*EH1004.1*

February 28, 2020

ENGROSSEDHOUSE BILL No. 1004

_____

DIGEST OF HB 1004 (Updated February 26, 2020 3:19 pm - DI 104)

Citations Affected: IC 12-7; IC 12-15; IC 16-18; IC 16-51; IC 25-1;IC 25-22.5; IC 27-1; IC 27-2; noncode.

Synopsis: Health matters. Requires a provider to include the servicefacility location in order to obtain Medicaid reimbursement from theoffice of the secretary of family and social services or the managed careorganization. Specifies health care billing forms to be used in certainhealth care settings. Requires: (1) a provider facility (including ahospital) in which a nonemergency health care service will beperformed; or (2) a practitioner (including a physician) who mayperform a nonemergency health care service; upon request from theindividual for whom the nonemergency health care service has beenordered, to provide a good faith estimate of the price for thenonemergency health care service not more than five business days

(Continued next page)

Effective: July 1, 2020.

Smaltz, Barrett, Lehman, Carbaugh(SENATE SPONSORS — CHARBONNEAU, BASSLER, BREAUX)

January 6, 2020, read first time and referred to Committee on Insurance.January 23, 2020, amended, reported — Do Pass.January 27, 2020, read second time, ordered engrossed.January 28, 2020, engrossed. Read third time, passed. Yeas 99, nays 0.

SENATE ACTIONFebruary 5, 2020, read first time and referred to Committee on Health and Provider

Services.February 27, 2020, amended, reported favorably — Do Pass.

EH 1004—LS 7088/DI 104

Digest Continued

after receiving information for the request from the individual.Provides that a facility that is an in network provider or a practitionerwho provides health care services in the in network facility may notcharge more for the health care services provided to a coveredindividual than allowed according to the rate or amount ofcompensation established by the network plan unless: (1) at least fivedays before the health care services are scheduled to be provided, thecovered individual is provided a statement that: (A) informs thecovered individual that the facility or practitioner intends to chargemore than allowed under the network plan; and (B) sets forth anestimate of the charge; and (2) the covered individual signs thestatement, signifying the covered individual's consent to the charge. Prohibits employment contracts between employers and practitioneremployees to include non-compete agreements. Provides forinformation and notification that an employer must give to a physicianwho leaves the employment of the provider.

EH 1004—LS 7088/DI 104EH 1004—LS 7088/DI 104

February 28, 2020

Second Regular Session of the 121st General Assembly (2020)

PRINTING CODE. Amendments: Whenever an existing statute (or a section of the IndianaConstitution) is being amended, the text of the existing provision will appear in this style type,additions will appear in this style type, and deletions will appear in this style type. Additions: Whenever a new statutory provision is being enacted (or a new constitutionalprovision adopted), the text of the new provision will appear in this style type. Also, theword NEW will appear in that style type in the introductory clause of each SECTION that addsa new provision to the Indiana Code or the Indiana Constitution. Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflictsbetween statutes enacted by the 2019 Regular Session of the General Assembly.

ENGROSSEDHOUSE BILL No. 1004

A BILL FOR AN ACT to amend the Indiana Code concerninghealth.

Be it enacted by the General Assembly of the State of Indiana:

1 SECTION 1. IC 12-7-2-174.7 IS ADDED TO THE INDIANA2 CODE AS A NEW SECTION TO READ AS FOLLOWS3 [EFFECTIVE JULY 1, 2020]: Sec. 174.7. (a) "Service facility4 location", for purposes of IC 12-15-11, means the address where5 the services of a provider facility or practitioner were provided.6 (b) The term consists of exact address and place of service codes7 as required on CMS forms 1500 and 1450, including an office,8 on-campus location of a hospital, and off-campus location of a9 hospital.

10 SECTION 2. IC 12-15-11-5, AS AMENDED BY P.L.195-2018,11 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE12 JULY 1, 2020]: Sec. 5. (a) A provider who participates in the Medicaid13 program must comply with the enrollment requirements that are14 established under rules adopted under IC 4-22-2 by the secretary.15 (b) A provider who participates in the Medicaid program may be16 required to use the centralized credentials verification organization17 established in section 9 of this chapter. include the address of the

EH 1004—LS 7088/DI 104

2

1 service facility location in order to obtain Medicaid reimbursement2 for a claim for health care services from the office or a managed3 care organization.4 (c) The office or a managed care organization is not required to5 accept a claim for health care services that does not contain the6 service facility location.7 SECTION 3. IC 12-15-11-6 IS AMENDED TO READ AS8 FOLLOWS [EFFECTIVE JULY 1, 2020]: Sec. 6. (a) After a provider9 signs a provider agreement under this chapter, the office may not

10 exclude the provider from participating in the Medicaid program by11 entering into an exclusive contract with another provider or group of12 providers, except as provided under section 7 of this chapter.13 (b) The office or a managed care organization contracting with14 the office may not prohibit a provider from participating in a15 network of another insurer, managed care organization, or health16 maintenance organization.17 SECTION 4. IC 16-18-2-163.6 IS ADDED TO THE INDIANA18 CODE AS A NEW SECTION TO READ AS FOLLOWS19 [EFFECTIVE JULY 1, 2020]: Sec. 163.6. (a) "Health care services",20 for purposes of IC 16-51-1, has the meaning set forth in21 IC 16-51-1-1.22 (b) "Health care services", for purposes of IC 16-51-2, has the23 meaning set forth in IC 16-51-2-1.24 SECTION 5. IC 16-18-2-167.8 IS ADDED TO THE INDIANA25 CODE AS A NEW SECTION TO READ AS FOLLOWS26 [EFFECTIVE JULY 1, 2020]: Sec. 167.8. (a) "Health maintenance27 organization", for purposes of IC 16-51-1, has the meaning set28 forth in IC 16-51-1-2.29 (b) "Health maintenance organization", for purposes of30 IC 16-51-2, has the meaning set forth in IC 16-51-2-2.31 SECTION 6. IC 16-18-2-188.4 IS ADDED TO THE INDIANA32 CODE AS A NEW SECTION TO READ AS FOLLOWS33 [EFFECTIVE JULY 1, 2020]: Sec. 188.4. "Individual provider34 form", for purposes of IC 16-51-1, has the meaning set forth in35 IC 16-51-1-3.36 SECTION 7. IC 16-18-2-190.7 IS ADDED TO THE INDIANA37 CODE AS A NEW SECTION TO READ AS FOLLOWS38 [EFFECTIVE JULY 1, 2020]: Sec. 190.7. "Institutional provider",39 for purposes of IC 16-51-1, has the meaning set forth in40 IC 16-51-1-4.41 SECTION 8. IC 16-18-2-190.8 IS ADDED TO THE INDIANA42 CODE AS A NEW SECTION TO READ AS FOLLOWS

EH 1004—LS 7088/DI 104

3

1 [EFFECTIVE JULY 1, 2020]: Sec. 190.8. "Institutional provider2 form", for purposes of IC 16-51-1, has the meaning set forth in3 IC 16-51-1-5.4 SECTION 9. IC 16-18-2-190.9 IS ADDED TO THE INDIANA5 CODE AS A NEW SECTION TO READ AS FOLLOWS6 [EFFECTIVE JULY 1, 2020]: Sec. 190.9. "Insurer", for purposes of7 IC 16-51-1, has the meaning set forth in IC 16-51-1-6.8 (b) "Insurer", for purposes of IC 16-51-2, has the meaning set9 forth in IC 16-51-2-3.

