SB0173 IN introduced

Health care matters.

privacy

Plain-English summary

1. **ONE-SENTENCE SUMMARY:** This bill addresses various healthcare regulations, including anesthesia coverage, reporting requirements for nonprofit hospitals, and restrictions on insurance practices.

2. **KEY REQUIREMENTS:**
   - Nonprofit hospitals must report specific information to the Indiana Department of Health and post it on their websites.
   - Practitioners can provide neuroplastogen treatments under certain conditions and must report adverse events and patient statistics.
   - Health insurers cannot use AI as the sole basis for adverse determinations and must follow specific rules for downcoding claims.
   - Insurers cannot label a drug as a specialty drug without meeting defined criteria.

3. **DEADLINES:**
   - The bill is currently introduced and does not specify an effective date; monitor for updates on when it may be enacted.

4. **PENALTIES:**
   - Increased penalties for nonprofit hospitals failing to file required reports, with fines deposited into the local public health fund.
   - The Department of Insurance can enforce downcoding requirements and impose penalties for violations.

5. **SMB IMPACT:** Small businesses in the healthcare sector, particularly those working with nonprofit hospitals or insurance providers, will need to ensure compliance with new reporting and treatment protocols, potentially increasing administrative responsibilities. Additionally, insurance practices may affect how small businesses manage healthcare costs and claims.

Source description

Health care matters. Prohibits: (1) the state employee health plan; (2) the Medicaid program; (3) an accident and sickness insurance policy; and (4) a health maintenance organization individual or group contract; from imposing a time limit on the amount of anesthesia time for a medical procedure or otherwise restricting or excluding coverage or payment of anesthesia time. Modifies the definitions of "charity care" and "community benefits" for purposes of certain hospital reporting requirements. Requires additional reporting of information by nonprofit hospitals to the Indiana department of health (state department). Requires the report to be posted on the nonprofit hospital's website and the state department's website. Increases the penalty for failure to file the report and changes the time frame in which the penalty may be assessed. Specifies that any penalty be deposited in the local public health fund. Allows for certain practitioners to provide neuroplastogen treatment concerning qualified patients with life threatening conditions if certain requirements are met. Allows for research to be conducted on neuroplastogen access. Requires reporting of adverse events and annual reporting of patient statistical information concerning the neuroplastogen treatment. Provides for immunity when treating using neuroplastogens. Requires a clinical peer to disclose certain information for a peer to peer review of an adverse determination. Prohibits a utilization review entity from using artificial intelligence as the primary means for making adverse determinations. Prohibits a health insurer from engaging in certain downcoding practices and sets forth conditions for downcoding a claim. Authorizes the department of insurance to enforce the downcoding requirements and impose certain penalties for a violation. Prohibits an insurer, pharmacy benefit manager, or other administrator of pharmacy benefits from designating a prescription drug as a specialty drug unless certain conditions are met.

Not legal advice. Summaries are generated by AI from publicly available bill text and may contain errors or omissions. Always consult counsel before making compliance decisions.