Indiana House Bill 1003

---

Spectrum: Partisan Bill (Republican 3-0)
Status: Introduced on January 21 2025 - 25% progression
Action: 2025-01-21 - First reading: referred to Committee on Insurance
Pending: House Insurance Committee
Hearing: Feb 4 @ 10:30 am in Room 156-B
Text: Latest bill text (Introduced) [PDF]

Health matters. Specifies that the Medicaid fraud control unit's (MFCU) investigation of Medicaid fraud may include the investigation of provider fraud, insurer fraud, and duplicate billing. Permits the attorney general to enter into a data sharing agreement with specified state agencies and authorizes the MFCU to analyze this data to carry out its investigative duties. Provides that the attorney general may designate investigators employed within the MFCU to be law enforcement officers of the state. Requires the office of the secretary of family and social services to establish: (1) metrics to assess the quality of care and patient outcomes; and (2) transparency and accountability safeguards; for a long term care risk based managed care program. Requires the Indiana department of health (state department) to: (1) develop standards for medical record interoperability and medical data security; and (2) mandate compliance with the standards by any when billing for a prescription drug obtained under the program. Allows the state department to: (1) enforce; and (2) assess a civil penalty for violations of; these provisions. Allows: (1) a manufacturer to provide; and (2) a patient to receive; individualized investigational treatment if certain conditions are met. Sets forth disclosures. Provides that when a health carrier is in the process of negotiating a health provider contract with a health provider facility or provider, the health carrier must provide certain information to the health provider facility or provider. Requires good faith estimates for health care services, issued before July 1, 2027, to be provided at least two business days (rather than five business days) before the health care services are scheduled to be provided. Requires good faith estimates, issued after June 30, 2027, to be provided immediately. Prohibits an out-of-network practitioner providing nonemergency health care services at an in network facility from being reimbursed more for the health care services than the 2019 median in network rate with the specified adjustment. (Current law allows the practitioner to obtain additional reimbursement if certain conditions are met.) Requires a provider to provide the patient with a written list of services that the: (1) patient received; and (2) provider intends to bill the patient; upon a patient's discharge from receiving certain services. Specifies billing and payment requirements. Removes language concerning the disclosure of a trade secret from provisions that allow for a health plan sponsor to access and audit claims data. Specifies certain provisions that may not be included in a health provider contract after June 30, 2025. Prohibits a health plan from rescinding a prior authorization that the health plan has previously approved. Requires a health plan to ensure that any denial of a request for prior authorization is made by a health care provider that meets the same credentialing requirements as the health care provider who requested the prior authorization. Provides that an insurer or a health maintenance organization may not deny a claim for reimbursement for a covered service or item on the basis that the referring provider is a direct primary care provider or an independent physician and out of network. Requires, if a fully credentialed physician becomes employed with another employer or establishes or relocates a medical practice in Indiana, an insurer and health maintenance organization to provisionally credential the physician for 90 days or until the physician is fully credentialed, whichever is earlier. Requires the state department to study ways in which to expand and improve access to and the interoperability of electronic health information and provide a report with recommendations to the general assembly.

Health matters.

Rep. Bradford Barrett [R]

Rep. Matthew Lehman [R]

Rep. Tony Isa [R]

Date	Chamber	Action
2025-01-21	House	First reading: referred to Committee on Insurance
2025-01-21	House	Authored by Representative Barrett
2025-01-21	House	Coauthored by Representatives Lehman and Isa

Type	Source
Summary	https://iga.in.gov/legislative/2025/bills/house/1003/details
Text	https://iga.in.gov/pdf-documents/124/2025/house/bills/HB1003/HB1003.01.INTR.pdf
Supplement	https://iga.in.gov/pdf-documents/124/2025/house/bills/HB1003/fiscal-notes/HB1003.01.INTR.FN001.pdf