10 SECTION 10. IC 16-18-2-254.7 IS ADDED TO THE INDIANA11 CODE AS A NEW SECTION TO READ AS FOLLOWS12 [EFFECTIVE JULY 1, 2020]: Sec. 254.7. "Office setting", for13 purposes of IC 16-51-1, has the meaning set forth in IC 16-51-1-7.14 SECTION 11. IC 16-18-2-288, AS AMENDED BY P.L.96-2014,15 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE16 JULY 1, 2020]: Sec. 288. (a) "Practitioner", for purposes of17 IC 16-42-19, has the meaning set forth in IC 16-42-19-5.18 (b) "Practitioner", for purposes of IC 16-41-14, has the meaning set19 forth in IC 16-41-14-4.20 (c) "Practitioner", for purposes of IC 16-42-21, has the meaning set21 forth in IC 16-42-21-3.22 (d) "Practitioner", for purposes of IC 16-42-22 and IC 16-42-25, has23 the meaning set forth in IC 16-42-22-4.5.24 (e) "Practitioner", for purposes of IC 16-51-2, has the meaning25 set forth in IC 16-51-2-4.26 SECTION 12. IC 16-18-2-295, AS AMENDED BY P.L.161-2014,27 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE28 JULY 1, 2020]: Sec. 295. (a) "Provider", for purposes of IC 16-21-8,29 has the meaning set forth in IC 16-21-8-0.2.30 (b) "Provider", for purposes of IC 16-38-5, IC 16-39 (except for31 IC 16-39-7), and IC 16-41-1 through IC 16-41-9, means any of the32 following:33 (1) An individual (other than an individual who is an employee or34 a contractor of a hospital, a facility, or an agency described in35 subdivision (2) or (3)) who is licensed, registered, or certified as36 a health care professional, including the following:37 (A) A physician.38 (B) A psychotherapist.39 (C) A dentist.40 (D) A registered nurse.41 (E) A licensed practical nurse.42 (F) An optometrist.

EH 1004—LS 7088/DI 104

4

1 (G) A podiatrist.2 (H) A chiropractor.3 (I) A physical therapist.4 (J) A psychologist.5 (K) An audiologist.6 (L) A speech-language pathologist.7 (M) A dietitian.8 (N) An occupational therapist.9 (O) A respiratory therapist.

10 (P) A pharmacist.11 (Q) A sexual assault nurse examiner.12 (2) A hospital or facility licensed under IC 16-21-2 or IC 12-25 or13 described in IC 12-24-1 or IC 12-29.14 (3) A health facility licensed under IC 16-28-2.15 (4) A home health agency licensed under IC 16-27-1.16 (5) An employer of a certified emergency medical technician, a17 certified advanced emergency medical technician, or a licensed18 paramedic.19 (6) The state department or a local health department or an20 employee, agent, designee, or contractor of the state department21 or local health department.22 (c) "Provider", for purposes of IC 16-39-7-1, has the meaning set23 forth in IC 16-39-7-1(a).24 (d) "Provider", for purposes of IC 16-48-1, has the meaning set forth25 in IC 16-48-1-3.26 (e) "Provider", for purposes of IC 16-51-1, has the meaning set27 forth in IC 16-51-1-8.28 SECTION 13. IC 16-18-2-295.3 IS ADDED TO THE INDIANA29 CODE AS A NEW SECTION TO READ AS FOLLOWS30 [EFFECTIVE JULY 1, 2020]: Sec. 295.3. "Provider facility", for31 purposes of IC 16-51-2, has the meaning set forth in IC 16-51-2-5.32 SECTION 14. IC 16-18-2-327.7 IS ADDED TO THE INDIANA33 CODE AS A NEW SECTION TO READ AS FOLLOWS34 [EFFECTIVE JULY 1, 2020]: Sec. 327.7. "Service facility location",35 for purposes of IC 16-51-2, has the meaning set forth in36 IC 16-51-2-6.37 SECTION 15. IC 16-51 IS ADDED TO THE INDIANA CODE AS38 A NEW ARTICLE TO READ AS FOLLOWS [EFFECTIVE JULY 1,39 2020]:40 ARTICLE 51. HEALTH CARE REQUIREMENTS41 Chapter 1. Health Care Provider Billing42 Sec. 1. (a) As used in this chapter, "health care services" means

EH 1004—LS 7088/DI 104

5

1 health care related services or products rendered or sold by a2 provider within the scope of the provider's license or legal3 authorization.4 (b) The term includes hospital, medical, surgical, dental, vision,5 and pharmaceutical services or products.6 Sec. 2. As used in this chapter, "health maintenance7 organization" has the meaning set forth in IC 27-13-1-19.8 Sec. 3. (a) As used in this chapter, "individual provider form"9 means a medical claim form, including an electronic version of the

10 form, that:11 (1) is accepted by the federal Centers for Medicare and12 Medicaid Services for use by individual providers or groups13 of providers; and14 (2) includes a claim field for disclosure of the site at which the15 health care services to which the form relates were provided.16 (b) The term includes the following:17 (1) The CMS-1500 form.18 (2) The HCFA-1500 form.19 Sec. 4. As used in this chapter, "institutional provider" means20 a facility, operated by a hospital licensed under IC 16-21-2, in21 which both of the following services are provided:22 (1) Emergency services.23 (2) Inpatient services.24 Sec. 5. (a) As used in this chapter, "institutional provider form"25 means a medical claim form, including an electronic version of the26 form, that is accepted by the federal Centers for Medicare and27 Medicaid Services for use by institutional providers.28 (b) The term includes the following:29 (1) The 837 Institutional form.30 (2) The CMS-1450 form.31 (3) The UB-04 form.32 Sec. 6. As used in this chapter, "insurer" has the meaning set33 forth in IC 27-8-11-1(e).34 Sec. 7. As used in this chapter, "office setting" means a location35 not physically located within the facility of an institutional36 provider and where a provider routinely provides health37 examinations and diagnosis and treatment of illness or injury on an38 ambulatory basis.39 Sec. 8. As used in this chapter, "provider" means an individual40 or entity duly licensed or legally authorized to provide health care41 services.42 Sec. 9. (a) A bill for health care services provided by a provider

EH 1004—LS 7088/DI 104

6

1 in an office setting:2 (1) must not be submitted on an institutional provider form;3 and4 (2) must be submitted on an individual provider form.5 (b) An insurer, health maintenance organization, employer, or6 other person responsible for the payment of the cost of health care7 services provided by a provider in an office setting is not required8 to accept a bill for the health care services that is submitted on an9 institutional provider form.

10 (c) This section applies only to an institutional provider form or11 an individual provider form submitted after December 31, 2020.12 Sec. 10. Before March 1 of each year an insurer and health13 maintenance organization shall submit information, specified by14 the department of insurance, concerning compliance by providers15 under this chapter.16 Sec. 11. The department of insurance shall adopt rules under17 IC 4-22-2 for the enforcement of this chapter.18 Chapter 2. Health Care Service Location Billing19 Sec. 1. (a) As used in this chapter, "health care services" means20 health care related services or products rendered or sold by a21 provider within the scope of the provider's license or legal22 authorization.23 (b) The term includes hospital, medical, surgical, dental, vision,24 and pharmaceutical services or products.25 Sec. 2. As used in this chapter, "health maintenance26 organization" has the meaning set forth in IC 27-13-1-19.27 Sec. 3. As used in this chapter, "insurer" has the meaning set28 forth in IC 27-8-11-1(e).29 Sec. 4. As used in this chapter, "practitioner" means an30 individual or entity duly licensed or legally authorized to provide31 health care services.32 Sec. 5. As used in this chapter, "provider facility" means any of33 the following:34 (1) A hospital.35 (2) A skilled nursing facility.36 (3) An end stage renal disease provider.37 (4) A home health agency.38 (5) A hospice organization.39 (6) An outpatient physical therapy, occupational therapy, or40 speech pathology service provider.41 (7) A comprehensive outpatient rehabilitation facility.42 (8) A community mental health center.

