New laws impact price estimates, physician contracts, out-of-network pay, e-prescribing
Although the health care industry has recently been focused on COVID-19 and the public health emergency’s impact on medical practices and patients, it is important for physicians to be prepared to comply with news laws passed during the 2020 legislative session. Most of these laws passed by the Indiana General Assembly go into effect on July 1, 2020. 

As ISMA has previously reported, the legislature was hyper-focused on health care issues in this election year and passed several measures related to health care costs, transparency and patient protections. Several key laws impacting physician practices are summarized below.

Good-faith estimates for nonemergency services (HEA 1004-2020)
Beginning July 1, 2020, if patients request it, health care practitioners must provide a good faith estimate of the total price they will charge for a nonemergency health care service that has been ordered, scheduled or referred. Patients may not be charged for this information and, if a service is to be provided in a facility, additional requirements apply. 

Non-binding: Estimates required by this law are not binding on the practitioner. There is no penalty for providing an incorrect estimate. Estimates must be accompanied by a notice stating that (1) the estimate is not binding, (2) that the final price may vary from the estimate based on the patient’s medical needs and (3) that the estimate is only valid for 30 days. 

Notice of right to receive a good faith estimate: Patients who have received an order for a nonemergency health care service must be provided with an electronic or written notice informing them of their right to request a good faith estimate. A similar notice must also be posted in waiting rooms and on practitioners’ websites (if applicable). Notices must be designed, lettered and positioned to be conspicuous and readable by any individual with normal vision who visits the waiting room or website.

Price: For the purposes of this law, “price” is defined differently for in-network and out-of-network physicians and for patients covered by Medicare. If the practitioner is in-network, the price is the negotiated rate between the practitioner and the patient’s insurer. If the practitioner is out-of-network, the price is whatever a practitioner charges uninsured patients for the service. If the patient is covered by Medicare, the Medicare rate applies. NOTE: Practitioners are not required to provide estimates of out-of-pocket costs to patients. 

Five business days: The practitioner must provide a requested estimate to a patient within five business days. If completing the estimate requires information from a facility in which a service is performed or from an insurer, the facility or insurer must respond with the relevant information within two business days.

Delivery: The patient may request that the estimate be provided in writing and be delivered to the patient either via email or through a mobile app or internet-based method, if available.

Failure to comply: If a practitioner fails to comply with these requirements, the appropriate licensing board may take action. An exception exists for scenarios where a facility or health insurance carrier does not provide information necessary for an estimate in a timely fashion.

Physician-patient relationship, noncompete provisions in physician employment contracts (HEA 1004-2020)
Starting July 1, 2020, if a physician leaves the employment of an employer, state law requires the employer to do the following:
  • Provide the departing physician with a copy of any notice concerning the physician’s departure that the employer has sent to patients seen by the physician during the last two years.
  • Provide a patient who has seen the departing physician during the previous two years with the physician’s last known or current contact and location information (i.e., the physician’s new practice location) upon the patient’s request;
  • Provide the departing physician with access to or copies of any medical record associated with a patient the departing physician has seen within the previous two years.

In addition, any physician agreement that contains a noncompete clause originally entered into on July 1, 2020, or later must (1) specifically enumerate the physician-patient relationship protections outlined above and (2) contain an option to purchase a complete and final release from the terms of the noncompete clause at a reasonable price.

Surprise billing (HEA 1004-2020)
A detailed discussion of the out-of-network (OON) billing provisions passed by the Indiana General Assembly can be found here.

The new law, effective July 1, 2020, prevents OON practitioners who provide a service at an in-network facility from being reimbursed more than allowed according to “the rate or amount of compensation established by the covered individual’s network plan,” unless (1) the OON practitioner provides a good faith estimate for the cost of the practitioner’s services at least five days in advance and (2) the patient signs a consent form (signifying that they consent to being charged the amount provided in the practitioner’s good faith estimate).

ISMA opposed these OON billing provisions. Go here for more information on how your practice can help ISMA advocate for a change to this new law next year.

Electronic prescribing laws effective Jan. 1, 2021 (SEA 176-2019; HEA 1207-2020)
In October 2018, President Donald Trump signed the SUPPORT for Patients and Communities Act, which requires prescriptions for Medicare Part D-covered controlled substances to be prescribed electronically beginning Jan. 1, 2021. In 2019, the Indiana General Assembly also passed a law that requires practitioners to prescribe controlled substances electronically starting Jan. 1, 2021, but – unlike the federal law, the state law applies to all controlled substance prescriptions, not just those for Medicare patients. 

However, the state law is significantly more flexible than the federal law, thanks to several exceptions secured by ISMA. For instance, Indiana physicians may issue a written prescription for controlled substances if they lack the technological ability or the technology necessary to issue electronic prescriptions. Indiana prescribers may also issue a written prescription if they reasonably determine that it would be impractical for the patient to obtain an electronic prescription in a timely manner and the delay would adversely affect the patient's medical condition. (NOTE: These state law exceptions do not apply to Medicare Part D-covered controlled substances prescriptions. The federal law applies, which requires that they be electronically prescribed.)  

This article is for general informational purposes only and does not constitute legal advice. Members should consult with their attorneys regarding any specific legal questions and to ensure their practices are in compliance with applicable law.