Indiana 2025 Regular Session Status: Enacted Bipartisan · 6 R · 2 D cosponsors

HB 1004 — Health care matters.

Last action — Signed by the Governor

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed House
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced January 21, 2025. Enacted.

Signed by Governor Mike Braun (Republican) on May 06, 2025.

Odds of enactment

High chance

Based on the sponsor, cosponsors, and committee posture, this bill has a high chance of becoming law.

Upgrade to see the exact probability and what's driving it.

A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Likely to advance 78% · moderate confidence

  • Enacted

    Current position in the legislative process.

  • 8 sponsors

    3 primary, 5 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (6 R · 2 D) — cross-party backing.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

Summary

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.

Bill Text

We don't have the full text on file for this bill yet.

Read HB 1004 on the official Indiana source →

Action History

  1. Signed by the Governor

  2. Public Law 216

  3. Signed by the President of the Senate

  4. Signed by the President Pro Tempore

  5. Signed by the Speaker

  6. Senator Charbonneau added as conferee

  7. Representative Shackleford removed as conferee

  8. Representative Barrett added as conferee

  9. Representative Barrett removed as advisor

  10. CCR # 1 filed in the House

  11. CCR # 1 filed in the Senate

  12. Rules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 566: yeas 68, nays 23

  13. Rules Suspended. Conference Committee Report 1: adopted by the Senate; Roll Call 528: yeas 37, nays 13

  14. Senator Yoder removed as conferee

  15. Senator Charbonneau removed as advisor

  16. House conferees appointed: Carbaugh and Shackleford

  17. House dissented from Senate amendments

  18. Senate advisors appointed: Ford J.D., Busch and Charbonneau

  19. Senate conferees appointed: Garten and Yoder

  20. House advisors appointed: Barrett, Lehman, McGuire, Garcia Wilburn, Gore and Porter

  21. Motion to dissent filed

  22. Returned to the House with amendments

  23. Senator Johnson T removed as third sponsor

  24. Third reading: passed; Roll Call 422: yeas 29, nays 19

  25. Amendment #9 (Yoder) failed; Roll Call 412: yeas 13, nays 36

  26. Amendment #17 (Bohacek) prevailed; voice vote

  27. Amendment #15 (Bohacek) prevailed; voice vote

  28. Amendment #23 (Garten) prevailed; Division of the Senate: yeas 34, nays 12

  29. Second reading: amended, ordered engrossed

  30. Senator Randolph added as cosponsor

  31. Committee report: amend do pass, adopted

  32. Committee report: do pass adopted; reassigned to Committee on Appropriations

  33. First reading: referred to Committee on Health and Provider Services

  34. Referred to the Senate

  35. Third reading: passed; Roll Call 239: yeas 68, nays 26

  36. Cosponsor: Senator Charbonneau

  37. Senate sponsors: Senators Garten, Busch, Johnson T

  38. Amendment #4 (Garcia Wilburn) failed; voice vote

  39. Amendment #6 (Carbaugh) prevailed; voice vote

  40. Amendment #1 (Bauer) prevailed; voice vote

  41. Second reading: amended, ordered engrossed

  42. Committee report: amend do pass, adopted

  43. Recommitted to Committee on Ways and Means pursuant to House Rule 126.3

  44. Committee report: amend do pass, adopted

  45. Representative Gore added as coauthor

  46. First reading: referred to Committee on Public Health

  47. Authored by Representative Carbaugh

  48. Coauthored by Representatives McGuire and Smaltz

Sponsors

Sponsorship breakdown

Export CSV (upgrade) →

3 sponsors · 5 co-sponsors · 142 not signed on

Sponsors (3)

Co-sponsors (5)

Not signed on (142)

142 members have not signed on to this bill.

Show all 142 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does HB 1004 do?
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.
Who sponsors HB 1004?
HB 1004 is sponsored by Lonnie Randolph (Democrat), Ed Charbonneau (Republican), Justin Busch (Republican), Chris Garten (Republican), Mitch Gore (Democrat), Ben Smaltz (Republican), Julie McGuire (Republican), and Martin Carbaugh (Republican).
What is the current status of HB 1004?
This bill has been enacted into law. Introduced January 21, 2025. Enacted.
Where can I track HB 1004?
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