IN SB 173: Health care matters.

Indiana SB 173 prohibits the state employee health plan, the Medicaid program, accident and sickness insurance policies, and health maintenance organization individual or group contracts from imposing a time limit on anesthesia time for a medical procedure, or otherwise restricting or excluding coverage or payment of anesthesia time.

The bill modifies the definitions of "charity care" and "community benefits" for purposes of certain hospital reporting requirements and imposes additional reporting obligations on nonprofit hospitals to the Indiana Department of Health (IDOH). The required report must be posted on both the nonprofit hospital's website and the IDOH website. The bill increases the penalty for failure to file the report, changes the time frame in which the penalty may be assessed, and specifies that any penalty collected be deposited in the local public health fund.

SB 173 allows certain practitioners to provide neuroplastogen treatment to qualified patients with life-threatening conditions if specified requirements are met, and allows research to be conducted on neuroplastogen access. The bill requires reporting of adverse events and annual reporting of patient statistical information related to neuroplastogen treatment, and provides immunity for practitioners when treating patients using neuroplastogens.

The bill requires a clinical peer to disclose certain information during a peer-to-peer review of an adverse determination, and prohibits a utilization review entity from using artificial intelligence as the primary means for making adverse determinations. It also prohibits health insurers from engaging in certain downcoding practices, sets forth conditions under which downcoding a claim is permissible, and authorizes the Indiana Department of Insurance (IDOI) to enforce the downcoding requirements and impose penalties for violations.

Finally, SB 173 prohibits an insurer, pharmacy benefit manager, or other administrator of pharmacy benefits from designating a prescription drug as a specialty drug unless certain specified conditions are met. The bill's latest action is a committee report recommending amendment and passage, with reassignment to the Committee on Appropriations.