# Indiana HB 1004: Health care matters. Indiana HB 1004, Health care matters., is a First Regular Session 124th General Assembly (2025) House bill sponsored by Martin Carbaugh (Republican); status signed, last action 2025-05-06 (Signed by the Governor); PRIA reads it as touching household money (as of 2026-10-17). - Canonical: https://policyrisk.com/state-bill/IN-HB1004-2025 - As of: 2026-10-17 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Bill: Indiana HB 1004 - State: Indiana - Session: First Regular Session 124th General Assembly (2025) - Title: Health care matters. - Status: signed - Chamber: House - Introduced: 2025-01-21 - Last action: 2025-05-06, Signed by the Governor - Sponsor: Martin Carbaugh (Republican) - Cosponsors: 7 - Subjects: public health, the senate, health and provider services, appropriations - Touches household money: yes - Roll calls: 5 (215 yes, 117 no in all) - Economic provisions PRIA read: 18 ## Summary Establishes: (1) a state directed payment program (program) for hospitals; and (2) a managed care assessment fee. Changes disproportionate share payments when a state directed payment program is in effect. Allows the incremental hospital fee fund to be used to fund the Medicaid program. Requires a nonprofit hospital system to submit audited financial statements. Provides for a $10,000 per day penalty for failure to submit the hospital's financial statements. Requires the office of management and budget (office) to: (1) develop a methodology to be used in conducting a study of commercial inpatient hospital prices and outpatient hospital prices; and (2) upon budget committee review, conduct the study to determine Indiana's statewide average inpatient and outpatient hospital prices. Requires the office to submit a report of the study to the governor and general assembly. Before June 30, 2029, requires an Indiana nonprofit hospital system's aggregate average inpatient and outpatient hospital prices to at least be equal to or less than the statewide average. States that a violation by the Indiana nonprofit hospital system results in a forfeiture of its nonprofit status. Requires, before October 1 of each year, every nonprofit hospital to provide the Indiana department of health with specified federally filed forms and specified data used to complete the forms. Requires the Indiana department of health to submit these forms to the health care cost oversight task force and impose a fine of $10,000 per day on a nonprofit hospital for failure to submit the nonprofit hospital's forms. Provides an exemption from health care billing requirements for a facility located in a specified populated municipality. Requires a third party administrator to disclose commissions and fees to policyholders in a separate notification. Requires an insurer and a health maintenance organization to submit specified data information to the all payer claims data base. Requires an insurance producer or third party administrator to, before or at the time of sale, provide the plan sponsor with a statement from the insurer or health maintenance organization, disclosing commissions and fees that the insurance producer or third party administrator will receive. Changes the time frame in which certain information and claims data must be submitted to a contract holder as part of an audit or claims data request. Sets requirements for certain hospitals concerning a direct to employer health care arrangement. Beginning January 1, 2026, requires a state employee health plan, a policy of accident and sickness insurance, and a health maintenance organization contract to provide a plan sponsor with the national average drug acquisition cost of a generic drug. States that if an agreement between a health plan and a pharmacy benefit manager provides that less than 85% of the estimated rebates will be deducted from the cost of prescription drugs before a covered individual's cost sharing requirement is determined, the pharmacy benefit manager must provide the policyholder with an annual notice that includes: (1) an explanation of what a rebate is; (2) an explanation of how rebates accrue to the health plan from the manufacturer; and (3) the aggregate amount of rebates that accrued to the health plan for prescription drugs dispensed under the policyholder's health plan for the previous year. Places limitations on hospital health provider contracts linking to or negotiating reimbursement or terms under a separate hospital health care provider contract or product. Requires the office to: (1) study the effect, including the fiscal impact, of requiring physician reimbursement rates under a commercial