Bill

HB 1003

Health matters.

2025 Regular Session Introduced by Brad Barrett and 5 co-sponsors

House Bill 1003 strengthens Medicaid fraud prevention, enhances care quality, and mandates transparent billing, improving health care integrity and patient outcomes in Indiana.

Public Law 215

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Bill Summary · HB 1003

Summary of House Bill 1003: Health Matters

Bill Information:
- Bill Number: HB 1003
- Title: Health Matters
- Status: Signed by the Governor on May 6, 2025
- Introduced: January 21, 2025
- Effective Date: July 1, 2025

Purpose and Intent

House Bill 1003 aims to enhance the oversight and regulation of health care practices in Indiana, particularly focusing on Medicaid fraud prevention, transparency in health care billing, and improving patient care outcomes. The bill seeks to empower the state Medicaid fraud control unit (MFCU) and establish new standards for health care providers and insurers.

Key Provisions

Medicaid Fraud Control Unit (MFCU) Enhancements:
- Expands the MFCU's authority to investigate various forms of Medicaid fraud, including provider fraud, insurer fraud, and duplicate billing.
- Allows the Attorney General to designate MFCU investigators as law enforcement officers, enhancing their investigative capabilities.
Data Sharing Agreements:
- Permits the Attorney General to enter into data-sharing agreements with state agencies, enabling the MFCU to analyze data for fraud investigations.
Confidentiality of Complaints:
- Establishes that all complaints made to the MFCU remain confidential until an action is filed regarding the complaint.
Quality of Care Metrics:
- Requires the Office of the Secretary of Family and Social Services to develop metrics for assessing the quality of care and patient outcomes in long-term care managed care programs.
Transparency in Health Care Billing:
- Mandates clinical laboratories and diagnostic imaging facilities to post pricing information for services by December 31, 2025.
- Requires good faith estimates for health care services to be provided at least two business days before services are scheduled (reduced from five days).
Individualized Investigational Treatment:
- Allows manufacturers to provide and patients to receive individualized investigational treatment under certain conditions.
Billing and Reimbursement Regulations:
- Specifies that out-of-network practitioners providing non-emergency services at in-network facilities cannot be reimbursed more than the 2019 median in-network rate.
- Prohibits health plans from rescinding prior authorizations within one year of approval.
Prior Authorization Process:
- Ensures that adverse determinations on prior authorization requests are made by clinical peers of the requesting provider.
Consumer Protection Measures:
- Prohibits insurers from denying claims based on the referring provider being an out-of-network direct primary care provider or independent physician.
Provisional Credentialing:
- Requires insurers to provisionally credential fully qualified physicians for 60 days when they change employers or relocate their practice.

Impact

This legislation is expected to significantly improve the integrity of Medicaid services in Indiana by enhancing fraud prevention measures and increasing accountability among health care providers. It aims to provide better transparency in health care costs, ultimately benefiting patients by ensuring they receive quality care and clear information about their health services.

Procedural Timeline

January 21, 2025: Introduced and referred to the Committee on Insurance.
February 4, 2025: Amended and reported as "Do Pass."
April 10, 2025: Further amendments and reported favorably.
April 24, 2025: Conference Committee Report adopted by both the House and Senate.
May 6, 2025: Signed into law by the Governor.