Legislative Update - January 21, 2022
Health Committees Discuss Telehealth, Noncompetes
House Committee on Public Health and the
Senate Committee on Health and Provider Services both considered additional legislation this week that would impact hospitals.
In the Senate,
Senate Bill (SB) 284, authored by Senator Charbonneau (R-Valparaiso), makes updates to Indiana's telehealth statute, building on the work done in 2021 to expand the types of providers able to utilize telehealth technology to care for patients. This bill, which passed committee unanimously, adds students of included health care professions to the list of individuals eligible to provide telehealth services. The bill also adds behavior analysts to the provider list. IHA testified in support of the legislation in committee and will continue to support the legislation as it moves forward.
House Bill (HB) 1295, authored by Representative Judy (R-Fort Wayne) was voted out of the House Public Health Committee this week. The bill would make some adjustments to the execution of physician non-compete agreements. The legislation provides that binding arbitration would be the required method of resolution if a physician and employer cannot agree on a reasonable purchase price for the buyout provision in a non-compete agreement. IHA has requested that the bill be amended to make binding arbitration an option available to disputing parties rather than the required method. IHA's Government Relations team will continue to work with legislators to achieve an agreeable outcome on the legislation.
Long-Term Services and Supports Bill Heard in Committee
Senate Committee on Health & Provider Services heard
SB 407 on Wednesday, which would require FSSA to pursue a fee-for-service integrated care model program for individuals receiving long-term services and supports to ensure care coordination for those eligible Hoosiers. This model would replace FSSA's
current plan to transition long-term services and supports to an insurance-based managed care model by 2024. Steve Long, CEO of Hancock Regional Hospital, testified on the bill to educate the committee about the potential impact the transition to insurance-based managed care would have on Indiana's nursing facilities and their partnerships with county and municipal hospitals. IHA continues to work with stakeholder partners and the administration to ensure an appropriate balance can be struck for a successful program that accomplishes the shared goals of all parties involved. SB 407 passed out of committee by a vote of 8-2 and was reassigned to the
Senate Committee on Appropriations for further consideration due to the potential fiscal impact of the legislation.
Workforce Bills Continue to Progress
HB 1003, authored by Representative Manning (R-Denver) passed the House by a vote of 91-2. The legislation supports the nursing workforce by streamlining education regulations and ensuring more students have the opportunity to study nursing in Indiana. The legislation will now be sent over to the Senate for consideration, where Senator Messmer (R-Jasper) will sponsor it through committee and Senate discussions.
SB 251, which would implement the interstate medical licensure compact in Indiana, was passed out of the Senate on Thursday. This bill is another opportunity to continue easing the health care workforce shortage in Indiana, allowing physicians to become licensed more quickly through the compact. The bill will now be sent to the House for consideration and sponsored by Representative Vermilion (R-Marion).
Worker's Compensation Bill in Progress
HB 1153, which addresses worker's compensation, was voted out of the
House Committee on Employment, Labor and Pensions this week. The bill originally added ambulatory surgery centers (ASCs), physician-owned hospital outpatient departments (HOPDs), and other physician-owned outpatient care facilities to the list of facilities in Indiana that are reimbursed at a negotiated rate of 200% of Medicare for worker's compensation services. While adding ASCs to the list had been discussed at length in previous years, the other additions had not been vetted and the implementation was complex and potentially detrimental to the other entities and their contracts. For this reason, IHA lobbied to remove the other facilities and only include ASCs in the bill. This change was made before the bill was voted out of committee. The bill still contains language that limits the worker's compensation negotiated rate, saying it is “not to exceed" 200% of Medicare. IHA is continuing to work with the bill author, Representative Lehman (R-Berne), and other legislators to remove this language from the bill and maintain the current method of determining reimbursement between providers and employers.
Legislative Update - January 14, 2022
Governor Holcomb Gives State of the State Address
On Tuesday, Governor Holcomb gave his State of the State address to the Indiana General Assembly focusing on the growth Indiana has experienced even during the pandemic. He also gave special attention to the important work Indiana's health care providers and public health experts continue to do across the state.
