IC 27-1-46.5-10: Offer of a direct to employer health care arrangement by a hospital; benchmark; requirements; audit; assessment

Sec. 10. (a) Beginning September 1, 2026, a hospital that is not a part of an Indiana nonprofit hospital system shall offer a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare.

(b) The benchmark described in subsection (a) shall be calculated by taking the sum of:

(1) hospital inpatient facility prices;

(2) hospital outpatient facility prices; and

(3) professional fee for services provided to a patient by an employed qualified practitioner;

expressed as a percentage of full Medicare.

(c) A hospital meets the requirements of subsection (a) by doing any of the following:

(1) Offering a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare as an individual hospital.

(2) Offering a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare as a hospital system.

(3) Participating in a narrow network of hospitals to offer a direct to employer health care arrangement that is at or below a benchmark of two hundred sixty percent (260%) of full Medicare.

(d) Beginning October 1, 2026, and before every October 1 thereafter, a hospital shall cooperate with an audit by the Indiana department of health to determine compliance with this section.

(e) The Indiana department of health shall assess a hospital that the Indiana department of health determines through an audit has violated this section with a civil penalty of ten thousand dollars ($10,000) per day per hospital that is unable to demonstrate compliance with this section. A fine collected under this subsection shall be deposited into the payer affordability penalty fund established by IC 12-15-1-18.5.