Health care matters.

New excise tax imposed on nonprofit hospitals charging facility fees exceeding 265% of Medicare rates for qualifying patients not enrolled in Medicare.

Removed provisions related to the payer affordability penalty fund and disproportionate share provider definitions that were part of the original enrolled version.

Tax applies to facility fees charged after December 31, 2025, with graduated tax rates: 33% in 2026, 66% in 2027, and 100% from 2028 onward.

Collected taxes deposited into a state general fund account to be used for Medicaid program costs and developing healthcare workforce in rural areas.

Nonprofit hospitals must submit annual reports comparing their charges to Medicare reimbursement rates and provide Schedule H portions of federal Form 990 to the health care cost oversight task force.

Hospitals charging facility fees exceeding 300% of Medicare rates forfeit their nonprofit hospital status and are subject to annual audits by the department of state revenue.

Added specific definitions for 'hospital', 'facility fee', 'qualifying patient', and 'Medicare facility fee' to clarify tax applicability.

Critical access hospitals are excluded from the excise tax statute.

The enrolled version adds the full statutory text with specific section numbers and code citations, replacing the digest summary found in the engrossed version.

The enrolled version confirms the effective date as upon passage, with specific provisions taking effect July 1, 2025, and includes detailed implementation timelines for various requirements.

The enrolled version establishes a payer affordability penalty fund to receive fines and allocate them to Medicaid and hospital impact studies, with specific rules on fund administration and investment.

The enrolled version adds detailed requirements for disproportionate share provider determinations, including specific utilization rate calculations and exceptions for certain providers.

The enrolled version includes new requirements for hospitals to submit financial statements, limits on community benefits, and price study requirements for commercial inpatient and outpatient hospital prices.

The enrolled version adds enforcement mechanisms including license revocation for failure to submit financial statements and forfeiture of nonprofit status for certain hospital price violations.

Removed the hospital facility fee excise tax that would have imposed 33-100% taxes on hospitals charging qualifying patients fees exceeding 265% of Medicare rates

Modified funding provisions to allow incremental hospital fee fund to be used for Medicaid program instead of separate excise tax account

Added requirements for hospitals to submit audited financial statements with potential license revocation for non-compliance

Added mandate for state to study commercial hospital prices and require nonprofit hospital systems to match statewide average pricing by 2029

Added insurance transparency requirements including commission disclosures to policyholders and drug rebate information notices

Added specific deadlines including June 30, 2026 for hospital pricing study and January 1, 2026 for drug cost disclosure requirements

New hospital facility fee excise tax established, replacing the previous focus on community benefit definitions and nonprofit status forfeiture.

Excise tax revenues designated for Medicaid program purposes and developing healthcare workforce in rural Indiana areas.

Threshold for nonprofit status forfeiture changed from 200% of Medicare reimbursement rate to 300% of modified Medicare reimbursement rate.

New definitions added for 'facility fee', 'qualifying patient', 'Medicare facility fee', and 'hospital' to support the excise tax provisions.

Tax rates phased in over three years: 33% in 2026, 66% in 2027, and 100% in 2028 and beyond.

Reporting requirements for nonprofit hospitals modified to include Schedule H Form 990 data with the health care cost oversight task force and general assembly website.

Department of state revenue now responsible for collecting and auditing hospital facility fee excise taxes, replacing the secretary of state's audit authority.

Critical access hospitals explicitly excluded from the excise tax statute.