The Governor asked all Hoosiers to speak to their doctor and become vaccinated to reduce the number of COVID-related hospitalizations. He acknowledged the strain and exhaustion health care providers have experienced over the last two years of the pandemic and thanked them for their service:
“No words, salary, or earthly awards will ever be enough to repay you for the lives you've cared for and saved. The ultimate judge will be kind to you for living your love for your neighbor."
The Governor also shared his priorities to support Hoosier mental health services, as well as public health initiatives. He specifically mentioned the Indiana Public Health Commission, of which IHA President Brian Tabor is a member. The Commission will produce a report this summer that will recommend appropriate actions to improve Indiana's public health system for the legislature's consideration during the 2023 legislative session.
In his speech, the Governor also discussed additional priorities to continue building Indiana's broadband capacity, supporting Indiana's already friendly business climate, and promoting public safety.
Governor Holcomb's full State of the State address can be accessed
Nursing Indiana Back to Health Bill Passes House Committee
This Wednesday, the
House Committee on Public Health approved House Bill (HB) 1003, termed the “Nursing Indiana Back to Health" bill. The bill provides flexibilities for nursing programs to expand the nurse workforce pipeline to address Indiana's ongoing workforce shortage. Multiple representatives of IHA testified in support of the bill, including Jean Putnam from Community Health Network, Rachel Spalding from Good Samaritan Hospital, and Jason Gilbert from Indiana University Health.
Specifically, the legislation allows for increased growth rates for Indiana nursing educational institutions, relieves some restrictions on the requirements for educators, and adjusts additional regulations to streamline the process for nursing students to enter and complete nursing programs.
The legislation also provides additional pathways for foreign-educated nurses to become licensed in Indiana, which will ensure nurses who want to practice in Indiana are able to do so as soon as possible. The bill also includes an extension of the health care workforce registry that was originally established under Governor Holcomb's public health emergency order. This extension will allow individuals on the registry to continue to serve through the end of the federal public health emergency.
IHA appreciates Representative Ethan Manning's (R-Denver) willingness to author this legislation. The Nursing Indiana Back to Health bill passed the committee unanimously and will now be considered by the entire House.
Workforce Legislation Passes Senate Committee
Senate Committee on Health and Provider Services considered multiple bills on Wednesday that would ease Indiana's health care workforce shortage as well. The committee also considered legislation that would ensure a measured approach to ending the state public health emergency.
Senate Bill (SB) 5, authored by Senator Liz Brown (R-Fort Wayne) creates license reciprocity for health care workers licensed in other states without the delay of the full Indiana licensure process. Senator Brown also authored
SB 251, which would allow Indiana to enter the interstate medical licensure compact. IHA testified in support of both pieces of legislation, and the committee passed both bills unanimously.
The committee also passed
SB 3, authored by Senator Ed Charbonneau (R-Valparaiso), unanimously. Carol Dozier, CEO of King's Daughter's Health, testified on behalf of IHA in support of the bill. The legislation puts provisions into statute that would allow the state to continue receiving federal funding that is tied to the public health emergency in the event that Indiana's public health emergency is ended. IHA appreciates the Senate's thoughtful approach to the potential end of the emergency declaration. The committee also amended the bill to include the emergency health care workforce registry. The registry's inclusion in multiple bills will increase the opportunity for the language to become law at the end of the legislative process.
The bills will now advance to the full Senate for consideration.
Legislative Update - January 7, 2022
2022 Legislative Session
The 2022 legislative session of the Indiana General Assembly convened on January 4. House and Senate leaders released their respective legislative agendas this week, and bills are already making their way through the process. The IHA government relations team is working closely with legislators and stakeholders to effectively represent the interests of hospitals.
The Senate Republicans' agenda includes three priorities for the legislative session, as follows:
- Making more Hoosiers eligible for the automatic taxpayer refund;
- Providing school funding stability for quarantined students; and
- Responsibly ending Indiana's public health emergency.
Senator Charbonneau (R-Valparaiso) has filed
Senate Bill (SB) 3 to address the responsible ending of the public health emergency, which currently includes the three items originally outlined by Governor Holcomb. IHA is working closely with the Senator to ensure needed provisions are included in the legislation so hospitals will not lose necessary flexibilities to address COVID-19 in the event that the public health emergency is ended.
