HB1004: Health care matters.

Legislative Summary

Health care matters. Establishes the health care cost oversight task force and sets forth duties of the task force. Provides a credit against state tax liability to certain physicians who have an ownership interest in a physician practice and meet other eligibility criteria. Allows a credit against the state tax liability of an employer with fewer than 50 employees if the employer has adopted a health reimbursement arrangement in lieu of a traditional employer provided health insurance plan and if the employer's contribution toward the health reimbursement arrangement meets a certain standard. Requires the office of the secretary of family and social services to research and compile data concerning Medicaid reimbursement rates for Indiana and all other states and the national reimbursement rate average. Requires the submission of a report to the health care cost oversight task force and the general assembly. Establishes the payer affordability penalty fund. Specifies additional information that a hospital must report to the Indiana department of health in the hospital's annual report and establishes a fine for a hospital that fails to timely file the report. Provides that a bill for health care services provided by certain qualified providers in an office setting must be submitted on an individual provider form. Prohibits an insurer, health maintenance organization, employer, or other person responsible for the payment of the cost of health care services from accepting a bill that is submitted on an institutional provider form. Repeals language requiring a hospital to hold a public forum. Requires the department of insurance to contract with a third party to calculate an Indiana nonprofit hospital system's prices from certain health plans for specified calendar years. Before November 1, 2024, and before November 1 each subsequent year, requires the department's third party contractor to compare certain Indiana nonprofit hospital system facility pricing information with 285% of Medicare. Requires the calculations to be submitted as a report for review. Provides that a health care provider that enters into: (1) a value-based health care reimbursement agreement; and (2) an electronic medical records access agreement; with a health plan may qualify to participate in the health plan's program to reduce or eliminate prior authorization requirements. Requires a health plan that establishes a program to reduce or eliminate prior authorization requirements to provide certain information to health care providers concerning the program. Requires a third party administrator, insurer, or health maintenance organization that has contracted with a person to administer a self-funded insurance plan or a fully insured group plan to provide claims data to the person not later than 15 days from a request for the data. Specifies certain claims data to be provided and establishes a fine for a failure to timely provide the claims data. Requires the all payer claims data base advisory board to discuss specified issues concerning reimbursement rates. Allows for the provisional credentialing of physicians who establish or join an independent primary care practice.