2015 Legislative Session Recap

The Indiana General Assembly passed the state’s biennial budget and adjourned sine die on Wednesday, April 29^th just moments before their midnight deadline. All enacted bills are on their way to the Governor for signature, with most having effective dates of July 1, 2015.

It was a good year for IAFP, as funding for Indiana's family medicine residencies remained intact (despite a lower-than-expected state revenue forecast), proposed changes to the medical malpractice act did not advance, efforts to make pseudoephedrine prescription-only were defeated, and the collaborative practice requirement for lay midwives remains intact. Additionally, IAFP staff worked very diligently to ensure additional prescribing regulations and barriers to treatment in the family physician's office did not progress this session. Here is a summary of the key legislative issues that will impact family medicine.

State Biennial Budget
The biennial budget fully funds the Medicaid expenditure forecast for State Fiscal Years (SFYs) 2016 and 2017. This is good news as it reduces the risk of administrative rate reductions or other cost containment measures over the two-year spending plan.

In addition, the budget funds the family practice residency program, the Primary Care Shortage Area Scholarship, which was established in the 2013 budget cycle for students of Marian University College of Osteopathic Medicine, and the budget contains new funding for the administrative costs of setting up a state-wide graduate medical education expansion program.

Annual funding for the Tobacco Use Prevention and Cessation Program remains at $5 million per year, while efforts to increase the cigarette tax by one dollar per pack, fell short in the final hours of session. The Indiana General Assembly will study the fiscal impact of a tobacco tax increase this summer.

Medical Malpractice
Possible changes to Indiana’s Medical Malpractice Act were a major focus for healthcare providers leading up to the 2015 session and in the first weeks of legislative action; however, the efforts ultimately were defeated or stalled. SB 55, which would have increased the amount with which a malpractice claim can bypass the medical review panel from $15,000 to $187,000, was defeated with the help of providers. As amended, the bill would have also allowed wrong-site surgery or retention of a foreign object cases to bypass the panel at any level. HB 1043 proposed to raise Indiana's overall malpractice damage award cap from the current $1.25 million to $1.65 million for claims arising after June 30, 2015. This bill did not advance either, but the topic of whether a modest increase in the cap will continue in light of recent constitutional challenges.

Midwives
Certified direct-entry midwives (CDEMs), or non-nurse lay midwives, were unsuccessful in their attempt to remove the CDEM certification requirement for collaborative practice. This legislation hit several roadblocks throughout the legislative process, including testimony from IAFP. While the collaborative agreement remains in place, immunity provisions were added for physicians who sign a collaborative agreement with a CDEM and for health care providers who employ these physicians.

Needle exchange
In response to the HIV epidemic in Southwest Indiana, this General Assembly has passed legislation that will permit the operation of needle or syringe exchange programs (SEPs) beyond what has been recently authorized in Scott County through Executive Order. Effective immediately, local governments will be permitted to request a public health emergency declaration by the ISDH based on an epidemic of hepatitis C or HIV associated with IV drug use, after which certain entities may operate a SEP as part of a comprehensive public health response.

HPV immunizations
Legislation failed that would have called for ISDH to establish plans to increase Indiana's HPV immunization rate to 80% among girls and boys between the ages of 13 and 16 — about four times the current rate. Though the bill did not require childhood vaccinations against HPV, concerns were raised that this effort may lead to an eventual immunization mandate (HEA 1359). Legislation also passed that makes several updates related to childhood immunizations, including HPV, and requires the distribution of information related to the HPV vaccine to parents of all children in the 6th grade (current law requires only the parents of female students) (SEA 461).

No opioid prescribing rules for the treatment of substance abuse
Legislation did not pass that would have required the DMHA to adopt opioid prescribing rules for the treatment of substance abuse. The proposed regulations would have been similar to the rules adopted by the Medical Licensing Board for health care providers who prescribe opioids for the treatment of pain. This legislation would have also essentially prohibited reimbursement for the prescribing of Subutex and Suboxone for the treatment of pain. IAFP worked actively to defeat (or amend) this provision (SB 439).

The General Assembly has created an oversight board to evaluate the state's prescription drug monitoring program (INSPECT) after concerns were raised in a state-commissioned report regarding the management and security of the program (SEA 358). Legislators also passed legislation that will permit medical residents with temporary medical licenses to access and use INSPECT, effective July 1, 2015 (SEA 168).