Legislative Update - 5/9/2011

On April 29th just minutes before midnight, the 2011 Indiana Legislative Session voted on their last bill and ended a history making session, for better or worse.

What many will remember about this session was the five weeks of walkout by the House Democrats over the education and right to work legislation proposed by the House Republicans. It was also a busy year for health: see our nearly comprehensive list of health related legislation below.

Bills that have passed both houses:

Concussions and Head Injuries in Students, SB 93
This legislation requires the department of education to develop materials and forms on the risks of concussions and head injuries for schools to disseminate to parents and athletes. The new law requires students suspected of a head injury to be evaluated and cleared by a licensed health care provider who is trained in evaluating head injuries and concussions before returning to athletics. If the health care provider is a volunteer and acts in good faith, he/she is immune from liability in this scenario.

Medical Licensing Board Investigations, SB 223
Under this legislation the Medical Licensing Board will investigate and institute fines of up to $1,000 for certain violations by a physician in lieu of requiring a Medical Licensing Board hearing. The list of violations are: (1) Licensure renewal fraud, (2) Improper termination of a physician and patient relationship, (3) Practicing with an expired medical license, (4) Providing office based anesthesia without the proper accreditation, (5) Failure to perform duties required for issuing birth or death certificates. Physicians can appeal these Medical Licensing Board decisions. The penalties for these violations are not to be reported to the National Practitioner Data Bank.

Criminal Background Checks for Health Professionals, SB 363
This legislation requires certain health professionals seeking an initial Indiana health care license to submit themselves to a national background check. The list of health professionals is quite extensive and includes: physicians, occupational therapists, dentists, massage therapists, nurses, physician assistants, chiropractors, podiatrists, optometrists, psychologists and more.

Death Certificates, SB 366
This much anticipated legislation removes the misdemeanor penalty for physicians failing to timely file a death certificate. No penalties can be enforced until 2012 and, after that time, the Medical Licensing Board is authorized to levy fines for physicians failing to sign (this is included in SB 223).  The IAFP lobbied and was successful in having SB 366 amended to allow a physician enrolled in a residency to sign a death certificate, which was previously illegal and a great frustration to Family Medicine Residencies across the state.

Pseudoephedrine and Ephedrine, SB 503
Originally six pieces of legislation were introduced this session about with pseudoephedrine and ephedrine, all with the goal of reducing meth use and production in the state. There were two camps that the legislation fell into: bills that would institute more state wide tracking of the medications and bills that would require a prescription for all pseudoephedrine and ephedrine purchases. Dr. Richard Feldman, chair of the IAFP COL, testified that many patients easily find illegal prescription medicine on the streets and thus prescription only pseudoephedrine would not stop the problem of meth production. The final version of the bill that passed both houses will require retailers to use a national log to track the purchase of ephedrine and pseudoephedrine.

Budget, HB 1001
The final budget was passed in the last minutes of the 2011 session. The IAFP was relieved that despite mounting cuts and the elimination of many programs that the budget did contain the Family Medicine Residency funding at $1.9 million a year. However, the bill cut tobacco prevention dollars to $8 million and moved all the functions of the successful Indiana Tobacco Prevention and Cessation (ITPC) agency to the State Department of Health. The IAFP made several attempts to save ITPC’s independence, but was unable to save the agency.

Anatomic Pathology Services, HB 1071
This bill requires that only a physician who performs a pathology reading can bill for that reading.

Spice and Salvia Divinorum, HB 1102 and SB 57
Both bills make synthetic cannabinoids and salvia divinorum (a hallucinogen) possession, dealing, and manufacturing illegal and equivalent to the possession, dealing, and manufacturing of marijuana. The Governor chose to sign both bills into law.

Texting while driving, HB 1129
At least seven various electronic communications while driving bills were introduced during the 2011 session. The version that passed, HB 1129, prohibits all drivers from operating a motor vehicle and typing, reading, or sending an email or text. This law goes into effect July 1, 2011.

Diagnostic Codes and forms for Medicaid Claims, HB 1171
This legislation requires the Office of Medicaid Policy and Planning (OMPP) to create a single system that a physician can use to verify the eligibility of a Medicaid patient. It also requires OMPP to institute all coding changes within 90 days of their release from CMS.

Physician Assistants, HB 1233
Among the many subjects in this legislation are new statutes concerning physician assistants Originally the Physician Assistants came forward with a bill that would have removed the state requirement that physicians can only supervise two physician assistants, the bill would have allowed them the ability to sign all documents a physician can sign. The IAFP originally opposed that bill, but we were able to negotiate with the Indiana State Medical Association and the Indiana Academy of Physician Assistants to clarify the current physician assistant statutes without a real expanding their scope of practice, and ended up with a decent compromise.

The new physician assistant law, which is effective July 1, 2011, states that for a physician assistant to be practicing their supervising physician (or physician designee) must be onsite with them or the physician must be available by electronic means within the county or contiguous county of the physician assistant and available within 24 hours.  The former physician assistant law stated that a physician assistant could practice if their supervising physician was at or traveling to or from any hospital or nursing home anywhere, which was broad and unenforceable.

The new physician assistant law also changes the chart review requirements and prescription. Previously, Indiana law required physicians to review 100% of physician assistant charts in 24 hours, a near impossibility in most offices. The chart review requirement was amended to require that 100% of all charts must be reviewed in 72 for the first three years of employing the physician assistant, after that 50% of the charts must be reviewed in 72 hours. We also heard complaints from members about physician assistants only being able to prescribe a controlled substance for 7 days. The law in this bill allows physician assistants to prescribe controlled substances, if delegated by their supervising physician, in a onetime 30-day supply. If an additional prescription is needed, a physician must be the one to write it.

Pharmacists, HB 1233
HB 1233 also contains provisions about pharmacists. The law allows a physician to hire and supervise a pharmacist in the outpatient setting (currently allowed in hospitals and nursing homes). This part of the legislation arose after some physician practices in Indiana wanted to try a new model of using contracted pharmacists as a midlevel provider, but found current law prohibited it. The law requires on site physician supervision of the pharmacist.

The Indiana Pharmacist Alliance, which is the association for pharmacists in the state, sought this year to expand the vaccines pharmacists can give under a physician drug order, prescription, or physician protocol. Although the pharmacists started wanting to give pneumonia and shingles, they did concede the expansion only to shingles.

Bills that failed to pass…

Smoke free Air, HB 1018
Once again Representative Charlie Brown introduced a comprehensive smoke free air law, which would have prohibited smoking in all enclosed public places. The ban was riddled with amendments including for nursing homes, bars, casinos, private clubs, and so forth. Advocates including the IAFP lobbied for the inclusion of at least bars and restaurants in the law, but the Senate Public Policy committee refused, and the bill died.

Open Access Clauses in Insurance Contracts, HB 1080
For the third year, legislation that would ban open access clauses in insurance contracts was introduced. These clauses require physicians to continue taking patients from a particular insurer or close their practice to all new patients.  House Bill 1080 was heard in the House Insurance committee on January 26th and 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. A study committee on insurance, which was passed in HB 1233, may study the issue.

Physician Referrals, HB 1582
This law would have placed an incredible burden on physicians. It would have required 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 amended the bill so it would only create a study committee on insurance issues, the bill died, but was later amended into HB 1233.

Physical Therapy Services with a Referral, HB 1151
This year Physical Therapists sought direct access to patients. The current law in Indiana states that patients must have a referral before treatment by a physical therapist. House Bill 1151 would have allowed 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. The bill was passed out of committee, but because of the House Democrat walk out the bill died. The IAFP was pleased to see it was not revived through an amendment into another bill.