SB 225

           Second Regular Session of the 124th General Assembly (2026)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
  Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
 Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2025 Regular Session of the General Assembly.
    SENATE ENROLLED ACT No. 225
    AN ACT to amend the Indiana Code concerning health.
    Be it enacted by the General Assembly of the State of Indiana:
    SECTION 1. IC 4-6-2-13 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2026]: Sec. 13. (a) The attorney general may:
      (1) suspend the authority of a hospital, or a debt collector or
      other third party on behalf of a hospital, to pursue medical
      debt collection as described in IC 16-21-16-3; and
      (2) terminate the suspension upon the hospital's compliance
      with IC 16-21-16, as determined by the Indiana department
      of health.
    (b) The attorney general shall enforce IC 16-21-16.
    SECTION 2. IC 16-18-2-14, AS AMENDED BY P.L.213-2025,
SECTION 146, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 14. (a) "Ambulatory outpatient
surgical center", for purposes of IC 16-19, IC 16-21, IC 16-32-5, and
IC 16-38-2, means a public or private institution that meets the
following conditions:
      (1) Is established, equipped, and operated primarily for the
      purpose of performing surgical procedures and services.
      (2) Is operated under the supervision of at least one (1) licensed
      physician or under the supervision of the governing board of the
      hospital if the center is affiliated with a hospital.
      (3) Permits a surgical procedure to be performed only by a
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    physician, dentist, or podiatrist who meets the following
    conditions:
        (A) Is qualified by education and training to perform the
        surgical procedure.
        (B) Is legally authorized to perform the procedure.
        (C) Is privileged to perform surgical procedures in at least one
        (1) hospital within the county or an Indiana county adjacent to
        the county in which the ambulatory outpatient surgical center
        is located.
        (D) (C) Is admitted to the open staff of the ambulatory
        outpatient surgical center.
    (4) Requires that a licensed physician with specialized training or
    experience in the administration of an anesthetic supervise the
    administration of the anesthetic to a patient and remain present in
    the facility during the surgical procedure, except when only a
    local infiltration anesthetic is administered.
    (5) Provides at least one (1) operating room and, if anesthetics
    other than local infiltration anesthetics are administered, at least
    one (1) postanesthesia recovery room.
    (6) Is equipped to perform diagnostic x-ray and laboratory
    examinations required in connection with any surgery performed.
    (7) Does not provide accommodations for patient stays of longer
    than twenty-four (24) hours.
    (8) Provides full-time services of registered and licensed nurses
    for the professional care of the patients in the postanesthesia
    recovery room.
    (9) Has available the necessary equipment and trained personnel
    to handle foreseeable emergencies such as a defibrillator for
    cardiac arrest, a tracheotomy set for airway obstructions, and a
    blood bank or other blood supply.
    (10) Maintains a written agreement with at least one (1) hospital
    for immediate acceptance of patients who develop complications
    or require postoperative confinement.
    (11) Provides for the periodic review of the center and the center's
    operations by a committee of at least three (3) licensed physicians
    having no financial connections with the center.
    (12) Maintains adequate medical records for each patient.
    (13) Meets all additional minimum requirements as established by
    the state department for building and equipment requirements.
    (14) Meets the rules and other requirements established by the
    state department for the health, safety, and welfare of the patients.
  (b) The term does not include a birthing center.
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   (c) "Ambulatory outpatient surgical center", for purposes of
IC 16-34, refers to an institution described in subsection (a) and that
has a majority ownership by a hospital licensed under IC 16-21.
   SECTION 3. IC 16-18-2-223.2 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 223.2. "Medical debt", for
purposes of IC 16-21-16, has the meaning set forth in
IC 16-21-16-2.
   SECTION 4. IC 16-18-2-328.8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 328.8. "Service line", for
purposes of IC 16-21-17.1, has the meaning set forth in
IC 16-21-17.1-1.
   SECTION 5. IC 16-21-16 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2026]:
   Chapter 16. Medical Debt Collection Restrictions
   Sec. 1. This chapter applies to medical debt incurred after June
30, 2026.
   Sec. 2. (a) As used in this chapter, "medical debt" means any
amount owed that is past due by at least one hundred twenty (120)
days for health care services, products, or devices provided to an
individual by or in a hospital.
   (b) The term does not include debt purchased by, payable to, or
owed to a financial institution (as defined in IC 28-1-1-3(1)) or the
financial institution's assignee.
   Sec. 3. (a) A hospital, or a debt collector or other third party on
behalf of a hospital, may not pursue collection of a medical debt
unless the hospital is in compliance with the following statutes, if
applicable to the hospital:
     (1) IC 16-21-6.
     (2) IC 16-21-9.
     (3) IC 16-21-17.1.
     (4) IC 16-21-19.
   (b) The state department shall determine on a semiannual basis
whether a hospital is in compliance with the statutes specified in
subsection (a) and notify a hospital, in writing, of the state
department's determination concerning the hospital's compliance.
