Legislative Update - September 10, 2021
Indiana Hospital Association Recognizes Outstanding Individuals in Health Care
The Indiana Hospital Association (IHA) honored multiple individuals this week at its Annual Meeting, which was held virtually this year. Among the awards presented was the John C. Render Award for Health Policy. The award was created in 2011 and is presented to individuals who have had a significant influence on health care policy affecting Indiana hospitals. Render has had an enormous impact on health care, having dedicated his career to improving the lives of Hoosiers by advocating and educating on behalf of IHA’s member hospitals.
This year’s recipient of the John C. Render Award for Health Policy was the former Secretary of the Family and Social Services Administration (FSSA), Dr. Jennifer Sullivan. Dr. Sullivan served as FSSA Secretary for over six years, making her the longest-serving secretary in the agency’s history. Her tenure in the position was marked by multiple achievements contributing to the health and wellbeing of Hoosiers.
CMS to Require COVID-19 Vaccination of Staff at Medicare & Medicaid-Certified Facilities
On September 9, 2021, the federal Centers for Medicare & Medicaid Services (CMS)
it will require COVID-19 vaccination of staff at all
Medicare and Medicaid-certified facilities, including hospitals, ambulatory surgical centers, skilled nursing facilities, home health agencies, and dialysis facilities. CMS is expected to issue an Interim Final Rule with Comment Period in October 2021 to implement this requirement. IHA will continue to provide updates as more information becomes available.
The Interim Final Rule is expected to apply to 50,000 healthcare providers and over 17 million healthcare staff at Medicare and Medicaid-certified facilities across the country.
Indiana Medicaid Issues Prior Authorization Bulletins
In response to the continuing impact of the Delta variant and Governor Holcomb’s recent
Executive Order 21-24 regarding prior authorizations (PA), the Indiana Health Coverage Programs (IHCP) has issued several Bulletins related to PAs, as follows:
IHCP temporarily reinstates revisions to PA process for acute care hospital non-elective inpatient admissions (BT202174): Effective for dates of service (DOS) on or after August 30, 2021, acute care hospitals will only be required to submit basic information on the Universal PA Form for non-elective admissions and inter-hospital transfers that are necessary to increase bed capacity. Acute care hospitals must submit the PA request within 72 hours of the member’s admission, and authorizations will be automatically approved for a period of 60 days unless fewer days are requested.
IHCP temporarily revises timeframes for certain PA approvals (BT202178): Effective September 1, 2021, existing PAs will automatically be extended for 180 days from the expiration date of the PA for non-emergent surgeries or procedures that are postponed to ensure sufficient COVID-19 response capabilities.
IHCP reinstates inpatient SUD and psychiatric admission policy changes (BT202179): Effective for DOS on or after September 8, 2021, providers will only be required to submit basic information using the most appropriate IHCP PA form for inpatient substance use disorder (SUD) and psychiatric admissions. Providers must submit the PA request within 72 hours of the member’s admission, and initial PAs for inpatient SUD and psychiatric admissions will include seven days.
PA changes temporarily reinstated for some DME/HME services and supplies (BT202180): Effective for DOS on or after September 8, 2021, IHCP is temporarily removing PA requirements for the DME/HME services and supplies outlined in the Bulletin.
IHCP reinstates temporary PA changes for managed care SNF admissions (BT202181): Effective for DOS on or after September 8, 2021, providers will only be required to submit basic information using the Universal PA Form for skilled nursing facility (SNF) admissions. Providers must submit the PA request within 72 hours of the member’s admission, and authorizations will be approved for a period of 14 days unless fewer days are requested or the member has less than 14 days remaining in their skilled nursing benefit limit.
IHCP temporarily reinstates PA policy for LTAC and AIR facility admissions (BT202182): Effective for DOS on or after September 8, 2021, providers will only be required to submit basic information using the Universal PA Form for long-term acute care (LTAC) and acute inpatient rehabilitation (AIR) facility admissions. Providers must submit the PA request within 72 hours of the member’s admission, and authorizations will be approved for a period of 14 days.
