The No Surprises Act (NoSA) was signed into law in December 2020 as part of the Consolidated Appropriations Act of 2021. It was meant to address issues that tend to result in surprise medical bills when patients obtain medical services outside their network without realizing the services are out of network.
Many states have also passed individual laws to fight surprise medical bills. Indiana is one of these states; its house bills 1004 and 1447 aim to improve healthcare billing transparency in Indiana.
Indiana House Bill 1004 summary
Indiana House Bill (HB) 1004 was authored in January 2020 by Representative Smaltz and signed by the Governor in March, becoming Public Law 93. Indiana HB 1004 is titled "Health Matters." In large part, the bill centers upon the rules and rights attached to the good faith estimate (GFE). HB 1004 states the following regarding good faith estimates:
- As of July 1, 2021, health care providers must provide a GFE to individuals on the price of non-emergency health care services to be rendered.
- The specific requirements for providing a GFE are detailed.
- An individual has the right to request a GFE from a health care provider for the total price of upcoming non-emergency services that have been referred, ordered, or scheduled.
- When someone requests a GFE, the healthcare provider is required to provide the GFE.
- The requirements of the GFE are detailed.
- Individuals have the right to request a GFE from their health carrier that estimates the amount the health carrier will pay or reimburse and to alert the individual of any applicable benefit limitations of the proposed non-emergency health care service.
- HB 1004 prohibits an out-of-network practitioner from an in-network facility from charging more for services than allowed according to the individual's network plan unless:
- They provide the individual with a statement at least five days before the services are provided that:
- Informs the individual of the intent to charge more than is allowed under the individual's network plan, and
- Provides an estimate of the charge, and
- The covered individual signs the provided statement, signifying their consent to the charge.
Essentially, the bill mandates transparent pricing for potential patients in Indiana.
Who must receive a Good Faith Estimate according to HB 1004?
According to House Bill 1004, a GFE must be provided to individuals with a non-emergency health care service that is ordered, scheduled, or referred more than five days in advance. Additionally, patients who request a GFE are entitled to receive one.
According to Section 16, when a practitioner orders a non-emergency health care service, they are to provide the patient with a written notice that the patient has the right to request an estimate of the price of the service. When a patient requests a GFE, the practitioner or facility must provide it within five business days.
Under Section 17, if an individual eligible for Medicare requests a GFE, the practitioner must provide the GFE within five business days.
Under Indiana HB 1004, a practitioner is not required to provide a good faith estimate to an individual obtaining emergency health care services or if the non-emergency health care service is scheduled within five days.
Indiana price transparency updates under House Bill 1447
Indiana House Bill 1447 was authored by Representative Vermilion and became Public Law 202 in April 2021. Indiana HB 1447 is titled "Good faith health care estimates." The Indiana healthcare transparency law revised and updated the existing HB 1004 by defining terms, setting more realistic effective dates, and clarifying requirements.
New definition for "practitioner"
Indiana HB 1447 presents a new definition of "practitioner" in Section 7.
The following is the new term in HB 1447:
The additions to HB 1004's definition are highlighted in bold.
HB 1447 Section 8(a):
(a) As used in this chapter, "practitioner" means the following:
(1) An individual:
(A) who holds:
(i) an unlimited license, certificate, or registration
(ii) a limited or probationary license, certificate, or registration;
(iii) a temporary license, certificate, registration, or permit;
(iv) an intern permit; or
(v) a provisional license;
issued by the board (as defined in IC 25-0.5-11-1) regulating the profession in question; and
(B) who provides professional healthcare services to individuals in a facility.
(2) An entity that:
(A) is owned by, or employs; or
(B) performs billing for professional healthcare services rendered by;
an individual described in subdivision (1).
(b) The term does not include the following:
(1) A dentist licensed under IC 25-14.
(2) An optometrist licensed under IC 25-24.
(3) A provider facility.
Postponed effective date
Another essential revision of the Indiana price transparency law was to postpone the date it goes into effect. Indiana HB 1447 pushed back the effective date when a practitioner must provide a GFE from July 1, 2021 to January 1, 2022.
"Conspicuous" communication and written notices
Indiana HB 1447 requires conspicuous communication and written notices provided to individuals by their practitioners. Specifically, the Indiana healthcare transparency law requires that the communication from the practitioner and provider facility to the patient regarding the patient's right to request a GFE should be conspicuous.
It states that the written notice the practitioner provides must declare that a GFE need not be provided if the service is scheduled within five business days of the patient's request. Previously, the "conspicuous" communications were to be in type of at least font 14.
Another revision concerns the content of the written statement that an out-of-network (OON) practitioner providing health care services at an in-network facility must give to a covered individual.
Written explanation for charges
Another interesting update within HB 1447 is the requirement for facilities or practitioners to provide the patient with a written explanation if the actual charge exceeds the GFE by the greater of five percent or $100.
Overall, the revisions and updates introduced by Indiana HB 1447 aim to protect healthcare recipients by increasing medical billing transparency. These changes should help patients avoid billing surprises and evaluate the importance of non-emergency health care treatments based on reliable, good faith estimates.