Establishes the prescription drug assistance program for the elderly (program) to be administered by the division of aging. Sets forth requirements of the program. Establishes the prescription drug assistance program for the elderly fund. Creates a Class A misdemeanor for fraud under the program.
Requires, upon issuance and renewal of a policy, an insurer to provide a directory of providers with which the insurer has entered into a reimbursement agreement to an insured or prospective insured. (Under current law, an insurer may provide a directory of providers to an insured.) Provides that: (1) a directory of providers provided by an insurer must include every provider that has entered into a reimbursement agreement with the insurer; and (2) a list of providers provided by a health maintenance organization must include every provider who provides health care services through the health maintenance organization.
Provides a credit against state tax liability for expenses incurred in the manufacture of a small modular nuclear reactor (SMR) in Indiana. Establishes procedures under which certain energy utilities may request approval for one or more of the following from the Indiana utility regulatory commission (IURC): (1) An expedited generation resource plan (EGR plan) to meet customer load growth that exceeds a specified threshold. (2) A generation resource submittal for the acquisition of a specific generation resource in accordance with an approved EGR plan. (3) A project to serve one or more large load customers. Sets forth: (1) the requirements for approval of each of these types of requests; (2) standards for financial assurances by large load customers; and (3) cost recovery mechanisms for certain acquisition costs or project costs incurred by energy utilities. Amends the statute concerning public utilities' annual electric resource planning reports to the IURC to provide that for an annual report submitted after December 31, 2025, a public utility must include information as to the amount of generating resource capacity or energy that the public utility plans to retire or refuel with respect to any electric generation resource of at least 125 megawatts. Provides that for any planned retirement or refueling, the public utility must include, along with other specified information, information as to the public utility's plans with respect to the following: (1) For a retirement, the amount of replacement capacity identified to provide approximately the same accredited capacity within the appropriate regional transmission organization (RTO) as the capacity of the facility to be retired. (2) For a refueling, the extent to which the refueling will maintain or increase the current generating resource accredited capacity or energy that the electric generating facility provides, so as to provide approximately the same accredited capacity within the appropriate RTO. Requires IURC staff to prepare a staff report for each public utility report that includes a planned electric generation resource retirement. Provides that if, after reviewing a public utility's report and any related staff report, the IURC is not satisfied that the public utility can satisfy both its planning reserve margin requirement and the statute's prescribed reliability adequacy metrics, the IURC shall conduct an investigation into the reasons for the public utility's inability to meet these requirements. Provides that if the public utility's report indicates that the public utility plans to retire an electric generating facility within one year of the date of the report, the IURC must conduct such an investigation. Provides that: (1) a public utility may request, not earlier than three years before the planned retirement date of an electric generation facility, that the IURC conduct an investigation into the planned retirement; and (2) if the IURC conducts an investigation at the request of the public utility within that three year period, the IURC may not conduct a subsequent investigation that would otherwise be required under the bill's provisions unless the IURC is not satisfied that the public utility can satisfy both its planning reserve margin requirement and the statutory reliability adequacy metrics as of the time the investigation would otherwise be required. Provides that if a CPCN is granted by the IURC for a facility intended to repower or replace a generation unit that is planned for retirement, and the CPCN includes findings that the project will result in at least equivalent accredited capacity and will provide economic benefit to ratepayers as compared to the continued operation of the generating unit to be retired, the CPCN constitutes approval by the IURC for purposes of an investigation that would otherwise be required. Provides that if, after an investigation, the IURC determines that the capacity resources available to the public utility will not be adequate to allow the public utility to satisfy both its planning reserve margin requirements and the statute's prescribed reliability adequacy metrics, the IURC shall issue an order: (1) directing the public utility to acquire or construct; or (2) prohibiting the retirement or refueling of; such capacity resources that are reasonable and necessary to enable the public utility to meet these requirements. Provides that if the IURC does not issue an order in an investigation within 120 days after the initiation of the investigation, the public utility is considered to be able to satisfy both its planning reserve margin requirement and the statutory reliability adequacy metrics with respect to the retirement of the facility under investigation. Provides that if the IURC issues an order to prohibit the retirement or refueling of an electric generation resource, the IURC shall create a sub-docket to authorize the public utility to recover in rates the costs of the continued operation of the electric generation resource proposed to be retired or refueled, subject to a finding by the IURC that the continued costs of operation are just and reasonable. Makes a technical change to another Indiana Code section to recognize the redesignation of subsections within the section containing these provisions.
Provides that the director of the state personnel department may make a determination to provide coverage under the state employee health plan for emergency medical services as part of a mobile integrated healthcare program. Provides that the requirement for a policy of accident and sickness insurance and a health maintenance organization contract to provide reimbursement for emergency medical services includes emergency medical services that are performed or provided as part of a mobile integrated healthcare program. Repeals a provision that requires the department of insurance to maintain an electronic system for the collection and storage of information concerning transactions involving residential property. Provides that the article regarding consumer data protection does not apply to any organization exempt from taxation under Section 501(c)(4) of the Internal Revenue Code that is: (1) established to detect or prevent insurance related crime or fraud; and (2) subject to a memorandum of understanding with a statewide law enforcement agency. Changes the deadline for the Indiana Public Employers' Plan, Inc., to apply to the insurance commissioner for a certificate of authority to transact business as a domestic tax exempt reciprocal insurance company from before December 31, 2026, to before December 31, 2030. Repeals the statute requiring carriers of health insurance plans to conduct annual public forums. Provides that provisions requiring a notice of material change apply to personal automobile or homeowner's policies that are issued, delivered, amended, or renewed after June 30, 2026. Amends the definition of "small employer" in the chapter regarding small employer group health insurance. Makes corresponding changes.