Controlled Substance Registration to Be Required for Ambulance Service Providers
On August 25, 2021, the Indiana Board of Pharmacy published
LSA Document #20-455(F), a Final Rule requiring each ambulance service provider that purchases, stores, or dispenses any controlled substance to obtain a controlled substance registration (CSR). This Final Rule repeals the previous language under 856 IAC 2-3-4(c) that waived the requirement for ambulance service providers to obtain a CSR. The Final Rule is effective 30 days from its publication.
Further highlights from the Final Rule are as follows:
CSR Registration: A separate registration is required for each principal place of business where controlled substances are stored. However, a separate registration is not required for each ambulance owned or operated by the provider. Additionally, agents or employees of the provider are not required to register if they are acting in the usual course of employment.
Hospital Pharmacies: A hospital pharmacy may, but is not required to:
Enter into a written agreement with an ambulance service provider to provide, sell or deliver stocks of controlled substances for use in an ambulance; or
Enter into a written agreement with an ambulance service provider to act as an agent for the provider and supply a sub-stock of controlled substances for use in the provider's ambulances.
Hospital CSR: A registrant owned or operated by a hospital may:
Utilize the hospital pharmacy's registration for the delivery of controlled substances for use in any authorized ambulance;
Maintain the provider's controlled substances as part of the hospital's controlled substances sub-stock; and
Have the hospital act as the agent for the provider.
Note: a separate CSR is still needed by the ambulance service provider for other actions, such as purchasing and dispensing controlled substances.
We encourage you to review the entirety of the rule, which includes documentation, storage, and security requirements for registrants.
Legislative Update - September 3, 2021
Governor Holcomb Issues New Executive Order on COVID-19
Governor Holcomb's Executive Order (EO) 21-24 took effect on September 2, 2021. The EO extends the state's public health emergency due to the surge related to the Delta variant. The EO contains multiple provisions aimed at providing flexibility and relief to the healthcare community:
Hospitals are directed to implement evidence-based criteria to ensure sufficient capacity and staffing, and should postpone non-emergency surgeries and procedures where necessary. The EO notes that hospitals should consult the best practice and recommendations of their medical associations and industries when making this assessment.
Hospitals are required to report information to the Indiana Department of Health's EM Resource system, including diversion status, hours spend in diversion for emergency departments and critical care units, and other information related to coordination and resources.
The Indiana Department of Insurance is directed to request insurers extend prior authorization timeframes for open and approved authorizations, and waive clinical information requirements for prior authorization in the case of patient transfer and discharge to post-acute, home-based, and other appropriate placement.
Advanced Practice Registered Nurses are allowed to provide service at multiple locations as long as they have an existing collaborative agreement on file.
Governor Holcomb stressed in the EO that unvaccinated individuals are most at risk for serious illness, hospitalization, and death related to COVID-19, and 93% of new COVID-19 cases since January of this year were unvaccinated individuals. The Governor urged Hoosiers to be vaccinated to be protected against hospitalization and serious illness from COVID-19.
The full text of the EO can be foundhere.
IHA President Brian Tabor issued a statement on the EO: “We appreciate that the State of Indiana recognizes how strained Indiana hospitals currently are with the Delta variant wave. One region in southern Indiana has already exceeded its highest number of COVID-19 hospitalizations at any point during the pandemic. According to Kentucky Governor Andy Beshear, only 115 intensive care unit (ICU) beds
were available in the entire state of Kentucky earlier this week. There is a massive storm cloud of this virus sweeping up through Indiana, and increasing our state's vaccination rate is the most effective way to ease the burden on our courageous health care heroes and ensure a hospital bed for every Hoosier that needs one."
Interim Committee on Public Health Concludes and Releases Report
The Interim Committee on Public Health, Behavioral Health, and Human Services had their final meeting on Wednesday to discuss outstanding topics and to present their draft final report.
