Legislative Update - 3/28/2011

The stalemate between Indiana House of Representatives Democrats and Indiana House of
Representatives Republicans continues to disrupt the movement and passage of legislation in
Indiana. As of today, March 28th, the Indiana House failed to have a quorum, although there are
talks between the two sides and it was just announced the House Dems will return at 5 p.m.
today. In recent times but prior to 2011, there were walkouts by both parties in 1991, 1995, 2001,
and 2005. Democrats walked out twice and Republicans walked out twice although none were as
long as 2011 nor did they leave the state.

The House Rules Committee has met several times since the February 21st walkout began to push
back deadlines so that bills on the House second and third reading calendar can be considered
alive. The most recent meeting pushed the deadline back to March 31st. However, the House
Rules Committee report still needs to be adopted by the full House with a quorum for those
deadlines to officially go into effect.

How exactly is the walkout stopping almost all legislation?
There are several reasons why:
1. Legislation that has passed the Senate cannot be assigned to House committees without a
quorum of the full House
2. Legislation that was assigned to House committees before the walk out cannot be voted on
because the House committees also do not have a quorum to do business
3. All bills in the House on second or third reading have been temporarily killed but could be
resurrected if the rules for deadline are waived and the quorum requirements are met.
4. Some bills were additionally killed because committee reports had not been submitted or
adopted prior to the walk-out.
5. If legislation that has already passed the House is amended in the Senate (which is very
common), it has to be voted on in the House again, but the House is unable to vote without a
quorum

Committees in both Houses continue to meet and hold hearings on legislation so that voting
can be expedited when the House Democrats return. Many bill authors are working to find
ways to amend their legislation into House bills that have passed the House and are in Senate
Committees, hoping to avoid the extra hurdle of a House committee vote.

The deadline for the Indiana Legislative session to end is April 29th, 2011. In a budget writing
session, such as 2011, it is expected that the Indiana Legislators will pass a budget before that
deadline. If the Indiana Legislature fails to finish the budget or any bill on the Governor's agenda
by April 29th, the Governor has the ability to call the legislators back into to session. If the
Governor calls the legislators back and while the Governor can try to limit subject matter, the
legislative leadership determines what will be heard. The current fiscal year ends on June 30th,
and a new budget is needed prior to that deadline to avoid a government shut down.

In spite of the showdown at the Statehouse, the IAFP held the third annual legislative breakfast on March 16th.
Dr. Jason Marker, the current president of the IAFP, spoke on how the shortage
of family physicians will raise healthcare costs, and the importance of raising payment to family
physicians to increase student interest in the specialty.

Members of the IAFP Executive Committee, Board, and Commission on Legislation were
delighted to be joined by House Public Health Chairman Tim Brown (Crawfordsville),
Representative Tim Wesco (Osceola), Representative Mike Karickhoff (Kokomo), Representative
Bob Heaton (Terre Haute), Representative Rhonda Roads (Corydon), Representative Ron Bacon
(Chandler), and Senator Ed Charbonneau (Valparaiso). Most legislators stayed after Dr. Marker’ s
presentation to speak with the physicians in attendance about family medicine and legislation of
concern to the IAFP.

Below is an update on bills that have had hearings or amendments since the last legislative
update. 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. The Senate has begun unofficial
Budget hearings as they wait for the House to have a quorum and pass the Budget.

Family and Social Services Administration is making a presentation on March 28th on its
Medicaid forecast.

Medicaid Coding
House Bill 1171 would require Medicaid to adopt new billing and procedure codes within
90 days of their release. When Medicaid uses outdated codes it requires physicians to code
differently for Medicaid than they do for commercial insurance and Medicare, an extra hassle for
physicians. The hope is to reduce the amount of claims that are being rejected and ease the burden
Medicaid places on physicians. The bill was passed out of the House and received a hearing in the
Senate Health and Provider Services committee on March 16th. The Senate Health and Provider
Services committee is holding hearings but not voting on any bills or amendments at this time.

Health Care Reform Preparation
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 changing income eligibility for the Healthy Indiana Plan (HIP) to 133%
of Federal Poverty Level and turning HIP into an entitlement program by removing the cap on
the number of participants in 2014. Senate Bill 461 has passed the Senate and was heard by an
unofficial meeting of the House Public Health Committee on March 23th.

Also on March 23rd the Family and Social Services Agency (FSSA) held their first public meeting
on the proposed state plan amendment that FSSA intends to send to the Federal Health and
Human Services Agency. FSSA will be requesting authorization from the federal government
to make the changes to HIP in regards to eligibility and benefit package. The proposed changes
to the benefit package include adding maternity care, dental care for those age 21 and under,
and requiring all participants to partially fund a product similar to a personal Health Savings
Account. FSSA is requesting that HIP be accepted as the Affordable Care Act mandated
Medicaid expansion in the state of Indiana. The proposed state plan amendment currently retains
a hallmark of the current HIP plan, paying physicians at Medicare rates or 130% of Medicaid
rates when there is no Medicare rate available.

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. 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 and is awaiting a House committee assignment. Senator Miller is
looking for a germane House bill that has already passed the Indiana House to amend
the legislation into to avoid needing a House committee hearing

Texting While Driving
House Bill 1129 originally was written to ban texting while driving, but after the bill passed the
House, the Senate amended the bill to ban texting and phone calls while driving. Because of the
amendments in the Senate, the bill will need another vote by the full House.

Smokefree Air
House Bill 1018 which was originally written to protect all workers from second hand smoke,
was dramatically watered down with exemptions such as bars, casinos, and nursing homes in the
House. The bill did pass out of the House before the walkout and on March 23rd the Senate Public
Policy committee met to hear the bill. The Senate Public Policy Committee heard testimony but
has not yet taken a vote or amended the bill.