The House Republicans' agenda includes four priorities for the legislative session, as follows:
- Legislating COVID-19 exemptions and ending Indiana's public health emergency;
- Reducing Indiana's income and business personal property tax rates;
- Addressing the state's health care workforce shortage by supporting Hoosier nurses; and
- Boosting local public safety efforts.
House Bill (HB) 1003, filed by Representative Manning (R-Denver) addresses the House Republican's efforts to support Hoosier nurses and grow the nurse workforce pipeline. IHA worked closely with Rep. Manning to develop this legislation, which has been titled “Nursing Indiana Back to Health".
In even-numbered years, the General Assembly has a “short session", which means no budget is considered and the legislature meets for only 10 weeks. Given the limited timeframe, business will be conducted quickly in the Statehouse. The IHA team is working diligently to keep you apprised of issues as they come up, and we are happy to answer questions or provide additional information as needed. Please do not hesitate to reach out to us.
Update on HB 1001 COVID-19 Vaccination Language
House Committee on Employment, Labor and Pensions passed
HB 1001 out of committee this week. The bill contains language that requires a business to allow certain exemptions for employees if the business chooses to require the COVID-19 vaccination as a condition of employment. The bill is expected to be considered by the full House next week.
The bill was considered by two committees in the General Assembly in November and December and the legislators heard a total of fourteen hours of testimony on the legislation. IHA provided testimony in both committees about hospital concerns regarding the inconsistencies between the bill and the pending CMS rule requiring vaccinations for health care workers and other federal regulations. IHA is continuing to engage with legislators on this issue and will provide relevant updates as they become available.
IHA Legislative Agenda
Over the past year, the IHA government relations team has worked with the IHA membership to develop a 2022 legislative agenda that addresses the most pressing needs and concerns of Indiana hospitals. The agenda includes specialty drug administration (white bagging), health care workforce shortage initiatives (including Nursing Indiana Back to Health), and insurer transparency.
Patient Safety in Specialty Drug Administration
Support for Indiana's Health Care Workforce
During the 2021 legislative session, it became clear that new insurer policies regarding white bagging of specialty drugs were causing delayed care and harm to patients and continue to do so. IHA worked with the legislature to pass a bill that required the Indiana Department of Health to produce a report of specialty drug administration best practices. This year, IHA and Hoosiers for Safe Meds have worked with Representative Ed Clere (R-New Albany) to introduce HB 1158, which puts the resulting best practices into Indiana code. Specifically, the bill requires the Indiana Board of Pharmacy to adopt rules to establish safeguards for the practice of white bagging.
Hospitals continue to struggle with a depleted and exhausted workforce, and one method of addressing that challenge is legislation that will increase the nurse workforce pipeline and make obtaining a license easier. IHA has developed a legislative package that includes HB 1003, known as Nursing Indiana Back to Health, which removes barriers to flexibility and allows nursing schools to add additional students to begin addressing Indiana's workforce needs. The package also includes SB 5, authored by Senator Liz Brown (R-Fort Wayne), which grants license reciprocity to multiple health care professions in Indiana.
Parity in Health Care Transparency
Over the past few years, the Indiana legislature and the federal government have both passed legislation regarding hospital price transparency, and hospitals have gone above and beyond to provide information to patients regarding the cost of their care. However, hospital price transparency does not tell the whole story of the cost of health care. SB 249, authored by Senator Liz Brown, brings transparency parity to the health insurance industry, requiring insurance companies to provide explanations of premium increases and transparency about the costs employers incur for health care. By aligning insurance transparency requirements with existing hospital transparency requirements, Indiana will be better able to understand and address health care costs in the state.
IHA's full legislative agenda can be found here.
IHA Responds to Letter from Legislature
This week, Speaker Todd Huston (R-Fishers) and President Pro Tempore Rod Bray (R-Martinsville) released
a statement and letter addressed to certain non-profit hospitals and insurance companies in Indiana. The letter discussed health care costs in Indiana and directed the recipients to develop a plan to lower hospital facility costs by 2025. The letter indicated the plan should be presented to the legislature by April 2022. They wrote, “Absent a viable plan, we will be left with no choice but to pursue legislation to statutorily reduce prices."
