Offer of a direct to employer health care arrangement by Indiana nonprofit hospital system; benchmark; requirements; audit; assessment

Sec. 9. (a) Beginning September 1, 2025, 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; and (2) hospital outpatient facility prices; expressed as a percentage of full Medicare. (c) An Indiana nonprofit hospital system 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 at each individual hospital within the Indiana nonprofit hospital system. (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 an Indiana nonprofit 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, 2025, and before every October 1 thereafter, an Indiana nonprofit hospital system 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 an Indiana nonprofit hospital system 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 for which the Indiana nonprofit hospital system 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.