A BILL FOR AN ACT to amend the Indiana Code concerning health.

Plain English Breakdown

The official summary does not provide specific details about when these changes will start or how compliance will be ensured, leaving some uncertainty.

Health Care Changes in Indiana

This bill changes health care rules for insurance plans and hospitals in Indiana to improve coverage, reporting requirements, and patient safety.

What This Bill Does

• Removes time limits on how long anesthesia can be used during medical procedures for certain insurance plans.
• Changes what counts as charity care and community benefits that hospitals must report.
• Requires nonprofit hospitals to share more information about their services online.
• Allows doctors to use a new treatment called neuroplastogen for patients with serious conditions, if they meet specific requirements.
• Prevents health insurers from using certain unfair practices when deciding how much to pay for medical treatments.

Who It Names or Affects

• People who have insurance through the state employee plan or Medicaid in Indiana.
• Hospitals that do not make money and must report information about their services.
• Doctors and patients who might use neuroplastogen treatment.
• Health insurers, pharmacies, and other groups involved in managing health care benefits.

Terms To Know

Neuroplastogen

A new medical treatment that can be used for certain serious conditions if doctors follow specific rules.

Downcoding

When a health insurer pays less than what they should for a medical service by changing how it is described in the insurance claim.

Limits and Unknowns

• The bill does not say when exactly these changes will start.
• It's unclear if all hospitals and insurers will follow these new rules without additional guidance or enforcement.

Official Summary Text

A BILL FOR AN ACT to amend the Indiana Code concerning health.
Health care matters.

Current Bill Text

A BILL FOR AN ACT to amend the Indiana Code concerning health.

Health care matters.

Prohibits: (1) the state employee health plan; (2) the Medicaid program; (3) an accident and sickness insurance policy; and (4) a health maintenance organization individual or group contract; from imposing a time limit on the amount of anesthesia time for a medical procedure or otherwise restricting or excluding coverage or payment of anesthesia time. Modifies the definitions of "charity care" and "community benefits" for purposes of certain hospital reporting requirements. Requires additional reporting of information by nonprofit hospitals to the Indiana department of health (state department). Requires the report to be posted on the nonprofit hospital's website and the state department's website. Increases the penalty for failure to file the report and changes the time frame in which the penalty may be assessed. Specifies that any penalty be deposited in the local public health fund. Allows for certain practitioners to provide neuroplastogen treatment concerning qualified patients with life threatening conditions if certain requirements are met. Allows for research to be conducted on neuroplastogen access. Requires reporting of adverse events and annual reporting of patient statistical information concerning the neuroplastogen treatment. Provides for immunity when treating using neuroplastogens. Requires a clinical peer to disclose certain information for a peer to peer review of an adverse determination. Prohibits a utilization review entity from using artificial intelligence as the primary means for making adverse determinations. Prohibits a health insurer from engaging in certain downcoding practices and sets forth conditions for downcoding a claim. Authorizes the department of insurance to enforce the downcoding requirements and impose certain penalties for a violation. Prohibits an insurer, pharmacy benefit manager, or other administrator of pharmacy benefits from designating a prescription drug as a specialty drug unless certain conditions are met.