Republican gubernatorial candidate Sen. Mike Braun (R-Indiana) made the announcement. healthcare plan On Thursday, it will expand on past legislative efforts, including several policies that failed in the past few Congresses. Brown’s plan includes prior authorization reform, regulation of pharmacy benefit managers and a ban on non-compete clauses.
The plan was created in collaboration with Hoosiers for Opportunity, Prosperity and Enterprise, Inc., a nonprofit organization based in Terre Haute. Brown said in a statement that he is partnering with HOPE to develop the policy proposal.
The plan focuses on six key areas including quality, cost, transparency, access, wellness and competition. The plan published by HOPE, Inc. says it builds on the “solid foundations” established by the General Assembly, but the success of its policies has varied.
New plan, old bill
Brown’s plan positions preclearance reform as a way to increase transparency. Pre-approval refers to the process by which an insurance company may require prior approval before covering medical services. This practice has been criticized for creating barriers to patient care and administrative burden on health care providers.
Prior authorization reform was a key part of Senate Republicans’ policy priorities in the last Congress, but Republicans ultimately killed the reform bill because of “.financial concerns. ”
The plan proposes banning non-compete clauses for “licensed medical personnel” at nonprofit hospitals. Federal Trade Commission Rules prohibiting commercial use. Congress passed a ban on non-compete clauses in 2023,however, primary care physician.
Brown also wants to regulate pharmacy benefit managers (PBMs).
“In reality, these intermediaries between pharmacies and drug companies only drive up the cost of prescription drugs,” the plan states.
He proposes prohibiting third-party administrators who implement health insurance plans’ pharmacy benefits from directing people to pharmacies in which PBMs hold equity.
Lawmakers passed the bill last session This added transparency measures for PBMs, but no regulations beyond audits. Attempts to regulate PBMs in 2023 have been watered down.almost irrelevant”
The plan also includes policy changes to “protect Hoosiers from integration.” country experts Linked Healthcare consolidation due to lack of competition and rising healthcare costs in Indiana.
Mr. Brown proposes requiring all private equity mergers and acquisitions in the healthcare industry to be approved by the Attorney General.
During the 2024 legislative session, lawmakers Measures passed This would allow the Attorney General to review and request information if the value of at least one party to a merger is $10 million or more. The bill does not give the attorney general the power to approve or deny a merger, nor does it create penalties for someone failing to notify the attorney general.
Mr. Brown’s plan would require approval for mergers involving private equity “regardless of valuation.” He also wants to give the attorney general “power” to block certain mergers found to cause “adverse consumer effects.”
Mr. Brown also proposed giving the attorney general’s office the authority to appoint law enforcement officers within the Medicaid fraud division. subject of the bill Last session failed.
Several other policies included in the plan will also require legislative action.
Medicaid policy, fraud prevention
In addition to recommendations for law enforcement officers in the Medicaid Fraud Enforcement Division, the plan also proposes several other policies related to Indiana Medicaid aimed at reducing costs.
The plan calls for independent audits of Medicaid and the State Employees Health Plan to identify “unreasonable or inappropriate amounts paid on claims” and identify trends within the program. .
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The plan also calls for the attorney general’s office to work with the Department of Family and Social Services to investigate suspected overpayments, duplicate claims, or other suspicious claims or billing practices, “regardless of the amount.” .
A “whistleblower” lawsuit is currently progressing in court alleging that several Indiana hospital systems and managed care organizations committed “tens of millions, possibly hundreds of millions of dollars” of Medicaid fraud.
But the plan doesn’t just focus on Medicaid fraud. It also proposes policies aimed at improving quality and increasing access to care.
The plan advocates, among other things, expanding telehealth for Medicaid members and establishing new health care quality metrics for Indiana. Pathways to Aging Program.
Another plan policy would require Medicaid members to consult their primary care physician before going to the emergency room for non-emergencies, while encouraging private plans to implement similar requirements. is.
But the plan recognizes that to do so, members need to have better access to primary care providers. To expand primary care options for Medicaid members, Brown would give patients “access to program funds to support direct primary care practice members.”
He also advocates setting “clear metrics” to measure the state’s health care quality and patient outcomes. New long-term care program Eligible to Medicaid members age 60 and older.
Infant and maternal mortality rates
Brown’s plan also includes ideas such as: how to deal with that situation tall toddler and maternal mortality rate By increasing access to maternity services in rural areas.
Indiana has several worst toddler And the country’s maternal mortality rate is even worse among Black Hoosiers and Black Americans. in the countryside.
Brown is asking the Indiana Graduate Medicaid Education Fund to provide rural training placements for obstetrics, or OBs, health care providers, and “other high-need occupations” to address rural workforce shortages. We ask that you give priority to
He also advocates the establishment of new training programs for obstetricians, former family physicians, and midwives. Currently, there are no midwife training programs in the state.
Abigail is our health reporter. Contact details are as follows: [email protected].