EH 1004—LS 7088/DI 104

7

1 (9) A critical access hospital.2 (10) A federally qualified health center.3 (11) A histocompatibility laboratory.4 (12) An Indian health service facility.5 (13) An organ procurement organization.6 (14) A religious nonmedical health care institution.7 (15) A rural health clinic.8 Sec. 6. As used in this chapter, "service facility location" means9 the address where the services of a provider facility or practitioner

10 were provided. The term consists of exact address and place of11 service codes as required on CMS forms 1500 and 1450, including12 an office, on-campus location of a hospital, and off-campus location13 of a hospital.14 Sec. 7. (a) A provider facility or practitioner shall include the15 address of the service facility location in order to obtain16 reimbursement for a commercial claim for health care services17 from an insurer, health maintenance organization, employer, or18 other person responsible for the payment of the cost of health care19 services.20 (b) An insurer, health maintenance organization, employer, or21 other person responsible for the payment of the cost of health care22 services is not required to accept a bill for health care services that23 does not contain the service facility location.24 Sec. 8. A patient is not liable for any additional payment that is25 the result of a practitioner or provider facility filing an incorrect26 form or not including the correct service facility location as27 required under this chapter.28 SECTION 16. IC 25-1-9-23 IS ADDED TO THE INDIANA CODE29 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY30 1, 2020]: Sec. 23. (a) As used in this section, "covered individual"31 means an individual who is entitled to be provided health care32 services at a cost established according to a network plan.33 (b) As used in this section, "in network practitioner" means a34 practitioner who is required under a network plan to provide35 health care services to covered individuals at not more than a36 preestablished rate or amount of compensation.37 (c) As used in this section, "network plan" means a plan under38 which facilities and practitioners are required by contract to39 provide health care services to covered individuals at not more40 than a preestablished rate or amount of compensation.41 (d) As used in this section, "practitioner" means the following:42 (1) An individual licensed under IC 25 who provides

EH 1004—LS 7088/DI 104

8

1 professional health care services to individuals in a facility.2 (2) An organization:3 (A) that consists of practitioners described in subdivision4 (1); and5 (B) through which practitioners described in subdivision6 (1) provide health care services.7 (3) An entity that:8 (A) is not a facility; and9 (B) employs practitioners described in subdivision (1) to

10 provide health care services.11 (e) An in network practitioner who provides health care services12 to a covered individual may not charge more for the health care13 services than allowed according to the rate or amount of14 compensation established by the individual's network plan.15 (f) An out of network practitioner who provides health care16 services to a covered individual may charge more for the health17 care services than allowed according to the rate or amount of18 compensation established by the individual's network plan if all of19 the following conditions are met:20 (1) At least five (5) days before the health care services are21 scheduled to be provided to the covered individual, the22 practitioner provides to the covered individual, on a form23 separate from any other form provided to the covered24 individual by the practitioner, a statement in conspicuous type25 at least as large as fourteen (14) point type that meets the26 following requirements:27 (A) Includes a notice reading substantially as follows:28 "[Name of practitioner] intends to charge you more for29 [name or description of health care services] than allowed30 according to the rate or amount of compensation31 established by the network plan applying to your coverage.32 [Name of practitioner] is not entitled to charge this much33 for [name or description of health care services] unless you34 give your written consent to the charge.".35 (B) Sets forth the practitioner's good faith estimate of the36 amount that the practitioner intends to charge for the37 health care services provided to the covered individual.38 (C) Includes a notice reading substantially as follows39 concerning the good faith estimate set forth under clause40 (B): "The estimate of our intended charge for [name or41 description of health care services] set forth in this42 statement is provided in good faith and is our best estimate

EH 1004—LS 7088/DI 104

9

1 of the amount we will charge. If our actual charge for2 [name or description of health care services] exceeds our3 estimate, we will explain to you why the charge exceeds the4 estimate.".5 (2) The covered individual signs the statement provided under6 subdivision (1), signifying the covered individual's consent to7 the charge for the health care services being greater than8 allowed according to the rate or amount of compensation9 established by the network plan.

10 (g) If the charge of a practitioner for health care services11 provided to a covered individual exceeds the estimate provided to12 the covered individual under subsection (f)(1)(B), the facility or13 practitioner shall explain in a writing provided to the covered14 individual why the charge exceeds the estimate.15 SECTION 17. IC 25-1-9.8 IS ADDED TO THE INDIANA CODE16 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE17 JULY 1, 2020]:18 Chapter 9.8. Practitioner Good Faith Estimates19 Sec. 1. As used in this chapter, "covered individual" means an20 individual who is entitled to be provided health care services21 according to a health carrier's network plan.22 Sec. 1.5. As used in this chapter, "episode of care" means the23 medical care ordered to be provided for a specific medical24 procedure, condition, or illness.25 Sec. 2. As used in this chapter, "good faith estimate" means a26 reasonable estimate of the price a practitioner anticipates charging27 for an episode of care for nonemergency health care services that:28 (1) is made by a practitioner under this chapter upon the29 request of:30 (A) the individual for whom the nonemergency health care31 service has been ordered; or32 (B) the provider facility in which the nonemergency health33 care service will be provided; and34 (2) is not binding upon the practitioner.35 Sec. 3. (a) As used in this chapter, "health carrier" means an36 entity:37 (1) that is subject to IC 27 and the administrative rules38 adopted under IC 27; and39 (2) that enters into a contract to:40 (A) provide health care services;41 (B) deliver health care services;42 (C) arrange for health care services; or

EH 1004—LS 7088/DI 104

10

1 (D) pay for or reimburse any of the costs of health care2 services.3 (b) The term also includes the following:4 (1) An insurer, as defined in IC 27-1-2-3(x), that issues a5 policy of accident and sickness insurance, as defined in6 IC 27-8-5-1(a).7 (2) A health maintenance organization, as defined in8 IC 27-13-1-19.9 (3) An administrator (as defined in IC 27-1-25-1(a)) that is

10 licensed under IC 27-1-25.11 (4) A state employee health plan offered under IC 5-10-8.12 (5) A short term insurance plan (as defined by IC 27-8-5.9-3).13 (6) Any other entity that provides a plan of health insurance,14 health benefits, or health care services.15 Sec. 4. As used in this chapter, "in network", when used in16 reference to a practitioner, means that the health care services17 provided by the practitioner are subject to a health carrier's18 network plan.19 Sec. 5. (a) As used in this chapter, "network" means a group of20 provider facilities and practitioners that:21 (1) provide health care services to covered individuals; and22 (2) have agreed to, or are otherwise subject to, maximum23 limits on the prices for the health care services to be provided24 to the covered individuals.25 (b) The term includes the following:26 (1) A network described in subsection (a) that is established27 pursuant to a contract between an insurer providing coverage28 under a group health policy and:29 (A) individual provider facilities and practitioners;30 (B) a preferred provider organization; or31 (C) an entity that employs or represents providers,32 including:33 (i) an independent practice association; and34 (ii) a physician-hospital organization.35 (2) A health maintenance organization, as defined in36 IC 27-13-1-19.37 Sec. 6. As used in this chapter, "network plan" means a plan of38 a health carrier that:39 (1) requires a covered person to receive; or40 (2) creates incentives, including financial incentives, for a41 covered person to receive;42 health care services from one (1) or more providers that are under

EH 1004—LS 7088/DI 104

11

1 contract with, managed by, or owned by the health carrier.2 Sec. 7. As used in this chapter, "nonemergency health care3 service" means a discrete service or series of services ordered by4 a practitioner for an episode of care for the:5 (1) diagnosis;6 (2) prevention;7 (3) treatment;8 (4) cure; or9 (5) relief;

