Legislative Update - 2/24/2011

With Indiana making national news, the IAFP is sure you are aware how contentious negotiations have been this year in the Indiana House of Representatives. While the union and education related legislation have been the hot topics in the news, the health bills introduced have also been controversial.

When the Indiana House of Representatives Democrats refused to return to the Statehouse a number of pieces of legislation were left that had not received a full House vote. Originally the deadlines for bills to pass out of their first House was February 25th, but the House Rules committee has voted to move the deadline to Friday, March 4th. However the committee report still needs to be adopted by the full House with a quorum for the new deadlines to go into effect. It is unknown at this time whether the House of Representatives deadlines will be pushed back again if the House Democrats continue their boycott. The Senate is continuing with their normal deadline schedule.

The state budget and the midlevel provider scope of practice bills are included in the list of bills that will die if not heard by the new House deadline of March 4th. However, it is not unusual for dead bills to be amended into other legislation later on in session.

The IAFP Commission on Legislative and Governmental Affairs (COL) met on January 26th to discuss all the introduced health related legislation and determine appropriate action. The IAFP COL, which comprised of family physicians from across the state with an interest in policy, had to consider over 50 bills owing to the vast number of health related bills that were introduced.

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Below is the breakdown of key health legislation of which Family Physicians should be aware. If you have questions on IAFP advocacy, or are interested in participating in IAFP advocacy please contact Meredith Edwards or Doug Kinser, JD at 317-237-4237 or medwards@in-afp.org.

2011 Budget
The IAFP can report that currently the Family Medicine Residency funding remains in the budget, with the 15% cut that the Governor required of all boards and agencies. The Indiana Tobacco Prevention and Cessation agency received a larger cut than other agencies, reducing their budget to $8.05 million.

Scope of Practice Issues
As the IAFP expected, many non physician health care providers came to the legislature seeking scope of practice expansions. At this point in session we know the bill allowing non-nurse midwives to perform home births will not be moving forward.

The physician assistants originally came forward with a bill that would have grossly expanded their scope of practice, however through negotiations between the IAFP, the State Medical Association, and the Indiana Academy of Physician Assistants, the groups are working on a bill we can agree on. Currently House Bill 1298 gives supervising physicians up to 72 hours to review charts, and allows a supervising physicians to delegate to their physician assistants the prescription of schedule 2-5 controlled substances not to exceed a 30 day supply (current law is only seven days). This bill is currently awaiting a House vote and will die if not voted out of the House by March 4th.

Physical therapists are seeking direct access to patients this year. The current law in Indiana states that patients must have a referral before treatment by a physical therapist. House Bill 1151 would allow physical therapists to treat patients for 30 days before requiring a referral from a physician. The House Public Health Committee heard House Bill 1151 on February 16th and IAFP past president Teresa Lovins, MD of Columbus, IN testified in opposition of the bill citing patient safety. This bill is awaiting House amendments and will die if not voted out of the House by March 4th.

Online Death Registry
Senate Bill 366 has been much anticipated by the IAFP. Among other provisions it will remove the criminal penalties associated with failing to sign a death certificate. New penalties will begin after 2012, but will be at the discretion of the Medical Licensing Board and likely fine based. With the introduction of the new online death registry another problem was quickly discovered, medical residents were unable to sign any death certificates. At the urging of the Family Medicine residency directors in the state the IAFP sought to have Senate Bill 366 amended to include a provision to allow all residents to sign death certificates. The bill was amended and has been passed out of the Senate.

Insurance and Payment
For the third year, legislation that would ban open access clauses in insurance contracts was introduced. House Bill 1080 was heard in the House Insurance committee on January 26th where IAFP member Dr. Topper Doehring of Indianapolis testified on how open access clauses prohibit physicians from having control over their practice. This year the bill failed to move out of committee, but may be studied this summer.

The Insurance committee also heard House Bill 1582 which would require physicians to give patients five provider options for any referral and the costs that patients could expect. The IAFP spoke to Representative Heath VanNatter, the author of the bill, about our opposition. Representative Heath VanNatter noted our concerns and the bill was amended to form a study committee on this issue. The bill is awaiting a full House vote and will die if not passed out by March 4th.

Criminal Background Checks
Senator Pat Miller introduced Senate Bill 363, which would require national criminal background checks for certain professionals seeking their initial license to practice in Indiana. The list of included professionals is extensive and includes physicians, podiatrists, genetic counselors, nurses, pharmacists, chiropractors, and massage therapists. The bill was passed out of the Senate.

Public Health
In the pubic health realm, bills concerning student concussions, the drug spice, and texting while driving bills all look like they will pass out of both houses at this time. Senate Bill 57 makes possessing, dealing in, manufacturing, or delivering a synthetic cannabinoid (commonly referred to as spice) equivalent to the same crimes for marijuana. Senate Bill 18 would prohibit the use of handheld electronic devices from being used to send or read emails or texts. Senate Bill 93 requires the Indiana Department of Education to create materials educating coaches, athletes and parents about the risks of head injuries and requires the evaluation of students with suspected head injuries.

Health Care Reform Implementation
The Federal Patient Protection and Affordable Care Act (PPACA) left much of its implementation to the states. Senate Bill 461 would prepare Indiana for implementation of health care reform, by decreasing income eligibility for the Healthy Indiana Plan (HIP) to 113% of Federal Poverty Level. The state plans to change HIP into an entitlement program in 2014 so it can function as Indiana’s Medicaid expansion as required under PPACA. Currently the state administration and CMS are in discussions about whether the state can keep personal patient contributions a part of the HIP program under the expansion. Senate Bill 461 also gives the Family and Social Services Agency the ability to alter Medicaid coverage to match the federal minimum benefits package, when that package is announced. The bill has passed out of the Senate.