§ 16-19-9-4 — Posting of information and pricing; shoppable services

Indiana § 16-19-9-4

• Jurisdiction: Indiana
• Title 16: HEALTH
• Art. 19: STATE DEPARTMENT OF HEALTH
• Ch. 9: Clinical Laboratories

Text

(a) As used in this section, "clinical laboratory"
means a laboratory that:
(1) provides clinical services;
(2) holds a federal Clinical Laboratory Improvement Act (CLIA)
certificate of accreditation; and
(3) is not owned or operated by a hospital licensed under IC 16-21-2.
(b) As used in this section, "de-identified maximum negotiated
charge" means the highest charge that a clinical laboratory has
negotiated with any third party payer for an item or service.
(c) As used in this section, "de-identified minimum negotiated
charge" means the lowest charge that a clinical laboratory has
negotiated with any third party payer for an item or service.
(d) As used in this section, "discounted cash price" means the
charge that applies to an individual who pays cash or the cash
equivalent for a clinical laboratory item or service.
(e) As used in this section, "gross charge" means the charge for an
individual item or service that is reflected on a clinical laboratory's
chargemaster, absent any discounts.
(f) As used in this section, "item or service" means any item or
service, including service packages, that could be provided by a clinical
laboratory to a patient for which the clinical laboratory has established
a standard charge. The term includes the following:
(1) Supplies.
(2) Procedures.
(3) Use of the facility and other facility fees.
(4) Services of employed physicians and non-physician
practitioners, including professional charges.
(5) Anything that a clinical laboratory has established as a
standard charge.
(g) As used in this section, "payer-specific negotiated charge"
means the charge that a clinical laboratory has negotiated with a third
party payer for an item or service.
(h) As used in this section, "standard charge" means the regular rate
established by the clinical laboratory for an item or service provided to
a specific group of paying patients. The term includes the following:
(1) Gross charge.
(2) Payer-specific negotiated charge.
(3) De-identified minimum negotiated charge.
(4) De-identified maximum negotiated charge.
(5) Discounted cash price.
(i) Not later than July 31, 2026, a clinical laboratory serving patients
in Indiana shall post on the website of the clinical laboratory the
following information and pricing, to the extent applicable, for the fifty
(50) laboratory services designated by the department of insurance as
shoppable for consumers who would be self paying for those services
without the benefit of a health insurance plan or government subsidy:
(1) A description of the service in plain language.
(2) The discounted cash price.
(3) The de-identified minimum negotiated charge.
(4) The de-identified maximum negotiated charge.
(j) Not later than May 1, 2026, the department of insurance shall:
(1) determine the fifty (50) laboratory services to be disclosed as
shoppable for consumers as required under this section; and
(2) post a list of the designated shoppable services on the
department's website.

Legislative History

As added by P.L.215-2025, SEC.21.