IndianaHB 1271Second Regular Session 124th General Assembly (2026)HouseWALLET

Payment of health claims.

Sponsored By: Julie McGuire (Republican)

Signed by Governor

Summary

Requires a hospital to: (1) disclose information concerning payment assistance programs; (2) post signs concerning the programs in specified locations of the hospital; and (3) make information concerning the programs available to individuals through the hospital's patient portal. Requires a hospital to make a reasonable effort to notify individuals of available payment assistance programs before beginning a collection action against the individual. Prohibits the use of downcoding in a specified manner. Prohibits a provider from using an automated process, system, or tool to submit a health benefits claim without the review of a provider or other person involved in the development of the claim for submission. Prohibits an insurer that issues a policy of accident and sickness insurance (insurer) and a health maintenance organization from retroactively reducing the reimbursement rate for any CPT code. Sets forth limitations on the time frame in which an insurer and a health maintenance organization: (1) may request repayment of an overpayment, adjust a subsequent claim, recoup a paid claim, or retroactively audit a paid claim; and (2) is required to correct a payment error to a provider. Provides that if an insurer or a health maintenance organization recoups payment from a provider due to an error in coordination of benefits, the provider may submit a claim for the same services to the appropriate insurer or health maintenance organization.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 3 benefits, 0 costs, 0 mixed.

Hospital patients get help before collections

Beginning July 1, 2026, Indiana hospitals must explain available charity care, financial help, and payment plans. They must give patients or their representatives program details at registration or intake, discharge, or with the first bill. Notices must explain eligibility, how to apply, and where to get help. Delivery can be on paper, by email, or through a patient portal, consistent with patient communication preferences. Hospitals must post signs in registration areas and emergency departments and provide information through any patient portal they maintain. Before selling or assigning medical debt to collectors or suing, hospitals must make reasonable efforts to notify patients about assistance and provide an application. Financial-indigence standards use hospital criteria and means testing tied to federal poverty guidelines for uninsured or underinsured patients. Medical-indigence standards compare bills remaining after other payments with a hospital-set share of annual gross income, subject to the referenced statutory threshold. Nonprofit hospitals must report compliance annually through community benefits reporting. The state may adopt enforcement rules and fine hospitals up to $1,000 per violation; fines go to the state general fund.

Providers gain limits on payment clawbacks

The law limits insurers and health maintenance organizations when they take back provider payments or cut payment rates. These rules take effect July 1, 2026, with coverage tied to plan years beginning after December 31, 2026. They cover accident and sickness policies issued, delivered, amended, or renewed after June 30, 2026. They also cover health maintenance organization contracts entered into, delivered, amended, or renewed after that date. Recovery requests and adjustments to later claims generally must occur within 180 days after payment. Paid claims cannot be recouped after 180 days or retroactively audited more than three years after initial payment. A fully processed claim's payment error need not be corrected without notice within 180 days after payment was received. These deadlines do not apply after a court's final fraud ruling, and licensed hospitals can agree in writing to different deadlines. Insurers and health maintenance organizations cannot retroactively cut rates for medical procedure codes. Future cuts require at least 60 days' notice to providers by mail or email, plus website notice. When payment is taken back because insurers' payment responsibilities were coordinated incorrectly, providers can bill the correct insurer or health maintenance organization within 90 days. They must document the original claim and recoupment; the correct payer can allow more time. Resubmission to an insurer carries the policy and plan-year conditions above; the separate health maintenance organization remedy provides the same 90-day window.

Providers gain protections against claim reductions

Beginning July 1, 2026, insurers face new limits on downcoding—changing a claim's service code to reduce payment. These rules cover health plans under the chapter, but exclude Medicaid and Medicaid managed care. Insurers cannot use downcoding to block providers from billing or collecting payment for the care actually given. They cannot reduce claims based only on diagnosis codes or target providers who routinely treat complex or chronic conditions. Insurers cannot rely solely on automated medical-necessity decisions to downcode claims without an employee or contractor reviewing medical records. Providers also must have a provider or another person involved in developing the claim review it before automated submission. Insurers must clearly disclose artificial intelligence use in downcoding or adverse prior-authorization decisions. Downcoding notices must use appropriate claim-adjustment and remittance codes and explain the reason, clinical criteria, and appeal rights. They must show both the original and revised service codes and payment amounts. Insurers must offer accessible appeals with instructions, contact information, at least 180 days to appeal, and unrestricted batch appeals for substantially similar claims. The insurance department may adopt rules on artificial intelligence, disclosures, and provider appeals.

Sponsors & Cosponsors

Sponsor

  • Julie McGuire

    Republican • House

Cosponsors

  • Liz Brown

    Republican • Senate

  • Lonnie Randolph

    Democratic • Senate

  • Lori Goss-Reaves

    Republican • House

  • Martin Carbaugh

    Republican • House

  • Michael Crider

    Republican • Senate

  • Tyler Johnson

    Republican • Senate

  • Victoria Garcia Wilburn

    Democratic • House

Roll Call Votes

All Roll Calls

Yes: 218 • No: 1

House vote • 2/26/2026

House concurred with Senate amendments

Yes: 87 • No: 0

Senate vote • 2/24/2026

Third reading: passed

Yes: 46 • No: 1

House vote • 2/2/2026

Third reading: passed

Yes: 85 • No: 0

Actions Timeline

  1. Public Law 88

    3/4/2026House
  2. Signed by the Governor

    3/4/2026House
  3. Signed by the President Pro Tempore

    2/27/2026Senate
  4. Signed by the President of the Senate

    2/27/2026Senate
  5. House concurred with Senate amendments; Roll Call 391: yeas 87, nays 0

    2/26/2026House
  6. Signed by the Speaker

    2/26/2026House
  7. Motion to concur filed

    2/25/2026House
  8. Returned to the House with amendments

    2/25/2026Senate
  9. Third reading: passed; Roll Call 248: yeas 46, nays 1

    2/24/2026Senate
  10. Amendment #4 (Brown L) prevailed; voice vote

    2/23/2026Senate
  11. Second reading: amended, ordered engrossed

    2/23/2026Senate
  12. Pursuant to Senate Rule 68(b); reassigned to Committee on Rules and Legislative Procedure

    2/19/2026Senate
  13. Committee report: Rules Committee Report; adopted voice vote

    2/19/2026Senate
  14. Senator Randolph added as cosponsor

    2/19/2026Senate
  15. Committee report: amend do pass, adopted

    2/19/2026Senate
  16. Pursuant to Senate Rule 68(b); reassigned to Committee on Appropriations

    2/12/2026Senate
  17. Committee report: amend do pass, adopted

    2/12/2026Senate
  18. First reading: referred to Committee on Health and Provider Services

    2/5/2026Senate
  19. Referred to the Senate

    2/3/2026House
  20. Senate sponsors: Senators Brown L, Crider, Johnson T

    2/2/2026House
  21. Third reading: passed; Roll Call 179: yeas 85, nays 0

    2/2/2026House
  22. Amendment #4 (McGuire) prevailed; voice vote

    1/29/2026House
  23. Second reading: amended, ordered engrossed

    1/29/2026House
  24. Representatives Goss-Reaves, Carbaugh, Garcia Wilburn added as coauthors

    1/27/2026House
  25. Representatives Goss-Reaves, Garcia Wilburn, Campbell removed as coauthors

    1/22/2026House

Bill Text

  • Engrossed House Bill (H)

  • Engrossed House Bill (S)

  • Enrolled House Bill (H)

  • House Bill (H)

  • House Bill (S)

  • Introduced House Bill (H)

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