Ind. Code § 27-1-46.5-10
This is the official text of Ind. Code § 27-1-46.5-10, part of Indiana’s Code — part of the compiled statutory law of Indiana, published by the state as "Code." Browse the sections below, each linked to its official government source.
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Offer of a direct to employer health care arrangement by a hospital; benchmark; requirements; audit; assessment
Official statutory text
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.
As added by P.L.216-2025, SEC.46.
(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.
As added by P.L.216-2025, SEC.46.
Status: in_force · Read it on the official government site
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