Indiana Code 27-1-47.5-7. Calculating and comparing prices; review of data and resources
(1) self-funded plan prices;
Terms Used In Indiana Code 27-1-47.5-7
- Contract: A legal written agreement that becomes binding when signed.
- Department: means "the department of insurance" of this state. See Indiana Code 27-1-2-3
- Indiana nonprofit hospital system: means a hospital that:
Indiana Code 27-1-47.5-3
- prices: means allowables that are paid for patient care services. See Indiana Code 27-1-47.5-4
- Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5
(3) the individual market prices; and
(4) the total combined prices of subdivisions (1) through (3);
expressed as a percentage of how much Medicare would have paid for the same services.
(b) Before November 1, 2024, and before November 1 of each subsequent year, the department’s third party contractor shall compare:
(1) hospital inpatient prices;
(2) hospital outpatient prices; and
(3) practitioner services prices;
calculated separately and combined in total as a percentage of Medicare for all patient care services provided to the commercially insured market. The third party contractor shall make these calculations for each Indiana nonprofit hospital within an Indiana nonprofit hospital system and for the Indiana nonprofit hospital system, expressed as a percentage of how much Medicare would have paid for the same services in comparison to what two hundred eighty-five percent (285%) of Medicare would have been for the same services.
(c) The department and the department’s third party contractor shall review the data and resources submitted concerning prices in Indiana specific to each Indiana nonprofit hospital system.
As added by P.L.203-2023, SEC.21.