The committee heard testimony from the Alcohol and Tobacco Commission (ATC) regarding the implementation and enforcement of smoking laws. Additionally, Dr. Box testified on behalf of the Indiana Department of Health to provide an update to the General Assembly on the OB Navigator program, which is now known as My Healthy Baby. The presentation contained preliminary data, and IDOH plans to release expanded data from July 1, 2020 – June 30, 2021, in November. Through December 2020, over 1,200 women accepted referrals for home visiting services to receive care for their pregnancy. Dr. Box's full presentation can be viewedhere.
The committee also released their draft report containing the committee's findings and recommendations based on the meeting presentations. The purpose of the report is to direct and inform any potential legislation on the topics addressed. However, while legislation may be filed on these topics, the report recommendations do not automatically require legislation. The committee's recommendations include:
Multiple recommendations regarding the state's trauma care system, including urging the Indiana State Trauma Care Committee to assess Indiana's trauma center system
Multiple recommendations concerning Indiana's transition to risk-based or capitated managed care for long-term care Medicaid services, including urging FSSA to review and address the impact on intergovernmental transfers and to continue meeting with stakeholders regarding the transition.
The full draft report can be foundhere.
IHA named to Governor’s Public Health Commission
On August 18th, Governor Holcomb issued an Executive Order (EO) establishing the Governor’s Public Health Commission. The goal of the commission is to advise the Governor and the Indiana Department of Health regarding Indiana’s public health system. Citing Indiana’s poor public health rankings nationally, as well as the challenges and lessons learned from the COVID-19 pandemic, the Governor’s EO states that Indiana’s public health system would benefit from comprehensive review and evaluation with the aim of improving efficiency and efficacy for Hoosier health. The EO names IHA as one of the 15 commission members, along with the State Health Commissioner, the Indiana Rural Health Association, the Indiana Minority Health Coalition, the Indiana Public Health Association, three elected officials, a representative for healthcare workforce initiative, an academician from the public health field, a public health administrator from the Local Health Department Manager’s Association, two local health officers, and two representatives of the public, who will serve as co-chairs of the commission
The EO creating the commission can be foundhere.
Legislative Update - August 13, 2021
Interim Public Health Committee Discusses Long Term Care
This week, the
Interim Study Committee on Public Health, Behavioral Health, and Human Services
met to discuss Long Term Care Services and Supports. The committee heard testimony from Dr. Dan Rusyniak, newly appointed FSSA Secretary, during which he outlined the state’s current path to LTSS reform, including discussions of risk-based managed care or capitated, managed care for Medicaid recipients. Of great concern is the goal to allow more Hoosiers to age in their homes while receiving any needed care if they so choose. Dr. Rusyniak emphasized FSSA’s focus on choice, cost, and quality of care, and their prioritization of stakeholder partnership and feedback during the ongoing reform process. Dr. Rusyniak’s presentation can be viewed
. The committee received additional testimony from long-term care stakeholders, including the Indiana Health Care Association, LeadingAge, AARP, the Indiana Association of Area Agencies on Aging, and others.
Chairman Charbonneau confirmed that the committee will meet once more during the interim on August 25 to discuss further topics, and then will adopt the final study committee report with any recommendations the committee feels are necessary.
Regulatory Waivers Renewed
The Indiana Department of Health reissued temporary blanket waivers for hospitals and ambulatory outpatient surgical centers on August 9th. The new order allows all previously issued waivers for acute and continuing care facilities to continue. These reissued waivers were effective on August 9, 2021, and will be in effect for 45 days past the expiration of the current Public Health Emergency declared by Governor Holcomb. You can find the notice of waivers here
Hospital Price Transparency Rule
Hospital Price Transparency rule
issued by CMS has been in effect since January 1, 2021. Since April, CMS has been issuing warning letters letting hospitals know about non-compliance with the rule, which can result in fines of up to $300 per day. CMS
recently proposed an increase
in the non-compliance penalty based on the number of beds, with the goal of further incentivizing hospitals to comply with the rule.
According to the
, the price transparency rule requires two things: “a comprehensive machine-readable file with all items and services” and “a display of shoppable services in a consumer-friendly format”. The IHA team is available to provide guidance and assistance as Indiana hospitals continue working toward full compliance with this new rule.
