Indiana § 27-1-46.5-10 Offer of a direct to employer health care arrangement by a hospital;
benchmark; requirements; audit; assessment

Indiana Statutes

§ 27-1-46.5-10 — Offer of a direct to employer health care arrangement by a hospital; benchmark; requirements; audit; assessment

Indiana § 27-1-46.5-10

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 46.5Direct to Employer Health Care Arrangements

This text of Indiana § 27-1-46.5-10 (Offer of a direct to employer health care arrangement by a hospital; benchmark; requirements; audit; assessment) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-1-46.5-10 (2026).

Text

(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 indivi

Free access — add to your briefcase to read the full text and ask questions with AI

(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.