10 of a physical, mental, or behavioral health condition, illness, injury,11 or disease that is not provided on an emergency or urgent care12 basis.13 Sec. 8. As used in this chapter, "practitioner" means an14 individual or entity duly licensed or legally authorized to provide15 health care services.16 Sec. 8.5. As used in this chapter, "price" means the negotiated17 rate between the:18 (1) provider facility and practitioner; and19 (2) covered individual's primary health carrier.20 Sec. 9. As used in this chapter, "provider" means:21 (1) a provider facility; or22 (2) a practitioner.23 Sec. 10. As used in this chapter, "provider facility"means any of24 the following:25 (1) A hospital licensed under IC 16-21-2.26 (2) An ambulatory outpatient surgery center licensed under27 IC 16-21-2.28 (3) An abortion clinic licensed under IC 16-21-2.29 (4) A birthing center licensed under IC 16-21-2.30 (5) Except for an urgent care facility (as defined by31 IC 27-1-46-10.5), a facility that provides diagnostic services to32 the medical profession or the general public.33 (6) A laboratory where clinical pathology tests are carried out34 on specimens to obtain information about the health of a35 patient.36 (7) A facility where radiologic and electromagnetic images are37 made to obtain information about the health of a patient.38 (8) An infusion center that administers intravenous39 medications.40 Sec. 11. (a) This section does not apply to an individual who is41 a Medicaid recipient.42 (b) An individual for whom a nonemergency health care service

EH 1004—LS 7088/DI 104

12

1 has been ordered may request from the practitioner who may2 provide the nonemergency health care service a good faith estimate3 of the total price the practitioner will charge for providing the4 nonemergency health care service.5 (c) A practitioner who receives a request from a patient under6 subsection (b) shall, not more than five (5) business days after7 receiving all the relevant information from the individual, provide8 to the individual a good faith estimate of the price that the9 practitioner will charge for providing the nonemergency health

10 care service.11 (d) A practitioner must ensure that a good faith estimate12 provided to an individual under this section is accompanied by a13 notice stating that:14 (1) an estimate provided under this section is not binding on15 the practitioner;16 (2) the price the practitioner charges the individual may vary17 from the estimate based on the individual's medical needs;18 and19 (3) the estimate provided under this section is only valid for20 thirty (30) days.21 (e) A practitioner may not charge an individual for information22 provided under this section.23 Sec. 12. (a) If:24 (1) the individual who requests a good faith estimate from a25 practitioner under this chapter is a covered individual with26 respect to a network plan; and27 (2) the practitioner from which the individual requests the28 good faith estimate is in network with respect to the same29 network plan;30 the good faith estimate that the practitioner provides to the31 individual under this chapter must be based on the negotiated price32 to which the practitioner has agreed as an in network provider.33 (b) If the individual who requests a good faith estimate from a34 practitioner under this chapter:35 (1) is not a covered individual with respect to any network36 plan; or37 (2) is not a covered individual with respect to a network plan38 with respect to which the practitioner is in network;39 the good faith estimate that the practitioner provides to the40 individual under this chapter must be based on the price that the41 practitioner charges for the nonemergency health care service in42 the absence of any network plan.

EH 1004—LS 7088/DI 104

13

1 Sec. 13. A practitioner may provide a good faith estimate to an2 individual under this chapter:3 (1) in a writing delivered to the individual;4 (2) by electronic mail; or5 (3) through a mobile application or other Internet web based6 method, if available;7 according to the preference expressed by the individual.8 Sec. 14. (a) A good faith estimate provided by a practitioner to9 an individual under this chapter must meet the following

10 requirements:11 (1) Provide a summary of the services and material items that12 the good faith estimate is based on.13 (2) Include:14 (A) the price that the provider facility in which the health15 care service will be performed will charge for:16 (i) the use of the provider facility to care for the17 individual for the nonemergency health care service;18 (ii) the services rendered by the staff of the provider19 facility in connection with the nonemergency health care20 service; and21 (iii) medication, supplies, equipment, and material items22 to be provided to or used by the individual while the23 individual is present in the provider facility in24 connection with the nonemergency health care service;25 (B) the price charged for the services of all practitioners,26 support staff, and other persons who provide professional27 health services:28 (i) who may provide services to or for the individual29 during the individual's presence in the provider facility30 for the nonemergency health care service; and31 (ii) for whose services the individual will be charged32 separately from the charge of the provider facility;33 for imaging, laboratory services, diagnostic services, therapy,34 observation services, and other services expected to be35 provided to the individual for the episode of care.36 (3) Include a total figure that is a sum of the estimated prices37 referred to in subdivisions (1) and (2).38 (b) Subsection (a) does not prohibit a practitioner from39 providing to an individual a good faith estimate that indicates how40 much of the total figure stated under subsection (a)(2) will be the41 individual's out-of-pocket expense after the health carrier's42 payment of charges.

EH 1004—LS 7088/DI 104

14

1 (c) A health carrier must provide a practitioner with the2 information needed by the practitioner to comply with the3 requirements under this chapter not more than two (2) business4 days after receiving the request.5 (d) A practitioner is not subject to the penalties under section 186 of this chapter if:7 (1) a health carrier or provider facility fails to provide the8 practitioner with the information as required under9 subsection (c);

10 (2) the practitioner provides the individual with a good faith11 estimate based on any information that the practitioner has;12 and13 (3) the practitioner provides the individual with an updated14 good faith estimate after the health carrier or provider facility15 has provided the information required under subsection (c).16 Sec. 15. If:17 (1) a practitioner is expected to provide a nonemergency18 health care service to an individual in a provider facility; and19 (2) the provider facility receives a request from an individual20 for a good faith estimate under IC 27-1-46;21 the practitioner, upon request from the provider facility, shall22 provide to the provider facility a good faith estimate of the23 practitioner's price for providing the nonemergency health care24 service to enable the provider facility to comply with25 IC 27-1-46-11.26 Sec. 16. (a) A practitioner that has ordered the individual for a27 nonemergency health care service shall provide to the individual28 an electronic or paper copy of a written notice that states the29 following, or words to the same effect: "A patient may at any time30 ask a health care provider for an estimate of the price the health31 care providers and health facility will charge for providing a32 nonemergency medical service. The law requires that the estimate33 be provided within 5 business days.".34 (b) The state department may adopt rules under IC 4-22-2 to35 establish requirements for practitioners to provide additional36 charging information under this section.37 Sec. 17. If:38 (1) a practitioner receives a request for a good faith estimate39 under this chapter; and40 (2) the patient is eligible for Medicare coverage;41 the practitioner shall provide a good faith estimate to the patient42 within five (5) business days based on available Medicare rates.

EH 1004—LS 7088/DI 104

15

1 Sec. 18. The appropriate board (as defined in IC 25-1-9-1) may2 take action against a practitioner:3 (1) under IC 25-1-9-9(a)(3) or IC 25-1-9-9(a)(4) for an initial4 violation or isolated violations of this chapter; or5 (2) under IC 25-1-9-9(a)(6) for repeated or persistent6 violations of this chapter;7 concerning the providing of a good faith estimate to an individual8 for whom a nonemergency health care service has been ordered or9 the providing of notice in the practitioner's office or on the

10 practitioner's Internet web site that a patient may at any time ask11 for an estimate of the price that the patient will be charged for a12 medical service.13 SECTION 18. IC 25-1-9.9 IS ADDED TO THE INDIANA CODE14 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE15 JULY 1, 2020]:16 Chapter 9.9. Practitioner Employment Contracts And17 Non-Compete Agreements18 Sec. 1. This chapter applies to an employment contract entered19 into, modified, renewed, or extended after June 30, 2020.20 Sec. 2. As used in this chapter, "employee" means a practitioner21 (as defined in IC 25-1-9-2) employed by an employer for wages or22 salary. The term includes an individual who has received an offer23 of employment from a prospective employer.24 Sec. 3. As used in this chapter, "employer" means an individual,25 corporation, partnership, limited liability company, or any other26 legal entity that has at least one (1) employee and is legally doing27 business in Indiana.28 Sec. 4. As used in this chapter, "non-compete agreement" means29 a contractual provision by which an employer attempts to limit an30 employee's ability to seek future employment or engage in future31 business activity after the employment relationship has terminated.32 Sec. 5. An employment contract entered into by an employer33 and employee may not contain a non-compete agreement.34 Sec. 6. A non-compete agreement in an employment contract in35 violation of this chapter is unenforceable and void.36 SECTION 19. IC 25-22.5-17 IS ADDED TO THE INDIANA37 CODE AS A NEW CHAPTER TO READ AS FOLLOWS38 [EFFECTIVE JULY 1, 2020]:39 Chapter 17. Physician's Patient Information40 Sec. 1. If a physician licensed under this article leaves the41 employment of an employer, the following apply:42 (1) The employer of the physician must provide the physician

