A quieter year for health care bills – Indiana Capital Chronicle

After several years of back-and-forth complex health care legislation, stakeholders still believe there is work to be done, while initiatives underway can mature.

The upcoming session is a non-budget year, when leaders have urged their members to prioritize emergency legislation and expedite action that would give the 125 members of the General Assembly more time to campaign.

Sen. Ed Charbonneau, R-Valparaiso

Sen. Ed Charbonneau, R-Valparaiso, isn’t expecting the same major legislation for 2023. As chairman of the Senate Health and Service Providers Committee, he wrote, co-wrote and sponsored several heavy-hitting bills, including funding for public health care, tracking pharmacy benefits. managers (PBMs) and track prices in five prominent not-for-profit hospital systems.

“I think too often we go back and make changes before our original actions have a chance to catch on and show if we made the right decision the first time,” Charbonneau said. This is probably a good session to see how we did (and) how they play.

But others see the need for constructive changes sooner rather than later, including those hospitals that took a hit in the 2023 session.

Brian Tabor, president of the Indiana Hospital Association, said the organization is working on a proposal to address related issues related to states’ Hospital Assessment Fee and Medicaid payments, the latter of which. the hospitals claim is so low they have to pass the cost on to private insurance companies and thus raise prices.

We have a lot of hospitals across the state that are struggling badly right now, and we can’t wait until the budget session to move that forward,” Tabor said.

Tabor said such actions would not require reopening the budget, but would still require legislation to change the current statute. However, after a $1 billion Medicaid accounting loss earlier this week, fixing Medicaid rates will be a tough sell in 2024. However, Tabor said the entities’ proposal includes a state review of managed care plans that could be used to tap into federal funding and reimburse Medicaid. costs along with hospital expenses.

What happened to the consumer database?

A relatively small agency, the Indiana Department of Insurance (IDOI) has several major responsibilities when it comes to legislative priorities to contain rising health care costs. A spokesperson for the agency declined an interview request and did not respond to an emailed list of questions on Friday, December 15.

According to the 2020 law, the department must build and maintain Database of all payer claims (APCD), which aggregates claim data from a variety of healthcare payer sources, including insurance companies, health maintenance organizations, PBMs and others into a consumer-facing dashboard.

Introductory page for the proposed All Payers Claims database presented to the Advisory Committee in September. (Screenshot from the September presentation)

… we think it’s helpful to see the big picture of all health care and health care claims,” IDOI Commissioner Amy Beard told the Interim Health Care Cost Control Task Force in August.

But rolling out the long-awaited dashboard has been a long process, and it’s uncertain how much it would affect health care costs.

IDOI tasked Onpoint Health Data with a a four-year, $8.2 million contract design and maintain the APCD, which appears to be nearing release date, based on three meetings’ worth of material including demonstration sites and contract information.

At the last APCD Advisory Board meeting in September, IDOI’s presentation included a preview of what the website might look like, and APCD Executive Director Jonathan Handsboroough announced that most shipper registrations had been completed.

Also in August, at a State Budget Committee meeting, Beard detailed the fines for health payers who do not submit reimbursement information to APCD.

The civil penalty ensures proper accountability for reporting to the APCD, and it’s important to ensure the APCD collects as much information as possible to meet its legislative goals, such as identifying health care needs and publicizing policies, Beard told the committee. … The Department is currently working closely with health care payers to ensure that they are familiar with the application requirements and procedures as part of implementing this new program, and believes that compliance with these requirements will be high.

The proposed civil penalty starts at $100 per day per violation for the first 30 days, then increases to $1,000 per day per violation.

He also told the committee members that IDOI had allocated $5.5 million from its budget for APCD.

Demo landing page for all payer claims database. (Screenshot from the September meeting)

But while Hoosier is able to compare the cost of hip replacements at different hospitals, not everyone is convinced that it has the effect of lowering prices. Charbonneau pointed out that employers paid most of the cost through company insurance and Hoosiers will likely weigh other factors between the options.

If I have insurance, I’m not going to pay so much attention to the cost, he said. If there’s a hospital I have in this area, it’s convenient, I go there.

Consumers are less likely to travel further to get a less expensive hip replacement if only their employer or insurance company sees the cost savings, he said.

APCD advisory board member Tabor said the project had potential as long as it is truly comprehensive. He noted that Onpoint also built the Maines APCD and included a wealth of information, including prescription drugs.

I don’t think we need another database that’s just about price, Tabor said. When we started this conversation in 2020, we had the idea that we would only have hospital rates. We have it now; it is available (elsewhere) I also see (APCD) as a tool to not only compare prices, but to truly help the consumer navigate the cost, quality and complexity of the healthcare system.

Still, he warned of a potential legal challenge, noting that federal law prohibited states from regulating certain large insurance plans and might not be able to legally force them to comply with the APCD.

Other ongoing projects

In addition to the APCD, the IDOI has at least two other legislative obligations: regulating PBMs and price monitoring system in five not-for-profit hospital systems, compared to a 285% Medicare share.

IDOI reports on the latter in August that it had sent out a service request to find a third-party supplier and hospitals had until March 2024 to provide the information. By November, the calculations and Medicare comparison should be completed for a final report to the Health Care Cost Task Force in December.

Also at the August meeting, Beard told the committee about ongoing efforts to license PBMs and audit pharmacy claims, along with the semiannual report. Lawmakers spent a significant amount of time in the 2023 legislative session trying to understand the costs and benefits of PBMs, ultimately coming up with reporting system calculate compensations and dictate that discount savings be passed on to consumers.

Healthcare in 2025 and beyond

Tabor said he hopes the ongoing data-gathering efforts will help leaders take a more nuanced and thoughtful approach to health care, even if those efforts don’t happen in 2024.

By 2025, and if legislation is needed, we can focus on legislation that enables market-based solutions. I think we have a lot of hospital transparency, but if we don’t have that much (transparency), then insurance premiums really go down,” Tabor said. While I don’t like all of the practices that have been put in place in the past, I think it’s wise to take a deeper look at making policy decisions based on data rather than on a session-by-session basis.

Brian Tabor

Other smaller pieces of legislation for 2024 may address nursing labor shortages, but generally not the burdensome laws of 2023.

“I think if we take a breath and look at some of that data, look at what’s being collected, I think we can hopefully make more informed decisions in 2025 and beyond,” Tabor said.

Charbonneau did not rule out the possibility of health care legislation, as he considered a bill to oversee the 340B drug pricing program, which allows certain financially troubled hospitals to buy expensive drugs at a discount. However, Charbonneau wanted to know which hospitals used the program and whether some states serving wealthier populations benefited from poorer systems.

I talked about it with Dr. (and Indiana US Rep. Larry) Buschon recently. He’s tried to deal with it at the federal level, and they just haven’t gotten much done, Charbonneau said. It seems like this is a well-designed program that has kind of taken on a life of its own and gone far from its goal.

He emphasized that he did not want to refer to impropriety or illegal events, but to a broader review of the current program to increase transparency.

As a former hospital CEO with a business background, Charbonneau said he is frustrated by the slow adoption of cost-cutting measures at the state level to increase the quality and affordability of health care.

Over the years it has become very frustrating. “We just don’t seem to be making progress in health care,” Charbonneau said.

He noted that the Indiana Chamber of Commerce often ranked low in the state in terms of health care costs, which he says will hurt the Indiana Economic Development Corporation’s ability to recruit businesses to the Hoosier State.

We have work to do and we are well on our way, Charbonneau said. But it seems to be painfully slow. But it will succeed, the more attention we pay to it, the more publicity we can get. The more of our 6.8 million Hoosiers we can educate about all of this, the better.


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