HB 1372 – Various Insurance Matters
Authored by Rep. Martin Carbaugh (R-Fort Wayne)
Sponsored by Sen. Eric Bassler (R-Washington)
Authorizes a local unit to establish and maintain: (1) an individual self-insurance program to provide health care benefits to its employees; and (2) a health savings account program under which employees may set aside funds tax-free to pay for medical expenses. Provides that a provider of ambulance service that transports a covered individual to an in-network facility or from an in-network facility to another facility shall not charge more than the amount allowed under the network plan applying to the covered individual’s coverage. Makes changes in the law concerning the permissible investments of life insurance.
Chamber position: Neutral (without amendment)
The latest: The amendment would have allowed an assignment of benefit by the individual for the emergency medical services (EMS) provider and allowed for arbitration in a dispute.
Indiana Chamber action/commentary: The Chamber has a long-standing policy that opposes assignment of benefits. An out-of-network provider is not entitled to receive a check as they are not a party to the contract because they aren’t in the network. Regarding the dispute resolution through arbitration, that is a line in the sand for employers – because if we allow it for EMS (though they are different than other providers), the physicians have already said that they want arbitration to be a part of their disputes as well.
We communicated these problems related to this amendment to Chairman Bassler. He subsequently changed the amendment to be a study committee on the issue.
Pharmacy Benefit Managers Bill in Spotlight in Senate Health and Provider Services Committee
HB 1042 – Pharmacy Benefit Managers
Authored by Rep. Steve Davisson (R-Salem)
Sponsored by Sen. Liz Brown (R-Fort Wayne)
Requires a pharmacy benefit manager (PBM) to obtain a license issued by the Indiana Department of Insurance (DOI) and sets forth requirements of the PBM. Provides for the DOI commissioner to adopt rules to specify licensure, financial standards and reporting requirements that apply to a pharmacy benefit manager. Sets forth requirements and prohibitions of a PBM. Allows a party that has contracted with a PBM to request an audit of compliance at least one time per year. Makes violations of the chapter concerning PBMs an unfair or deceptive act or practice in the business of insurance. Repeals the chapter of existing language on PBMs and moves the language concerning maximum allowable cost lists to the new chapter. Allows a PBM to obtain the license not later than December 31, 2020, in order to do business in Indiana and provide services for any health provider contract beginning January 1, 2021. (The introduced version of this bill was prepared by the Interim Study Committee on Public Health, Behavioral Health and Human Services.
Chamber position: Oppose in part
The latest: The bill was amended to encompass the language in SB 241, Sen. Brown’s PBM legislation. The measure then passed the Senate Health and Provider Services Committee 9-0 as amended.
Indiana Chamber action/commentary: The Chamber testified that we have consistently stated less regulation is more. Therefore, if legislation is going to be passed, we prefer Sen. Brown’s version over this bill. The Chamber further testified that TrueScripts founder Nathan Gabhart (a Chamber member) was a pharmacist and then created his own PBM. He has made suggestions/recommendations to SB 241, which Sen Brown has received. It is our recommendation that his suggestions be taken into serious consideration as this bill moves forward. Senator Brown indicated that there would be second reading amendments but no indication of what those might be.
Resource: Mike Ripley at (317) 264-6883 or email: [email protected]