EH 1004—LS 7088/DI 104

16

1 with a copy of any notice that:2 (A) concerns the physician's departure from the employer;3 and4 (B) was sent to any patient seen or treated by the physician5 during the two (2) year period preceding the termination6 of the physician's employment or the expiration of the7 physician's contract. However, the patient names and8 contact information must be redacted from the copy of the9 notice provided from the employer of the physician to the

10 physician.11 (2) The physician's employer must, in good faith, provide the12 physician's last known or current contact and location13 information to a patient who:14 (A) requests updated contact and location information for15 the physician; and16 (B) was seen or treated by the physician during the two (2)17 year period preceding the termination of the physician's18 employment or the expiration of the physician's contract.19 (3) The physician's employer must provide the physician with:20 (A) access to; or21 (B) copies of;22 any medical record associated with a patient described in23 subdivision (1) or (2) upon receipt of the patient's consent.24 (4) The physician's employer may not provide patient medical25 records to a requesting physician in a format that materially26 differs from the format used to create or store the medical27 record during the routine or ordinary course of business,28 unless a different format is mutually agreed upon by the29 parties. Paper or portable document format copies of the30 medical records satisfy the formatting provisions of this31 chapter.32 Sec. 2. A person or entity required to create, copy, or transfer33 a patient medical record for a reason specified in this chapter may34 charge a reasonable fee for the service as permitted under35 applicable state or federal law.36 SECTION 20. IC 27-1-3-7, AS AMENDED BY P.L.278-2013,37 SECTION 19, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE38 JULY 1, 2020]: Sec. 7. (a) The department may promulgate rules and39 regulations for any of the following enumerated purposes:40 (1) For the conduct of the work of the department.41 (2) Prescribing the methods and standards to be used in making42 the examinations and prescribing the forms of reports of the

EH 1004—LS 7088/DI 104

17

1 several insurance companies to which IC 27-1 is applicable.2 (3) Defining what is a safe or an unsafe manner and a safe or an3 unsafe condition for conducting business by any insurance4 company to which IC 27-1 is applicable.5 (4) For the establishment of safe and sound methods for the6 transaction of business by such insurance companies and for the7 purpose of safeguarding the interests of policyholders, creditors,8 and shareholders respecting the withdrawal or payment of funds9 by any life insurance company in times of emergency. Any rule or

10 regulation promulgated under this subdivision may apply to one11 (1) or more insurance companies as the department may12 determine.13 (5) For the administration and termination of the affairs of any14 such insurance company which is in involuntary liquidation or15 whose business and property have been taken possession of by the16 department for the purpose of rehabilitation, liquidation,17 conservation, or dissolution under IC 27-1.18 (6) For the regulation of the solicitation or use of proxies, in19 general and as they concern consents or authorizations, in respect20 of securities issued by any domestic stock company for the21 purpose of protecting investors by prescribing the form of proxies,22 including such consents or authorizations, and by requiring23 adequate disclosure of information relevant to such proxies,24 including such consents or authorizations, and relevant to the25 business to be transacted at any meeting of shareholders with26 respect to which such proxies, including such consents or27 authorizations, may be used, which regulations may, in general,28 conform to those prescribed by the National Association of29 Insurance Commissioners.30 (7) For regulation related to a health benefit exchange established31 under the federal Patient Protection and Affordable Care Act (P.L.32 111-148), as amended by the federal Health Care and Education33 Reconciliation Act of 2010 (P.L. 111-152), and operating in34 Indiana.35 (b) The department may adopt a rule under IC 4-22-2 to provide36 reasonable simplification of the terms and coverage of individual and37 group Medicare supplement accident and sickness insurance policies38 and individual and group Medicare supplement subscriber contracts in39 order to facilitate public understanding and comparison and to40 eliminate provisions contained in those policies or contracts which may41 be misleading or confusing in connection either with the purchase of42 those coverages or with the settlement of claims and to provide for full

EH 1004—LS 7088/DI 104

18

1 disclosure in the sale of those coverages.2 (c) The department shall adopt rules concerning the3 enforcement of health care billing requirements in IC 16-51-1.4 SECTION 21. IC 27-1-45 IS ADDED TO THE INDIANA CODE5 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE6 JULY 1, 2020]:7 Chapter 45. Health Facility Compensation8 Sec. 1. As used in this chapter, "covered individual" means an9 individual who is entitled to be provided health care services at a

10 cost established according to a network plan.11 Sec. 2. As used in this chapter, "facility" means an institution in12 which health care services are provided to individuals. The term13 includes:14 (1) hospitals and other licensed ambulatory surgical centers;15 and16 (2) ambulatory outpatient surgical centers.17 Sec. 3. As used in this chapter, "in network provider" means a18 provider that is required under a network plan to provide health19 care services to covered individuals at not more than a20 preestablished rate or amount of compensation.21 Sec. 4. As used in this chapter, "network plan" means a plan22 under which providers are required by contract to provide health23 care services to covered individuals at not more than a24 preestablished rate or amount of compensation.25 Sec. 5. As used in this chapter, "practitioner" means the26 following:27 (1) An individual licensed under IC 25 who provides28 professional health care services to individuals in a facility.29 (2) An organization:30 (A) that consists of practitioners described in subdivision31 (1); and32 (B) through which practitioners described in subdivision33 (1) provide health care services.34 (3) An entity that:35 (A) is not a facility; and36 (B) employs practitioners described in subdivision (1) to37 provide health care services.38 Sec. 6. As used in this chapter, "provider" means:39 (1) a facility; or40 (2) a practitioner.41 Sec. 7. (a) When a covered individual receives health care42 services in a facility that is an in network provider, neither:

EH 1004—LS 7088/DI 104

19

1 (1) the facility; nor2 (2) a practitioner who provides health care services in the3 facility;4 may charge more for the health care services provided to the5 covered individual than allowed according to the rate or amount6 of compensation established by the individual's network plan.7 (b) A facility that is an out of network provider or a practitioner8 who provides health care services in the facility may charge more9 for the health care services provided to the covered individual than

10 allowed according to the rate or amount of compensation11 established by the individual's network plan if all of the following12 conditions are met:13 (1) At least five (5) days before the health care services are14 scheduled to be provided to the covered individual, the facility15 or practitioner provides to the covered individual, on a form16 separate from any other form provided to the covered17 individual by the facility or practitioner, a statement in18 conspicuous type at least as large as fourteen (14) point type19 that meets the following requirements:20 (A) Includes a notice reading substantially as follows:21 "[Name of facility or practitioner] intends to charge you22 more for [name or description of health care services] than23 allowed according to the rate or amount of compensation24 established by the network plan applying to your coverage.25 [Name of facility or practitioner] is not entitled to charge26 this much for [name or description of health care services]27 unless you give your written consent to the charge.".28 (B) Sets forth the facility's or practitioner's good faith29 estimate of the amount that the facility or practitioner30 intends to charge for the health care services provided to31 the covered individual.32 (C) Includes a notice reading substantially as follows33 concerning the good faith estimate set forth under clause34 (B): "The estimate of our intended charge for [name or35 description of health care services] set forth in this36 statement is provided in good faith and is our best estimate37 of the amount we will charge.".38 (2) The covered individual signs the statement provided under39 subdivision (1), signifying the covered individual's consent to40 the charge for the health care services being greater than41 allowed according to the rate or amount of compensation42 established by the network plan.