Governor Holcomb Signs HEA 1468 Dealing with Various Health Matters
This week, the IHA team attended the bill signing ceremony for
, authored by Representative Steve Davisson (R-Salem). IHA supported the legislation during session this year, in particular, due to the provisions the bill contains related to mental health and addiction treatment. The bill requires FSSA to apply for a Medicaid state plan amendment for reimbursement of Medicaid rehabilitation option (MRO) services for eligible recipients of certain services in a community mental health center and for reimbursement of MRO services concurrent with residential addiction treatment reimbursement. The legislation also specifies that telehealth services satisfy any face-to-face meeting requirement between a clinician and a consumer for purposes of a community mental health center. The bill went into effect on July 1, 2021
Representative Davisson Receives Sagamore of the Wabash Award
Following the ceremonial bill signing, Governor Holcomb presented Representative Davisson (R-Salem) with a
Sagamore of the Wabash award
for his outstanding service to the state of Indiana. The Sagamore award is Indiana’s highest honor and is conferred upon deserving recipients at the Governor’s discretion. Representative Davisson has worked tirelessly to serve Indiana throughout his career as a state legislator, and as a pharmacist in Southern Indiana. IHA applauds the conferral of this award and joins with Governor Holcomb in expressing our appreciation for everything Representative Davisson has done to champion common-sense health care policies and protect the rights of Hoosiers.
Congratulations, Representative Davisson!
Legislative Update - August 5, 2021
Interim Study Committee Reviews Indiana’s Trauma System
This week, the Interim Committee on Public Health, Behavioral Health, and Human Services chaired by
Senator Ed Charbonneau (R-Valparaiso)
, convened to examine Indiana’s trauma system including pre-hospital, hospital, and post-acute care settings. The committee received testimony from regulatory agencies and stakeholders on the current state of Indiana’s trauma and EMS systems. The goal of the committee is to improve equity in the system for all Hoosiers regardless of location and to consider enhancements in governance to improve outcomes. The committee will have two more meetings and will submit a report to the Legislative Council with any recommendations. More information about this committee can be found
Study Committee Examines License Reciprocity in Indiana
The Interim Committee on Public Policy, chaired by
Senator Ron Alting (R-Lafayette)
, met today to discuss the advantages and disadvantages of professional licensing reciprocity, comparing Indiana with other states that allow reciprocity, including all of Indiana’s surrounding states. IHA testified in support of license reciprocity, emphasizing the pandemic’s devastating impact on Indiana’s pre-existing health care professional shortage and the urgent need to bolster the state’s workforce. The committee will meet again later this month and will submit a report to the Legislative Council with any recommendations.
to find more information on this committee.
IHA Promotes Trent Fox to Vice President of Government Relations
IHA is pleased to announce the promotion of Trent Fox to Vice President of Government Relations. Fox previously served as the association’s Senior Director of Public Policy and Legislative Relations. “IHA has a long history of working with the Indiana General Assembly and other stakeholders on health care policy issues, and we are fortunate to have outstanding talent like Trent to carry on this tradition,” said IHA President Brian Tabor. “I have full confidence in IHA’s legislative team to represent our members and advocate for the health of all Hoosiers.”
Brian Tabor Appointed to APCD Advisory Council
During the 2021 legislative session, the Indiana General Assembly passed
creating the All Payer Claims Database (APCD) Advisory Council, an important step in developing an effective and meaningful tool for Hoosiers seeking health care pricing and quality information. This week, IHA President Brian Tabor was appointed to serve on Indiana’s APCD Advisory Council. The addition of Tabor to the Advisory Council will ensure hospitals are comprehensively represented and that consumers will benefit from Indiana’s APCD, once established. As states strive to achieve high-quality, affordable care while improving health metrics, states are increasingly using data from APCDs to improve transparency. Policymakers, health care providers, and other stakeholders recognize APCDs as a promising tool that can help achieve this objective.