HB 1003 is a broad health care transparency, billing, and oversight bill that makes changes across Medicaid fraud enforcement, hospital and provider pricing disclosures, medical records access, insurance contracting, prior authorization reporting, and specialty billing rules. It expands the state Medicaid fraud control unit’s authority, allows the attorney general to enter data-sharing agreements with several state agencies, and makes complaints to the fraud control unit confidential until an action is filed. The bill also directs the office of the secretary of family and social services to establish metrics and accountability safeguards for the state’s risk-based managed care program.
A major portion of the bill focuses on price transparency. It requires hospitals and ambulatory outpatient surgical centers to continue posting standard charge information for shoppable and common services, and it creates new disclosure requirements for clinical laboratories and diagnostic imaging facilities. Those facilities must post prices for designated shoppable services, including discounted cash prices and negotiated charge ranges, by specified deadlines in 2026. The bill also updates and standardizes definitions used in existing transparency statutes, such as gross charge, payer-specific negotiated charge, discounted cash price, and standard charge.
HB 1003 also revises patient access to records and information. It clarifies that patients may obtain copies of x-ray film or x-ray images at no cost other than the provider’s actual cost, requires providers to retain x-ray images for at least five years, and defines electronic health records to include billing and administrative records. The bill limits charges for digital access to electronic health records and allows the department of insurance to set paper-copy fees by rule. It further shortens several deadlines for good-faith estimates from five business days to two business days and expands notice requirements so patients are more clearly informed of their right to request estimates.
The bill makes substantial changes to insurance and provider contracting rules. It prohibits insurers and HMOs from denying claims solely because the referring provider is out of network, requires provisional credentialing for certain physicians who change employers or open/relocate practices, and bars contract terms that force renegotiation after a change in law or guarantee reimbursement for legal changes. It also requires health carriers and providers to exchange more pricing data during contract negotiations, strengthens network adequacy standards, and creates a new reporting process for prior authorization disputes. In addition, it addresses pharmacy benefit manager audits and claims-data ownership for plan sponsors and public purchasers.
Overall, the bill appears to have been broadly supported, passing the House and Senate with clear majorities and then receiving strong conference committee approval in both chambers. The general sentiment reflected in the voting history suggests bipartisan interest in transparency, consumer access, and oversight of health care billing practices. Likely points of contention include the expanded reporting and disclosure obligations on hospitals, labs, imaging centers, insurers, PBMs, and providers; the new pricing and audit requirements; and the bill’s broader regulatory reach into private contracting and reimbursement practices. The individualized investigational treatment provisions may also draw attention because they create a special framework for experimental, patient-specific therapies while limiting liability and professional discipline exposure for physicians.
HB 1003 amends and adds numerous provisions in Titles 4, 12, 16, 25, and 27 of the Indiana Code. It expands Medicaid fraud enforcement authority, creates new confidentiality and data-sharing rules, imposes new price-transparency posting duties on hospitals, ambulatory outpatient surgical centers, clinical laboratories, and diagnostic imaging facilities, and revises medical-record access and x-ray retention requirements. It also changes insurance law by tightening good-faith estimate timelines, regulating provider billing and credentialing, limiting certain claim denials, requiring more information sharing in contract negotiations, and creating reporting and study requirements for prior authorization, network adequacy, and medical-record interoperability.
The bill’s voting history indicates generally favorable sentiment and strong legislative support, with comfortable margins in both chambers and additional support for the conference committee report. The measure’s broad health-care consumer and transparency themes likely contributed to that support. At the same time, the breadth of the bill suggests some lawmakers may have had reservations about the scope of new mandates on providers, insurers, and health systems, even though those concerns were not enough to prevent passage.
The most likely areas of contention are the bill’s extensive transparency and reporting mandates, especially for hospitals, laboratories, imaging facilities, PBMs, and insurers, which may be viewed as administratively burdensome or commercially sensitive. Provider and insurer stakeholders may also object to the new billing restrictions, provisional credentialing requirements, network adequacy standards, and limits on contract terms tied to changes in law. The individualized investigational treatment chapter could also be controversial because it authorizes access to highly personalized experimental therapies while limiting manufacturer liability and protecting physicians from discipline based solely on recommendations.