News

Indiana Price Transparency Laws Amended

posted: May 6, 2021

On April 29, Governor Eric Holcomb signed three pieces of legislation making changes to existing price transparency requirements enacted during the 2020 legislative session.

Price Transparency Provisions of HB 1421/SB 325

1. Extends the compliance date for the price transparency requirements for ASCs to December 31, 2021 (previously was March 31, 2021).
2. Clarifies that if an ASC provides fewer than 30 services, they must post price information for only those services provided (previously, the law had no exceptions for ASCs that perform fewer than 30 services.)
3. Changes the price posting requirement for as many of the 70 shoppable services specified in the final rule of the Centers for Medicare and Medicaid Services published in 84 FR 65524 that are provided by the ASC, in addition to the 30 most common services performed at the ASC not included in the CMS rule. ASCs must now post the “standard charges” as opposed to the previous requirement to post the “weighted average negotiated charge”.

 Good Faith Estimate Provisions of HB 1447

1. Pushes back the effective date for when practitioners must provide a good faith estimate of the cost of a health care service to January 1, 2022 (previously was July 1, 2021)
2. Requires a practitioner or facility to provide a written explanation if the charge for a health care service exceeds the practitioner’s or facility’s good faith estimate by the greater of: $100; or 5%.
3. Provides that a practitioner can comply with the requirement to provide a good faith estimate of the amount that the practitioner intends to charge a covered individual by complying with the requirements of the new federal No Surprises Act.
4. Requires a practitioner that has scheduled or ordered a nonemergency health care service provide notice that says: “A patient may ask a health care provider for an estimate of the price the health care providers and health facility will charge for providing a non emergency healthcare service.” The law requires that the estimate be provided within 5 business days of scheduling the nonemergency healthcare service unless the nonemergency healthcare service is scheduled to be performed by the practitioner within 5 business days of the date of the patient’s request.”
5. A good faith estimate must include the price that facility will charge for (1)the use of the facility, (2) the services rendered by the employed or contracted staff and (3) medication, supplies, equipment, and material items to be provided to or used by the individual while the individual is present in the provider facility and the price charged for the services of all practitioners, support staff, and other persons who provide professional health services who may provide services in the facility and for whose services the individual will be charged separately from the charge of the facility, including imaging, laboratory services, diagnostic services, therapy, observation services, and other services expected to be provided to the individual for the episode of care.

These improvements are in large part due to the work done by IFASC and ASCA to educate lawmakers as to the negative effects of the previous laws and the efforts made to provide alternative solutions that would still meet the required transparency requirements.

IFASC works hard to advance the interests of all Indiana ASCs. We hope you will continue to support these efforts with your participation with IFASC or join now to ensure our success in future efforts on your behalf.