policy to be set at a minimum reimbursement rate; and (2) report its findings under the study. Requires certain health carriers to provide claims data to a contract holder not more than four times per year (current law allows for the provision of the data twice annually). Requires certain insurers and health maintenance organizations to file specified information concerning changes in hospital reimbursement to the department of insurance. ## Bill overview: provisions PRIA read - Replacement coverage option for plan members: benefit, medium. If the Healthy Indiana Plan ends, Indiana’s secretary may establish replacement coverage for affected members. It must be consistent with the plan as it existed on January 1, 2014. Federal approval is required, and funding comes from the incremental hospital fee. The law allows this replacement but… - Price-benchmarked hospital offers for employers: benefit, medium. Starting September 1, 2025, nonprofit hospital systems must offer employers arrangements with combined facility prices no higher than 260% of full Medicare. Hospitals outside those systems face the benchmark September 1, 2026, including employed qualified practitioners’ professional fees. Hospitals… - Plans disclose drug costs and rebates: benefit, low. For covered agreements made, renewed, or renegotiated after December 31, 2025, pharmacy benefit managers must send policyholders annual rebate notices. Notices are due within 60 days after each policy year and explain total plan rebates without naming individual drugs. No notice is required when po… - Group health plans get more claims access: benefit, low. Since March 13, 2024, group-plan contract holders can request claims data four times per calendar year, up from twice. Insurers, health maintenance organizations, and third-party administrators must respond within 15 business days. The rule covers both self-funded and fully insured group plans. It… - Health plan buyers gain audit data: benefit, low. Pharmacy benefit managers, plan administrators, managed care organizations, and prepaid plans must supply requested audit claims data within 15 business days. Direct-to-employer plan administrators must answer contract holders’ claims-data requests within 30 days and follow health privacy rules. Th… - Hospitals receive remaining fee fund balances: benefit, low. Certain hospital payments can continue after fee collection stops, while funding remains available and reconciliation and termination rules allow. Remaining hospital Medicaid fee money first covers required program payments, subject to statutory limits. Any balance then goes to hospitals based on e… - Some small-town facilities escape hospital-system rules: benefit, low. The chapter governing Indiana nonprofit hospital systems exempts facilities with CMS place of service code 20. To qualify, a facility must be in a municipality with fewer than 20,000 people. This removes the chapter’s requirements for those facilities; it does not create a household payment or bene… - Healthy Indiana Plan faces coverage limits: cost, medium. Except for a stated legal exception, Healthy Indiana Plan eligibility must come through an approved federal demonstration, not Indiana’s Medicaid plan. Indiana must end the plan if its waiver ends or changes so the state cannot follow the law. Indiana may end the plan if federal support for covered… - Hospitals face tougher reporting rules: cost, medium. Indiana hospitals must give the Office of Management and Budget requested data for a statewide hospital-price study. The office sets how and when hospitals must send the data. Hospitals that miss required report deadlines pay $10,000 per overdue day, up from $1,000. These fines go to the payer affo… - Higher hospital payments with funding limits: mixed, medium. Indiana can develop Medicaid hospital payment programs aimed at Medicare-equivalent rates, with additional approved state-directed payments. Beginning July 1, 2025, the law authorizes the directed-payment program, subject to Budget Committee review and federal approval. Indiana must apply before Ja… - Large nonprofit hospitals face price ceilings: mixed, medium. By June 30, 2029, qualifying nonprofit hospital systems must keep average inpatient and outpatient prices at or below statewide averages. Covered systems have at least $2 billion in annual Indiana patient service revenue and meet nonprofit, licensing, and reporting requirements. Indiana’s budget of… - Health plans must reveal more fees: mixed, low. Covered insurers, health maintenance organizations, and licensed plan administrators must disclose commissions, service fees, and brokerage