EH 1004—LS 7088/DI 104

20

1 (c) If the charge of a facility or practitioner for health care2 services provided to a covered individual exceeds the estimate3 provided to the covered individual under subsection (b)(1)(B), the4 facility or practitioner shall explain in a writing provided to the5 covered individual why the charge exceeds the estimate.6 Sec. 8. (a) The insurance commissioner may, after notice and7 hearing under IC 4-21.5, impose on the provider facility a civil8 penalty of not more than one thousand dollars ($1,000) for each9 violation of this chapter.

10 (b) A civil penalty collected under this section shall be deposited11 in the department of insurance fund established by IC 27-1-3-28.12 SECTION 22. IC 27-1-46 IS ADDED TO THE INDIANA CODE13 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE14 JULY 1, 2020]:15 Chapter 46. Provider Facility Good Faith Estimates16 Sec. 0.5. Nothing in this chapter prohibits:17 (1) a self-funded health benefit plan that complies with the18 federal Employee Retirement Income Security Act (ERISA)19 of 1974 (29 U.S.C. 1001 et seq.); or20 (2) a self-insurance program established to provide group21 health coverage as described in IC 5-10-8-7(b), or a contract22 for health services as described in IC 5-10-8-7(c);23 from providing information requested by a practitioner or24 provider facility under this chapter.25 Sec. 1. As used in this chapter, "covered individual" means an26 individual who is entitled to be provided health care services27 according to a health carrier's network plan.28 Sec. 1.5. As used in this chapter, "episode of care" means the29 medical care ordered to be provided for a specific medical30 procedure, condition, or illness.31 Sec. 2. As used in this chapter, "good faith estimate" means a32 reasonable estimate of the price a provider anticipates charging for33 an episode of care for nonemergency health care services that:34 (1) is made by a provider under this chapter upon the request35 of the individual for whom the nonemergency health care36 service has been ordered; and37 (2) is not binding upon the provider.38 Sec. 3. (a) As used in this chapter, "health carrier" means an39 entity:40 (1) that is subject to IC 27 and the administrative rules41 adopted under IC 27; and42 (2) that enters into a contract to:

EH 1004—LS 7088/DI 104

21

1 (A) provide health care services;2 (B) deliver health care services;3 (C) arrange for health care services; or4 (D) pay for or reimburse any of the costs of health care5 services.6 (b) The term also includes the following:7 (1) An insurer, as defined in IC 27-1-2-3(x), that issues a8 policy of accident and sickness insurance, as defined in9 IC 27-8-5-1(a).

10 (2) A health maintenance organization, as defined in11 IC 27-13-1-19.12 (3) An administrator (as defined in IC 27-1-25-1(a)) that is13 licensed under IC 27-1-25.14 (4) A state employee health plan offered under IC 5-10-8.15 (5) A short term insurance plan (as defined by IC 27-8-5.9-3).16 (6) Any other entity that provides a plan of health insurance,17 health benefits, or health care services.18 Sec. 4. As used in this chapter, "in network", when used in19 reference to a provider, means that the health care services20 provided by the provider are subject to a health carrier's network21 plan.22 Sec. 5. (a) As used in this chapter, "network" means a group of23 provider facilities and practitioners that:24 (1) provide health care services to covered individuals; and25 (2) have agreed to, or are otherwise subject to, maximum26 limits on the prices for the health care services to be provided27 to the covered individuals.28 (b) The term includes the following:29 (1) A network described in subsection (a) that is established30 pursuant to a contract between an insurer providing coverage31 under a group health policy and:32 (A) individual provider facilities and practitioners;33 (B) a preferred provider organization; or34 (C) an entity that employs or represents providers,35 including:36 (i) an independent practice association; and37 (ii) a physician-hospital organization.38 (2) A health maintenance organization, as defined in39 IC 27-13-1-19.40 Sec. 6. As used in this chapter, "network plan" means a plan of41 a health carrier that:42 (1) requires a covered person to receive; or

EH 1004—LS 7088/DI 104

22

1 (2) creates incentives, including financial incentives, for a2 covered person to receive;3 health care services from one (1) or more providers that are under4 contract with, managed by, or owned by the health carrier.5 Sec. 7. As used in this chapter, "nonemergency health care6 service" means a discrete service or series of services ordered by7 a practitioner for an episode of care for the purpose of:8 (1) diagnosis;9 (2) prevention;

10 (3) treatment;11 (4) cure; or12 (5) relief;13 of a physical, mental, or behavioral health condition, illness, injury,14 or disease that is not provided on an emergency or urgent care15 basis.16 Sec. 8. As used in this chapter, "practitioner" means an17 individual or entity duly licensed or legally authorized to provide18 health care services.19 Sec. 8.5. As used in this chapter, "price" means the negotiated20 rate between the:21 (1) provider facility and practitioner; and22 (2) covered individual's primary health carrier.23 Sec. 9. As used in this chapter, "provider" means:24 (1) a provider facility; or25 (2) a practitioner.26 Sec. 10. As used in this chapter, "provider facility"means any of27 the following:28 (1) A hospital licensed under IC 16-21-2.29 (2) An ambulatory outpatient surgery center licensed under30 IC 16-21-2.31 (3) An abortion clinic licensed under IC 16-21-2.32 (4) A birthing center licensed under IC 16-21-2.33 (5) Except for an urgent care facility, a facility that provides34 diagnostic services to the medical profession or the general35 public, including outpatient facilities.36 (6) A laboratory where clinical pathology tests are carried out37 on specimens to obtain information about the health of a38 patient.39 (7) A facility where radiologic and electromagnetic images are40 made to obtain information about the health of a patient.41 (8) An infusion center that administers intravenous42 medications.

EH 1004—LS 7088/DI 104

23

1 Sec. 10.5. (a) As used in this chapter, "urgent care facility"2 means a freestanding health care facility that offers episodic,3 walk-in care for the treatment of acute, but not life threatening,4 health conditions.5 (b) The term does not include an emergency department of a6 hospital or a nonprofit or government operated health clinic.7 Sec. 11. (a) This section does not:8 (1) apply to a individual who is a Medicaid recipient; or9 (2) limit the authority of a legal representative of the patient.

10 (b) An individual for whom a nonemergency health care service11 has been ordered may request from the provider facility in which12 the health care service will be provided a good faith estimate of the13 price that will be charged as a result of the nonemergency health14 care service.15 (c) A provider facility that receives a request from an individual16 under subsection (b) shall, not more than five (5) business days17 after receiving all the relevant information from the individual,18 provide to the individual a good faith estimate of:19 (1) the price that the provider facility in which the health care20 service will be performed will charge for:21 (A) the use of the provider facility to care for the22 individual for the nonemergency health care service;23 (B) the services rendered by the staff of the provider24 facility in connection with the nonemergency health care25 service; and26 (C) medication, supplies, equipment, and material items to27 be provided to or used by the individual while the28 individual is present in the provider facility in connection29 with the nonemergency health care service; and30 (2) the price charged for the services of all practitioners,31 support staff, and other persons who provide professional32 health services:33 (A) who may provide services to or for the individual34 during the individual's presence in the provider facility for35 the nonemergency health care service; and36 (B) for whose services the individual will be charged37 separately from the charge of the provider facility.38 (d) The price that must be included in a good faith estimate39 under this section includes all services under subsection (c)(1) or40 (c)(2) for imaging, laboratory services, diagnostic services, therapy,41 observation services, and other services expected to be provided to42 the individual for the episode of care.

EH 1004—LS 7088/DI 104

24

1 (e) A provider facility shall ensure that a good faith estimate2 states that:3 (1) an estimate provided under this section is not binding on4 the provider facility;5 (2) the price the provider facility charges the individual may6 vary from the estimate based on the individual's medical7 needs; and8 (3) the estimate provided under this section is only valid for9 thirty (30) days.

