2015 Legislative Preview
November 18th marked the kickoff of the 2015 legislative session, as Indiana legislators convened in Indianapolis to be formally sworn into office. House and Senate Leaders released the official calendar of the upcoming session that, while subject to change, projects the first day of official legislative business will begin on January 6 and conclude no later than April 29th, 2015. Until then, legislators will remain busy preparing legislation for introduction and have only a few short weeks left until their deadline (December 12, 2014) to submit proposals to Indiana's Legislative Services Agency for formal bill drafting.
House and Senate Leaders recently announced the chairmanships of Senate and House legislative committees, in which there were few changes made to the committees most closely monitored by IAFP. Of note, Representative Cindy Kirchhofer (R-Beech Grove) was appointed as a new member and Vice Chair of the House Committee on Public Health, which will be chaired again by Representative Ed Clere (R-New Albany). In the Senate, leaders restructured several committees, merging the Financial Institutions Committee and Insurance Committee into one panel to be chaired by Senator Travis Holdman (R-Markle). The Senate Health and Provider Services Committee will remain under the leadership of longtime Chairwoman Patricia Miller (R-Indianapolis).
Legislators will have until mid-January to file bills for initial hearing, and while we will not know the full scope of issues that will be considered in the 2015 session until after the passing of the bill filing deadline on January 14th, IAFP has been closely monitoring the policy discussions that take place in the months leading up to the legislative session. Legislators, the Administration, and industry have been hard at work this summer interim, and it is anticipated that the House and Senate Health committees, in particular, will have a full agenda in the months to come. Below you will find a brief summary of the legislative proposals that IAFP anticipates will be considered by the General Assembly in the coming months.
The 2015 Legislative Session is a "long session" where legislators will write the state's budget, appropriating approximately $30 billion over the next two years. While the issue of K-12 education tends to dominate budget discussions, as more than half of the biennial budget goes to funding Indiana schools, legislative leaders have identified several health-related issues, such as mental health and addiction, graduate medical education and infant mortality, as funding priorities that will garner much discussion.
You can also expect legislators to address the following health-related issues during the budget process:
- Graduate Medical Education. Ways and Means Chairman Tim Brown has expressed interest in exploring graduate medical education expansion. While we expect any proposal to focus on a consortium model whereby hospitals, providers and community stakeholders will work together to expand residency slots, there is a chance that some level of funding will become available.
- Tobacco Tax and Electronic Cigarettes. Lawmakers are expected to consider proposals that would subject electronic cigarettes and other tobacco alternatives to Indiana's tobacco tax, which currently imposes a $1.00 tax on each pack of cigarettes. The American Cancer Society and other stakeholders of the newly-formed coalition, Hoosiers for a Healthier Indiana, are also seeking to increase the tobacco tax to fund smoking cessation efforts and other public health programs.
Health Care Administration & Compensation
- Medical Malpractice Caps. Indiana's Medical Malpractice Act plays an important role in ensuring physicians and other health care providers can afford to practice throughout the state. The Act was first passed into law in 1975 and has withstood multiple constitutional challenges over the years, as defense counsel have sought to overturn the Act’s limitations on jury awards in malpractice cases. These statutorily set liability caps have been raised twice by the General Assembly since their enactment, with the last increase made in 1999 to the current level of $1.25 million per malpractice occurrence (with an individual provider cap of $250,000). As the Act continues to face challenges in the courts, the Indiana Trial Lawyer Association will seek to address the Act through legislation which would raise the damage caps.
- Debt Collection Reform. The Indiana Attorney General's Office announced its intent to address through legislation several of the top consumer complaints received by its Consumer Protection Division each year. Among these legislative efforts, Attorney General Zoeller will seek to build on the federal Fair Debt Collection Practices Act by establishing additional state guidelines for debt collectors, including the requirement that collectors provide debtors with specific information at the outset of the collection process. We will be closely monitoring this issue to ensure that these reform efforts do not unreasonable burden health care providers in their ability to seek payment for medical services rendered.
- Telehealth Expansion. In recent sessions, legislators have sought to expand the use of telehealth and telemedicine services by removing certain reimbursement barriers and by establishing pilot programs that would permit physicians to issue certain prescription drugs without the need of an in-person patient consultation. We expect additional legislative efforts to expand the ability of Indiana health providers to engage in and be reimbursed for telehealth and telemedicine services.
Pharmacy and Controlled Substance Issues
- Pseudoephedrine and Ephedrine Scheduling. There is a renewed energy in efforts to combat Indiana's methamphetamine epidemic through proposals that would place extreme limitations on patient access to pseudoephedrine and ephedrine products. Several pieces of legislation are likely to be introduced that would make PSE and ephedrine prescription-only, or even controlled substances as Schedule III or IV products. IAFP and others will fight to protect patient access and oppose scheduling and prescription-only efforts. The health care provider and consumer stakeholders will instead advocate for the creation of a methamphetamine offender registry that would block certain drug offenders from over-the-counter purchases of PSE and ephedrine products for a period of time following their conviction.
- Opioid Prescribing Regulations. The Attorney General's Prescription Drug Abuse Task Force will continue its efforts to address the state's prescription drug abuse problem through legislative means. Past legislative efforts of the Task Force led to the enactment of the Medical Licensing Board's recently finalized pain management rules, which place limitations on the ability of providers to prescribe opioid drugs for the purposes of pain management. In anticipation of the coming session, the Task Force is considering proposals that include: the expansion of Indiana's prescription drug monitoring program, INSPECT; the requirement that prescribers receive a certification in pain management and pass competency tests in order to qualify for controlled substance registration; and the expansion of the addiction treatment medications available to Medicaid providers which are currently limited to narrow options within Medicaid formularies. IAFP will work to ensure these efforts are not unduly burdensome on Indiana’s physicians.