A determination under this subsection is subject to review under
IC 4-21.5.
   (c) The state department shall notify the office of the attorney
general if the state department makes a final determination after,
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if applicable, any review under IC 4-21.5, that a hospital is
noncompliant with the statutes described in subsection (a).
   (d) The state department shall notify the office of the attorney
general of the following under this chapter:
     (1) A final determination that a hospital is noncompliant.
     (2) A determination that a hospital that was noncompliant has
     remedied the noncompliance and is now compliant with the
     statutes.
Upon receiving a notice under subdivision (2), the office of the
attorney general shall terminate a suspension described in
subsection (e).
   (e) Unless a review under IC 4-21.5 by the hospital is pending,
the office of the attorney general may suspend the noncompliant
hospital's authority to pursue medical debt collection after
receiving the notification set forth in subsection (d)(1) until the
office of the attorney general receives the notice under subsection
(d)(2) that the noncompliance has been remedied.
   (f) An individual may raise a hospital's noncompliance with a
statute set forth in subsection (a) as an affirmative defense in any
medical debt collection action that occurs during a period of
noncompliance once a final determination has been made under
subsection (c).
   (g) A hospital may pursue collection of a medical debt
previously incurred by an individual when the hospital was
noncompliant under subsection (a) if the state department
subsequently makes a determination, in writing, that the
noncompliance has been remedied and the hospital is designated by
the state department as compliant under this chapter.
   Sec. 4. (a) The state department shall post and update a list of
the noncompliant hospitals on the state department's website.
   (b) The state department shall adopt procedures for the
following:
     (1) The state department's review of a hospital's compliance
     under this chapter, including a schedule for reviewing and
     issuing determinations concerning compliance.
     (2) A noncompliant hospital's subsequent compliance status
     review to determine if the noncompliance has been remedied.
   Sec. 5. (a) The attorney general shall enforce any suspension
under section 3(e) of this chapter and may do any of the following:
     (1) Investigate alleged violations.
     (2) Impose civil penalties of not more than ten thousand
     dollars ($10,000) per violation.
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      (3) Order restitution to an affected patient or individual.
      (4) Suspend or prohibit a hospital, a debt collector, or other
      third party from collecting medical debt until compliance is
      verified.
   (b) The attorney general may adopt rules under IC 4-22-2 to
implement and administer this chapter.
   Sec. 6. An individual injured by a violation of this chapter may
bring a civil action to recover in an appropriate court any of the
following:
      (1) Actual damages.
      (2) Statutory damages not to exceed one thousand dollars
      ($1,000).
      (3) Injunctive relief.
   SECTION 6. IC 16-21-17.1 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2026]:
   Chapter 17.1. Notice of Closure or Elimination of Service Lines
   Sec. 1. As used in this chapter, "service line" means a category
of hospital based clinical services offered to patients, including the
following:
      (1) Emergency.
      (2) Obstetrics.
      (3) Neonatal.
      (4) Trauma.
      (5) Behavioral health services.
   Sec. 2. (a) Except as provided in section 4 of this chapter, a
hospital shall provide written notice to the state department at
least sixty (60) days before the hospital does any of the following:
      (1) Closes a hospital licensed under IC 16-21 and permanently
      terminates all hospital operations.
      (2) Completely eliminates a service line for longer than ninety
      (90) days.
   (b) The notice under subsection (a) must include the following:
      (1) The proposed date of closure of the hospital or elimination
      of a service line.
      (2) A description of the affected services and capacity.
      (3) The hospital's plan for patient continuity of care.
   Sec. 3. Except as provided in section 4 of this chapter, not later
than ten (10) days after the notice is issued under section 2 of this
chapter, the following must occur:
      (1) The state department shall post a summary of the
      proposed closure of a hospital or an elimination of a service
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      line on the state department's website.
      (2) The state department shall notify the office of the
      secretary of family and social services and any other affected
      state agency of the closure of the hospital or elimination of a
      service line.
   Sec. 4. (a) The state department may waive the requirements in
sections 2 and 3 of this chapter upon written request by the
hospital only if:
      (1) the closure or an elimination of a service line described in
      section 2 of this chapter is necessary due to a natural disaster,
      catastrophic facility failure, or other emergency event beyond
      the hospital's control; or
      (2) the state department determines that the waiver is
      necessary to protect the public's health and safety, including
      the loss of practitioners necessary to provide the service line.
   (b) The state department shall in a reasonable time period post
on the state department's website any waiver granted under this
section and the justification for the waiver.
   Sec. 5. A hospital that violates this chapter may be subject to a
civil penalty not to exceed ten thousand dollars ($10,000).
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President of the Senate
President Pro Tempore
Speaker of the House of Representatives
Governor of the State of Indiana
Date:  Time:
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