented to allow for comparisons of geographic,
66+11 demographic, and economic factors and institutional size.
67+12 (5) Present data in a consumer friendly manner.
68+13 (6) Publish data collected from health payers regarding
69+14 physician reimbursement rates as a separate line item for
70+15 each contract instead of in the aggregate.
71+16 SECTION 3. IC 27-1-44.5-11, AS AMENDED BY P.L.225-2023,
72+17 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
73+18 JULY 1, 2025]: Sec. 11. (a) Except as provided in subsection (c), the
74+19 department shall adopt rules under IC 4-22-2 to implement this chapter.
75+20 The rules must include a requirement that health payer data sources
76+21 submit necessary information to the administrator. Rules enacted under
77+22 this subsection must cover all health payer data sources as follows:
78+23 (1) The department shall adopt rules that apply to health payers
79+24 regulated under IC 27.
80+25 (2) The office of the secretary of family and social services shall
81+26 adopt rules that apply to health payers regulated under IC 12.
82+27 (b) The department shall adopt provisional rules under
83+28 IC 4-22-2-37.1 establishing a fee formula for data licensing and the
84+29 collection and release of claims data.
85+30 (c) The department may adopt rules under IC 4-22-2 concerning the:
86+31 (1) requirement that health payers submit required data under
87+32 section 5 of this chapter; and
88+33 (2) establishment of a fee formula for data licensing, collection,
89+34 and release of claims described in section 9 of this chapter.
90+35 (d) The rules adopted by the department under this section
91+36 must:
92+37 (1) include a requirement that health payers report physician
93+38 reimbursement rates for each contract, including contracts
94+39 with physician groups and individual physicians; and
95+40 (2) specify a process for health payers to report the data
96+41 described in subdivision (1).
97+42 (d) (e) The department may impose a civil penalty on a health payer
10698 SB 147—LS 6335/DI 154 3
107-1 physician reimbursement rates as a separate line item for
108-2 each contract instead of in the aggregate.
99+1 that is required to submit information under this chapter and fails to
100+2 comply. A civil penalty collected under this section must be deposited
101+3 in the department of insurance fund created by IC 27-1-3-28.
109102 SB 147—LS 6335/DI 154 4
110103 COMMITTEE REPORT
111104 Mr. President: The Senate Committee on Health and Provider
112105 Services, to which was referred Senate Bill No. 147, has had the same
113106 under consideration and begs leave to report the same back to the
114107 Senate with the recommendation that said bill DO PASS.
115108 (Reference is to SB 147 as introduced.)
116109
117110 CHARBONNEAU, Chairperson
118111 Committee Vote: Yeas 11, Nays 1
119-_____
120-SENATE MOTION
121-Mr. President: I move that Engrossed Senate Bill 147, which is
122-eligible for third reading, be returned to second reading for purposes of
123-amendment.
124-BUSCH
125-_____
126-SENATE MOTION
127-Mr. President: I move that Senate Bill 147 be amended to read as
128-follows:
129-Page 1, line 3, delete "A referring" and insert "In accordance with
130-the federal Stark Law (42 U.S.C. 1395nn), a referring".
131-Page 1, between lines 7 and 8, begin a new paragraph and insert:
132-"SECTION 2. IC 25-22.5-11-3.6 IS ADDED TO THE INDIANA
133-CODE AS A NEW SECTION TO READ AS FOLLOWS
134-[EFFECTIVE JULY 1, 2025]: Sec. 3.6. The attorney general may do
135-the following:
136-(1) Investigate complaints of violations of section 3.5 of this
137-chapter or the federal Stark Law (42 U.S.C. 1395nn).
138-(2) Cooperate with federal, state, and local law enforcement
139-agencies in the investigation of a violation of section 3.5 of this
140-chapter or the federal Stark Law (42 U.S.C. 1395nn). To the
141-extent authorized by federal law, the attorney general may
142-enforce compliance with section 3.5 of this chapter or the
143-federal Stark Law (42 U.S.C. 1395nn) or refer suspected
144-SB 147—LS 6335/DI 154 5
145-violations of section 3.5 of this chapter or the federal Stark
146-Law (42 U.S.C. 1395nn) to the appropriate federal regulatory
147-agencies.
148-SECTION 3. IC 25-22.5-11-3.7 IS ADDED TO THE INDIANA
149-CODE AS A NEW SECTION TO READ AS FOLLOWS
150-[EFFECTIVE JULY 1, 2025]: Sec. 3.7. The attorney general may do
151-any of the following when conducting an investigation under
152-section 3.6 of this chapter:
153-(1) Issue and serve a subpoena for the production of records,
154-including records stored in electronic data processing systems,
155-books, papers, and documents, for inspection by the attorney
156-general or an investigator.
157-(2) Issue and serve a subpoena for the appearance of a person
158-to provide testimony under oath.
159-(3) Apply to a court with jurisdiction to enforce a subpoena
160-described in subdivision (1) or (2).".
161-Page 2, delete lines 16 through 42.
162-Delete page 3.
163-Renumber all SECTIONS consecutively.
164-(Reference is to SB 147 as printed January 24, 2025.)
165-BUSCH
166112 SB 147—LS 6335/DI 154