10 (f) A provider facility may not charge a patient for information11 provided under this section.12 Sec. 12. (a) If:13 (1) the individual who requests a good faith estimate from a14 provider facility under this chapter and has been verified as15 a covered individual with respect to a network plan; and16 (2) the provider facility from which the individual requests17 the good faith estimate is in network with respect to the same18 network plan;19 the good faith estimate that the provider facility provides to the20 individual under this chapter must be based on the price to which21 the provider facility and any practitioners referred to in section22 11(c)(2) of this chapter have agreed as in network providers.23 (b) If the individual who requests a good faith estimate from a24 provider facility under this chapter:25 (1) is not a covered individual with respect to any network26 plan; or27 (2) is not a covered individual with respect to a network plan28 with respect to which the provider facility is in network;29 the good faith estimate that the provider facility provides to the30 individual under this chapter must be based on the price that the31 provider facility and any practitioners referred to in section32 11(c)(2) of this chapter charge for the nonemergency health care33 services in the absence of any network plan.34 Sec. 13. A provider facility may provide a good faith estimate to35 an individual under this chapter:36 (1) in a writing delivered to the individual;37 (2) by electronic mail; or38 (3) through a mobile application or other Internet web based39 method, if available;40 according to the preference expressed by the individual.41 Sec. 14. (a) A good faith estimate provided by a provider facility42 to an individual under this chapter must:

EH 1004—LS 7088/DI 104

25

1 (1) provide a summary of the services and material items that2 the good faith estimate is based on; and3 (2) include a total figure that is a sum of the estimated prices4 referred to in subdivision (1).5 (b) Subsection (a) does not prohibit a provider facility from6 providing to an individual a good faith estimate that indicates how7 much of the total figure stated under subsection (a)(2) will be the8 individual's out-of-pocket expense after the health carrier's9 payment of charges.

10 (c) A health carrier or practitioner must provide a provider11 facility with the information needed by the provider facility to12 comply with the requirements under this chapter not more than13 two (2) business days after receiving the request.14 (d) A provider facility is not subject to the penalties under15 section 17 of this chapter if:16 (1) a health carrier or practitioner fails to provide the17 provider facility with the information as required under18 subsection (c);19 (2) the provider facility provides the individual with a good20 faith estimate based on any information that the provider21 facility has; and22 (3) the provider facility provides the individual with an23 updated good faith estimate after the health carrier or24 practitioner has provided the information required under25 subsection (c).26 Sec. 15. (a) As used in this section, "waiting room" means a27 space in a building used by a provider facility in which people28 check in or register to:29 (1) be seen by practitioners; or30 (2) meet with members of the staff of the provider facility.31 (b) A provider facility shall ensure that each waiting room of the32 provider facility includes at least one (1) printed notice that:33 (1) is designed, lettered, and positioned within the waiting34 room so as to be conspicuous to and readable by any35 individual with normal vision who visits the waiting room;36 and37 (2) states the following, or words to the same effect: "A38 patient may ask for an estimate of the amount the patient will39 be charged for a nonemergency medical service provided in40 this facility. The law requires that an estimate be provided41 within 5 business days.".42 (c) If a provider facility maintains an Internet web site, the

EH 1004—LS 7088/DI 104

26

1 provider facility shall ensure that the Internet web site includes at2 least one (1) printed notice that:3 (1) is designed, lettered, and featured on the Internet web site4 so as to be conspicuous to and readable by any individual with5 normal vision who visits the Internet web site; and6 (2) states the following, or words to the same effect: "A7 patient may ask for an estimate of the amount the patient will8 be charged for a nonemergency medical service provided in9 our facility. The law requires that an estimate be provided

10 within 5 business days.".11 Sec. 16. If:12 (1) a provider facility receives a request for a good faith13 estimate under this chapter; and14 (2) the patient is eligible for Medicare coverage;15 the provider facility shall provide a good faith estimate to the16 patient within five (5) business days based on available Medicare17 rates.18 Sec. 17. (a) If a provider facility fails or refuses:19 (1) to provide a good faith estimate as required by this20 chapter; or21 (2) to provide notice on the provider facility's Internet web22 site as required under this chapter;23 the insurance commissioner may, after notice and hearing under24 IC 4-21.5, impose on the provider facility a civil penalty of not25 more than one thousand dollars ($1,000) for each violation.26 (b) A civil penalty collected under this section shall be deposited27 in the department of insurance fund established by IC 27-1-3-28.28 SECTION 23. IC 27-2-25 IS ADDED TO THE INDIANA CODE29 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE30 JULY 1, 2020]:31 Chapter 25. Health Carrier Good Faith Estimates32 Sec. 1. As used in this chapter, "coverage" means the right of an33 individual to receive:34 (1) health care services; or35 (2) payment or reimbursement for health care services;36 from a health carrier.37 Sec. 2. As used in this chapter, "covered individual" means an38 individual who is entitled to coverage from a health carrier.39 Sec. 2.5. As used in this chapter, "episode of care" means the40 medical care ordered to be provided for a specific medical41 procedure, condition, or illness.42 Sec. 3. As used in this chapter, "good faith estimate" means a

EH 1004—LS 7088/DI 104

27

1 health carrier's reasonable estimate of:2 (1) the amount of the cost of a nonemergency health care3 service that the health carrier will:4 (A) pay for; or5 (B) reimburse to;6 a covered individual; or7 (2) the applicable benefit limitations of the nonemergency8 health care service a covered individual is entitled to receive;9 that a health carrier provides upon request to a covered individual

10 for whom a nonemergency health care service has been ordered.11 Sec. 4. (a) As used in this chapter, "health carrier" means an12 entity:13 (1) that is subject to this title and the administrative rules14 adopted under this title; and15 (2) that enters into a contract to:16 (A) provide health care services;17 (B) deliver health care services;18 (C) arrange for health care services; or19 (D) pay for or reimburse any of the costs of health care20 services.21 (b) The term also includes the following:22 (1) An insurer, as defined in IC 27-1-2-3(x), that issues a23 policy of accident and sickness insurance, as defined in24 IC 27-8-5-1(a).25 (2) A health maintenance organization, as defined in26 IC 27-13-1-19.27 (3) An administrator (as defined in IC 27-1-25-1(a)) that is28 licensed under IC 27-1-25.29 (4) A state employee health plan offered under IC 5-10-8.30 (5) A short term insurance plan (as defined by IC 27-8-5.9-3).31 (6) Any other entity that provides a plan of health insurance,32 health benefits, or health care services.33 Sec. 5. As used in this chapter, "in network", when used in34 reference to a practitioner, means that the health care services35 provided by the practitioner are subject to a health carrier's36 network plan.37 Sec. 6. (a) As used in this chapter, "network" means a group of38 provider facilities and practitioners that:39 (1) provide health care services to covered individuals; and40 (2) have agreed to, or are otherwise subject to, maximum41 limits on the prices for the health care services to be provided42 to the covered individuals.

EH 1004—LS 7088/DI 104

28

1 (b) The term includes the following:2 (1) A network described in subsection (a) that is established3 pursuant to a contract between an insurer providing coverage4 under a group health policy and:5 (A) individual provider facilities and practitioners;6 (B) a preferred provider organization; or7 (C) an entity that employs or represents providers,8 including:9 (i) an independent practice association; and

10 (ii) a physician-hospital organization.11 (2) A health maintenance organization, as defined in12 IC 27-13-1-19.13 Sec. 7. As used in this chapter, "network plan" means a plan of14 a health carrier that:15 (1) requires a covered person to receive; or16 (2) creates incentives, including financial incentives, for a17 covered person to receive;18 health care services from one (1) or more providers that are under19 contract with, managed by, or owned by the health carrier.20 Sec. 8. As used in this chapter, "nonemergency health care21 service" means a discrete service or series of services ordered by22 a practitioner for an episode of care for the:23 (1) diagnosis;24 (2) prevention;25 (3) treatment;26 (4) cure; or27 (5) relief;28 of a physical, mental, or behavioral health condition, illness, injury,29 or disease that is not provided on an emergency or urgent care30 basis.31 Sec. 9. As used in this chapter, "practitioner" means an32 individual or entity duly licensed or legally authorized to provide33 health care services.34 Sec. 9.5. As used in this chapter, "price" means the negotiated35 rate between the:36 (1) provider facility and practitioner; and37 (2) covered individual's primary health carrier;38 minus the amount that the health carrier will pay.39 Sec. 10. As used in this chapter, "provider" means:40 (1) a provider facility; or41 (2) a practitioner.42 Sec. 11. As used in this chapter, "provider facility"means any of

EH 1004—LS 7088/DI 104

29

1 the following:2 (1) A hospital licensed under IC 16-21-2.3 (2) An ambulatory outpatient surgery center licensed under4 IC 16-21-2.5 (3) An abortion clinic licensed under IC 16-21-2.6 (4) A birthing center licensed under IC 16-21-2.7 (5) Except for an urgent care facility (as defined by8 IC 27-1-46-10.5), a facility that provides diagnostic services to9 the medical profession or the general public.