Establishes: (1) a state directed payment program (program) for hospitals; and (2) a managed care assessment fee. Changes disproportionate share payments when a state directed payment program is in effect. Allows the incremental hospital fee fund to be used to fund the Medicaid program. Requires a nonprofit hospital system to submit audited financial statements. Provides for a $10,000 per day penalty for failure to submit the hospital's financial statements. Requires the office of management and budget (office) to: (1) develop a methodology to be used in conducting a study of commercial inpatient hospital prices and outpatient hospital prices; and (2) upon budget committee review, conduct the study to determine Indiana's statewide average inpatient and outpatient hospital prices. Requires the office to submit a report of the study to the governor and general assembly. Before June 30, 2029, requires an Indiana nonprofit hospital system's aggregate average inpatient and outpatient hospital prices to at least be equal to or less than the statewide average. States that a violation by the Indiana nonprofit hospital system results in a forfeiture of its nonprofit status. Requires, before October 1 of each year, every nonprofit hospital to provide the Indiana department of health with specified federally filed forms and specified data used to complete the forms. Requires the Indiana department of health to submit these forms to the health care cost oversight task force and impose a fine of $10,000 per day on a nonprofit hospital for failure to submit the nonprofit hospital's forms. Provides an exemption from health care billing requirements for a facility located in a specified populated municipality. Requires a third party administrator to disclose commissions and fees to policyholders in a separate notification. Requires an insurer and a health maintenance organization to submit specified data information to the all payer claims data base. Requires an insurance producer or third party administrator to, before or at the time of sale, provide the plan sponsor with a statement from the insurer or health maintenance organization, disclosing commissions and fees that the insurance producer or third party administrator will receive. Changes the time frame in which certain information and claims data must be submitted to a contract holder as part of an audit or claims data request. Sets requirements for certain hospitals concerning a direct to employer health care arrangement. Beginning January 1, 2026, requires a state employee health plan, a policy of accident and sickness insurance, and a health maintenance organization contract to provide a plan sponsor with the national average drug acquisition cost of a generic drug. States that if an agreement between a health plan and a pharmacy benefit manager provides that less than 85% of the estimated rebates will be deducted from the cost of prescription drugs before a covered individual's cost sharing requirement is determined, the pharmacy benefit manager must provide the policyholder with an annual notice that includes: (1) an explanation of what a rebate is; (2) an explanation of how rebates accrue to the health plan from the manufacturer; and (3) the aggregate amount of rebates that accrued to the health plan for prescription drugs dispensed under the policyholder's health plan for the previous year. Places limitations on hospital health provider contracts linking to or negotiating reimbursement or terms under a separate hospital health care provider contract or product. Requires the office to: (1) study the effect, including the fiscal impact, of requiring physician reimbursement rates under a commercial policy to be set at a minimum reimbursement rate; and (2) report its findings under the study. Requires certain health carriers to provide claims data to a contract holder not more than four times per year (current law allows for the provision of the data twice annually). Requires certain insurers and health maintenance organizations to file specified information concerning changes in hospital reimbursement to the department of insurance.
Specifies the persons that may file an action to obtain an injunction against an individual practicing dentistry without a license and the action that is required or allowed to be included in an injunction. Specifies information that a dentist who maintains a dental office must submit to the state board of dentistry. States that language concerning the administration of dental anesthetics may not be construed to prohibit a physician from practicing in a dental office. Allows a dentist to delegate the authority to take x-ray images to a dental assistant working in certain correctional facilities without direct supervision as long as the dentist is available to supervise the dental assistant remotely. Removes certain language regarding the regulation of dentists.
Sets forth requirements for a utilization review entity that requires prior authorization of a health care service. Prohibits a utilization review entity from requiring prior authorization for the first 12 physical therapy or chiropractic visits of each new episode of care. Provides that a claim for reimbursement for a covered service or item provided to an insured or enrollee may not be denied on the sole basis that the referring provider is an out of network provider. Repeals superseded provisions regarding prior authorization. Makes corresponding changes.
Requires the office of the secretary of family and social services (office) to report specified Medicaid data to the Medicaid oversight committee. Requires the office to annually prepare and present a report to the budget committee concerning the enforcement of the Medicaid five year look back period. Prohibits specified persons from advertising or otherwise marketing the Medicaid program. Provides that the office may adopt rules concerning permissible advertising or marketing indicating participation in the Medicaid program by a person that has contracted with the office. Allows the office to reimburse medical providers at the appropriate Medicaid fee schedule rate for certified medical claims prior to the beginning of benefits, provided the claims satisfy certain conditions. Repeals language allowing for marketing of the Medicaid program. Requires the office to receive and review data from specified federal and state agencies concerning Medicaid recipients to determine whether circumstances have changed that affect Medicaid eligibility for recipients and to perform a redetermination. Requires the office to establish: (1) performance standards for hospitals that make presumptive eligibility determinations and sets out action for when hospitals do not comply with the standards; and (2) an appeals procedure for hospitals that dispute the violation determination. Sets out a hospital's responsibilities when making a presumptive eligibility determination. Imposes corrective action and restrictions for failing to meet presumptive eligibility standards. Specifies requirements, allowances, and limitations for the healthy Indiana plan.
Requires the office of the secretary of family and social services to reapply before September 1, 2025, for a Medicaid state plan amendment that provides for the establishment of the long term care partnership program and the discontinuance of the current long term care program.
Maddy summaryHR 64 is a resolution that urges the Legislative Council to assign a specific task to the Medicaid Oversight Committee. This task involves studying the use of long-term care insurance.
