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Bill Summary · HB 1016

HB 1016 — Selection of Primary Care Provider (Summary)

Status (most recent): First reading; referred to Committee on Insurance (12/01/2025).
Introduced: Filed 11/12/2024 (appears in 2025–2026 legislative activity).
Jurisdiction/Topic: Indiana — Insurance law; provider selection rules.

Main purpose

Allow an insured or enrollee who must select a primary care provider (PCP) under an accident & sickness insurance policy or an HMO contract to choose a participating physical therapist (PT) or occupational therapist (OT) as the PCP for the delivery of physical therapy or occupational therapy services. The bill aims to expand direct access pathways to PT/OT services within managed plans while preserving scope-of-practice limits.

Key provisions

  • Creates a new insurance chapter (IC 27-8-24.8) and a new HMO provision (IC 27-13-37-1.5).
  • Applicability:
    • Applies to policies/contracts issued, delivered, amended, or renewed after June 30, 2026.
    • Effective date for the statute text: July 1, 2026.
  • Provider selection:
    • If a policy or HMO requires selecting a PCP, the insurer/HMO may permit an insured/enrollee to select a participating PT to provide physical therapy services or a participating OT to provide occupational therapy services.
  • Consumer information:
    • Policies and contracts must clearly state in explanatory literature that this option is available.
  • Cost protections:
    • Insurers/HMOs may not impose higher premiums, higher copayments, or other additional charges because an insured/enrollee selected a PT or OT as PCP under this provision.
  • Scope-of-practice safeguard:
    • The bill does not authorize PTs or OTs to practice beyond their statutory scope of practice (PT: IC 25‑27; OT: IC 25‑23.5).

Who is affected

  • Consumers enrolled in accident & sickness insurance policies or HMOs that require selection of a PCP — particularly patients who want PT/OT as an entry point for care.
  • Insurers and health maintenance organizations (administrative and plan design implications).
  • Participating physical therapists and occupational therapists (may be listed/recognized as PCPs for PT/OT services).
  • Employers or groups purchasing plans (if group contracts adopt the change).

Potential impacts

  • Increased access and more direct entry to PT/OT services for plan members.
  • Administrative adjustments for insurers/HMOs (policy language, provider network designation).
  • No explicit fiscal analysis in the bill text; the measure limits payor ability to charge higher cost-sharing for these selections.

Procedural / Timeline notes

  • The bill establishes its rules for new or renewed policies after June 30, 2026 and becomes effective July 1, 2026.
  • Current procedural status: at first reading and referred to the Committee on Insurance (as of 12/01/2025). Further committee action will determine next steps.

Compiled from official sources — confirm details with the bill’s official record.

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