10 (6) A laboratory where clinical pathology tests are carried out11 on specimens to obtain information about the health of a12 patient.13 (7) A facility where radiologic and electromagnetic images are14 made to obtain information about the health of a patient.15 (8) An infusion center that administers intravenous16 medications.17 Sec. 12. (a) A covered individual for whom a nonemergency18 health care service has been ordered may request from the health19 carrier a good faith estimate of:20 (1) the amount of the cost of the nonemergency health care21 service that the health carrier will:22 (A) pay for; or23 (B) reimburse to;24 the covered individual; or25 (2) the applicable benefit limitations of the ordered26 nonemergency health care service a covered individual is27 entitled to receive from the health carrier.28 (b) If:29 (1) a health carrier provides coverage to a covered individual30 through a network plan; and31 (2) the health carrier receives a request for a good faith32 estimate from a covered individual for whom a nonemergency33 health care service has been ordered;34 the health carrier shall inform the covered individual whether the35 provider facility in which the nonemergency health care service36 will be provided is in network and whether each scheduled37 practitioner who may provide the nonemergency health care38 service is in network.39 (c) A health carrier that receives a request from a covered40 individual patient under subsection (b) shall, not more than five (5)41 business days after receiving all the relevant information, provide42 to the individual a good faith estimate as described in section 14 of

EH 1004—LS 7088/DI 104

30

1 this chapter.2 (d) A health carrier must ensure that a good faith estimate3 states that the estimate provided under this section is only valid for4 thirty (30) days and that:5 (1) the amount that the health carrier will:6 (A) pay; or7 (B) reimburse;8 for or to the covered individual for the nonemergency health9 care services the individual receives; and

10 (2) the applicable benefit limitations of the nonemergency11 health care services the individual will receive;12 may vary from the health carrier's good faith estimate based on13 the individual's medical needs.14 (e) A health carrier may not charge an individual for15 information provided under this section.16 (f) A practitioner and provider facility shall provide a health17 carrier with the information needed by the health carrier to18 comply with the requirements under this chapter not more than19 two (2) business days after receiving the request.20 Sec. 13. A health carrier may provide a good faith estimate to an21 individual under this chapter:22 (1) in a writing delivered to the individual;23 (2) by electronic mail; or24 (3) through a mobile application or other Internet web based25 method, if available;26 according to the preference expressed by the individual.27 Sec. 14. (a) A good faith estimate provided by a health carrier28 to an individual under this chapter must:29 (1) in the case of an insurer or another health carrier that30 pays or reimburses the cost of health care services:31 (A) provide a summary of the services and material items32 that the good faith estimate is based on;33 (B) include a total figure that is a sum of the amounts34 referred to in clause (A); and35 (C) state the out-of-pocket costs the covered individual will36 incur, if any, beyond the amount that the health carrier37 will pay or reimburse; and38 (2) in the case of a health maintenance organization or39 another health carrier that provides health care services:40 (A) provide a summary of the applicable benefit limitations41 of the health care services to which the covered individual42 is entitled; and

EH 1004—LS 7088/DI 104

31

1 (B) state the out-of-pocket costs the covered individual will2 incur, if any, beyond being provided the health care3 services referred to in clause (A).4 (b) A practitioner and provider facility shall provide a health5 carrier with the information needed by the health carrier to6 comply with the requirements under this chapter not more than7 two (2) business days after receiving the request.8 (c) A health carrier is not subject to the penalties under section9 16 of this chapter if:

10 (1) a provider facility or practitioner fails to provide the11 health carrier with the information as required under12 subsection (b);13 (2) the health carrier provides the individual with a good faith14 estimate based on any information that the health carrier has;15 and16 (3) the health carrier provides the individual with an updated17 good faith estimate after the provider facility or practitioner18 has provided the information required under subsection (b).19 Sec. 15. A health carrier that provides an Internet web site for20 the use of its covered individuals shall ensure that the Internet web21 site includes a printed notice that:22 (1) is designed, lettered, and featured on the Internet web site23 so as to be conspicuous to and readable by any individual with24 normal vision who visits the Internet web site; and25 (2) states the following, or words to the same effect: "A26 covered individual may at any time ask the health carrier for27 an estimate of the amount the health carrier will pay for or28 reimburse to a covered individual for nonemergency health29 care services that have been ordered for the covered30 individual or the applicable benefit limitations of the ordered31 nonemergency health care services a covered individual is32 entitled to receive from the health carrier. The law requires33 that an estimate be provided within 5 business days.".34 Sec. 16. (a) If a health carrier fails or refuses:35 (1) to provide a good faith estimate as required by this36 chapter; or37 (2) to provide notice on the health carrier's Internet web site38 as required by section 15 of this chapter;39 the insurance commissioner may, after notice and hearing under40 IC 4-21.5, impose on the health carrier a civil penalty of not more41 than one thousand dollars ($1,000) for each day of noncompliance.42 (b) A civil penalty collected under this section shall be deposited

EH 1004—LS 7088/DI 104

32

1 in the department of insurance fund established by IC 27-1-3-28.2 SECTION 24. [EFFECTIVE JULY 1, 2020] (a) As used in this3 SECTION, "department" refers to the department of insurance.4 (b) The following shall submit, before September 1, 2021, a5 report described in this SECTION to the department and the6 general assembly in an electronic format under IC 5-14-6:7 (1) An insurer (as defined in IC 27-1-2-3) that issues a policy8 of accident and sickness insurance (as defined in IC 27-8-5-1).9 (2) A health maintenance organization (as defined in

10 IC 27-13-1-19).11 (c) The report must include an estimate of the total reduction in12 reimbursement for health service claims that were appropriately13 billed as being provided in an office setting under IC 16-51-1-9, as14 added by this act, instead of being billed as being provided in an15 institutional setting.16 (d) This SECTION expires December 31, 2021.

EH 1004—LS 7088/DI 104

33

COMMITTEE REPORT

Mr. Speaker: Your Committee on Insurance, to which was referredHouse Bill 1004, has had the same under consideration and begs leaveto report the same back to the House with the recommendation that saidbill be amended as follows:

Delete everything after the enacting clause and insert the following:

(SEE TEXT OF BILL)

and when so amended that said bill do pass.

(Reference is to HB 1004 as introduced.)

CARBAUGH

Committee Vote: yeas 12, nays 0.

_____

COMMITTEE REPORT

Madam President: The Senate Committee on Health and ProviderServices, to which was referred House Bill No. 1004, has had the sameunder consideration and begs leave to report the same back to theSenate with the recommendation that said bill be AMENDED asfollows:

Delete everything after the enacting clause and insert the following:

(SEE TEXT OF BILL)

and when so amended that said bill do pass.

(Reference is to HB 1004 as printed January 24, 2020.)

CHARBONNEAU, Chairperson

Committee Vote: Yeas 8, Nays 4.

EH 1004—LS 7088/DI 104