fees. Disclosures are due when coverage starts and at each renewal, showing percentage-based or flat per-member charges. This rule excludes fees already subjec… - Dedicated funding with tighter plan limits: mixed, low. From Healthy Indiana Plan 2.0 implementation until termination, trust money is reserved for specified state costs. These include plan costs beyond other available funding and the prior plan’s regular operating expenses. Phase-out costs are no longer a separately allowed use. All annual cigarette ta… - Hospital fee rules last two years longer: mixed, low. Indiana extends its hospital assessment and reimbursement chapter from June 30, 2025, through June 30, 2027. This keeps both hospital fee obligations and related payment authority in place. With federal approval, Indiana may exclude a physician-owned hospital or a class of those hospitals from the… - Hospital funds support broader Medicaid costs: mixed, low. The incremental hospital fee and its fund can support Medicaid beyond the listed Healthy Indiana Plan expenses. Allowed costs include specified directed-payment capitation, and Indiana must reconcile plan costs, funding, and assessed fees. The fee formula is set after January 31, 2015, before colle… - Hospitals disclose finances or face fines: mixed, low. Hospitals must file certified financial, payer, cost, charity-care, and ownership reports within 120 days after fiscal year-end; good-cause extensions are allowed. Ownership disclosures cover stakes of at least 5%, with business addresses but no Social Security numbers. Covered nonprofit systems mu… - Managed care plans face Medicaid assessments: mixed, low. With federal approval, Indiana can assess managed care organizations using member months, premium revenue, or another approved method. Revenue is limited to Medicaid’s state share; organizations pay one-twelfth monthly, and assessments stop if federal matching eligibility ends. Indiana can grant up… - New payment rules for safety-net hospitals: mixed, low. In directed-payment years, each qualifying acute care hospital receives a $1,000 annual disproportionate-share payment, funded partly through hospital fees. Remaining allotment money can support specified municipal providers and qualifying hospitals, after applicable state mental health institution… ## Sponsors and cosponsors - Sponsor: Martin Carbaugh (Republican), House - Cosponsor: Ben Smaltz (Republican), House - Cosponsor: Chris Garten (Republican), Senate - Cosponsor: Ed Charbonneau (Republican), Senate - Cosponsor: Julie McGuire (Republican), House - Cosponsor: Justin Busch (Republican), Senate - Cosponsor: Lonnie Randolph (Democratic), Senate - Cosponsor: Mitch Gore (Democratic), House ## Roll call votes | Date | Chamber | Motion | Result | Yes | No | Other | | --- | --- | --- | --- | --- | --- | --- | | 2025-04-24 | House | Rules Suspended. Conference Committee Report 1: adopted by the House | pass | 68 | 23 | | | 2025-04-24 | Senate | Rules Suspended. Conference Committee Report 1: adopted by the Senate | pass | 37 | 13 | | | 2025-04-15 | Senate | Third reading: passed | pass | 29 | 19 | | | 2025-04-14 | Senate | Amendment #9 (Yoder) failed | fail | 13 | 36 | | | 2025-02-20 | House | Third reading: passed | pass | 68 | 26 | | ## Actions (48) - 2025-05-06: Signed by the Governor (House) - 2025-05-06: Public Law 216 (House) - 2025-04-29: Signed by the President of the Senate (Senate) - 2025-04-28: Signed by the President Pro Tempore (Senate) - 2025-04-25: Signed by the Speaker (House) - 2025-04-24: Senator Charbonneau added as conferee (Senate) - 2025-04-24: Representative Shackleford removed as conferee (House) - 2025-04-24: Representative Barrett added as conferee (House) - 2025-04-24: Representative Barrett removed as advisor (House) - 2025-04-24: CCR # 1 filed in the House (House) - 2025-04-24: CCR # 1 filed in the Senate (Senate) - 2025-04-24: Rules Suspended. Conference Committee Report 1: adopted by the House; Roll Call 566: yeas 68, nays 23 (House) - 2025-04-24: Rules Suspended. Conference Committee Report 1: adopted by the Senate; Roll Call 528: yeas 37, nays 13 (Senate) - 2025-04-24: Senator Yoder removed as conferee (Senate) - 2025-04-24: Senator Charbonneau removed as advisor (Senate) - 2025-04-21: House conferees appointed: Carbaugh and Shackleford (House) - 2025-04-21: House dissented from Senate amendments (House) - 2025-04-21: Senate advisors appointed: Ford J.D., Busch and Charbonneau (Senate) - 2025-04-21: Senate conferees appointed: Garten and Yoder (Senate) - 2025-04-21: House advisors appointed: Barrett, Lehman, McGuire, Garcia Wilburn, Gore and Porter (House) - 2025-04-17: Motion to dissent filed (House) - 2025-04-16: Returned to the House with amendments (Senate) - 2025-04-15: Third reading: passed; Roll Call 422: yeas 29, nays 19 (Senate) - 2025-04-14: Senator Johnson T removed as third sponsor (Senate) - 2025-04-14: Amendment #15 (Bohacek) prevailed; voice vote (Senate) - 2025-04-14: Second reading: amended, ordered engrossed (Senate) - 2025-04-14: Amendment #9 (Yoder) failed; Roll Call 412: yeas 13, nays 36 (Senate) - 2025-04-14: Amendment #17 (Bohacek) prevailed; voice vote (Senate) - 2025-04-14: Amendment #23 (Garten) prevailed; Division of the Senate: yeas 34, nays 12 (Senate) - 2025-04-10: Committee report: amend do pass, adopted (Senate) - 2025-04-10: Senator Randolph added as cosponsor (Senate) - 2025-03-20: Committee report: do pass adopted; reassigned to Committee on Appropriations (Senate) - 2025-03-03: First reading: referred to Committee on Health and Provider Services (Senate) - 2025-02-21: Referred to the Senate (House) - 2025-02-20: Senate sponsors: Senators Garten, Busch, Johnson T (House) - 2025-02-20: Third reading: passed; Roll Call 239: yeas 68, nays 26 (House) - 2025-02-20: Cosponsor: Senator Charbonneau (House) - 2025-02-19: Amendment #1 (Bauer) prevailed; voice vote (House) - 2025-02-19: Second reading: amended, ordered engrossed (House) - 2025-02-19: Amendment #6 (Carbaugh) prevailed; voice vote (House) - 2025-02-19: Amendment #4 (Garcia Wilburn) failed; voice vote (House) - 2025-02-17: Committee report: amend do pass, adopted (House) - 2025-02-11: Recommitted to Committee on Ways and Means pursuant to House Rule 126.3 (House) - 2025-02-11: Committee report: amend do pass, adopted (House) - 2025-01-30: Representative Gore added as coauthor (House) - 2025-01-21: First reading: referred to Committee on Public Health (House) - 2025-01-21: Authored by Representative Carbaugh (House) - 2025-01-21: Coauthored by Representatives McGuire and Smaltz (House) ## Bill text - Engrossed House Bill (H): [PDF](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.07.ENGS?format=pdf) - Engrossed House Bill (S): [PDF](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.04.ENGH?format=pdf) - Enrolled House Bill (H): [PDF](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.08.ENRS?format=pdf) - House Bill (H): [PDF](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.02.COMH?format=pdf), [PDF](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.03.COMH?format=pdf) - House Bill (S): [PDF](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.05.COMS?format=pdf), [PDF](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.06.COMS?format=pdf) - Introduced House Bill (H): [PDF](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.01.INTR?format=pdf) ## Related bills - SB 231: Various corrections matters. (signed) - SB 324: Criminal procedures. (signed) - SB 80: Code publication. (signed) - SB 453: Various tax matters. (signed) - SB 464: Financial institutions and consumer credit. (signed) - SB 371: Workforce matters. (signed) ## Sources - [Engrossed House Bill (H) (PDF)](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.07.ENGS?format=pdf) - [Engrossed House Bill (S) (PDF)](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.04.ENGH?format=pdf) - [Enrolled House Bill (H) (PDF)](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.08.ENRS?format=pdf) - [House Bill (H) (PDF)](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.02.COMH?format=pdf) - [House Bill (H) (PDF)](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.03.COMH?format=pdf) - [House Bill (S) (PDF)](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.05.COMS?format=pdf) - [House Bill (S) (PDF)](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.06.COMS?format=pdf) - [Introduced House Bill (H) (PDF)](https://api.iga.in.gov/2025/bills/HB1004/versions/HB1004.01.INTR?format=pdf) ## Related - [SB 231: Various corrections matters.](https://policyrisk.com/state-bill/IN-SB231-2025) - [SB 324: Criminal procedures.](https://policyrisk.com/state-bill/IN-SB324-2025) - [SB 80: Code publication.](https://policyrisk.com/state-bill/IN-SB80-2025) - [SB 453: Various tax matters.](https://policyrisk.com/state-bill/IN-SB453-2025) - [SB 464: Financial institutions and consumer credit.](https://policyrisk.com/state-bill/IN-SB464-2025) - [SB 371: Workforce matters.](https://policyrisk.com/state-bill/IN-SB371-2025) - [Indiana bills](https://policyrisk.com/states/indiana/bills) - [Indiana state hub](https://policyrisk.com/states/indiana) - [All state legislation](https://policyrisk.com/state-bills) Source: PRIA, https://policyrisk.com/state-bill/IN-HB1004-2025 (as of 2026-10-17).