IHA has had conversations with both Speaker Huston and President Pro Tempore Bray and has expressed dismay at the letter's tone and implications, as well as to remind legislators about the work hospitals have done and continue to do to lower health care costs and provide quality care to Hoosiers.
IHA President Brian Tabor released a statement in response to the letter:
“Indiana hospitals remain committed to addressing health care affordability for Hoosiers. Hospitals have demonstrated this commitment even during the pandemic, with health systems working with insurers and collaborating directly with employers to lower costs for patients and businesses. Indiana's hospitals have also been recognized for leading the country in transparency. These initiatives are already proving to be effective.
Indiana hospitals are leaders in efforts to lower costs while improving the state's health. However, until all stakeholders are at the table, these efforts will always fall short. We must stop oversimplifying the causes and engage in honest, inclusive discussions without the threat of legislative rate-setting or appealing to outdated studies."
There is currently no legislation pending regarding statutory price reductions, and IHA will continue to engage in conversations with legislators to avoid harmful legislation that would hinder the good work hospitals are already doing regarding health care costs in Indiana. The IHA Board has also met with both Speaker Huston and Senator Bray regarding this matter.
The full letter from the General Assembly to Non-Profit Hospitals can be read here.
To keep up to date with all bill changes and updates in real-time, visit the IHA 2022 Legislative Bill Track.
Legislative Update - December 17, 2021
IHA President Brian Tabor Testifies on HB 1001 in Committee This Week
This week, theHouse Committee on Employment, Labor and Pensionsheld a hearing onHB 1001, which contains similar language to the proposed legislation heard in committee before Thanksgiving (you can read more about that committee hearing
HB 1001 contains provisions to ensure continued federal matching funds for Medicaid, continuation of enhanced benefits for SNAP, and the ability to efficiently vaccinate 5- to 11-year-olds, in the event that Governor Holcomb ends the public health emergency.
The bill also contains language regarding employers' ability to require COVID-19 vaccinations for their employees. This language is in conflict with Equal Employment Opportunity Commission guidance on federal exemptions and the CMS Interim Final Rule (IFR) which, though currently enjoined, would require hospitals to meet specific employee vaccination requirements to continue receiving Medicare and Medicaid reimbursement.
Given this language, IHA President Brian Tabor testified in committee to share concerns about the potential conflict between state and federal law that this bill would create, as well as explaining the difficult situation hospitals are facing regarding surging patients and lack of staffing.
The committee did not vote on the bill following the extensive testimony, and the legislature has indicated they will continue to consider the legislation between now and the beginning of session on January 4th, 2022. IHA will continue to engage legislators and other stakeholders on this issue to achieve the best outcome for Indiana hospitals.
President Biden Signs Legislative Package Extending Relief from Medicare Sequestration
Last Friday, President Biden signed a legislative package into law that contains provisions that provide financial relief for healthcare providers. Prior to the passage of the bill, Medicare Sequestration, which would reduce federal spending on Medicare by 2%, was due to begin on January 1, 2022. With the passage of the legislation, Medicare sequestration was delayed until April 1, 2022, and then reduced to a 1% sequester through June 30, 2022. The package also included a provision to stop the 4% PAYGO sequester from going into effect in 2022.
While further discussions about the future of Medicare sequester are expected, this new law provides a reprieve for hospitals by eliminating immediate funding cuts at the beginning of 2022 while the pandemic continues to challenge hospital operations.
Legislative Update - November 24, 2021
Legislative Update - November 19, 2021
Important: IHA Surprise Billing Toolkit
With a variety of new federal and state requirements designed to address surprise medical bills, IHA worked in conjunction with
Hall Render to compile a comprehensive toolkit to assist IHA members in responding to the evolving legislative and regulatory landscape addressing out-of-network reimbursement, balance billing protections, and good faith estimates. The toolkit includes template documents that can be adapted by hospitals to assist in complying with current state and federal requirements. Download the toolkit items below.
Organization Day Kicks off 2022 Legislative Session
On Tuesday, legislators gathered at the Statehouse for Organization Day, which ceremonially began the 2022 session of the Indiana General Assembly. On this day, newly added legislators are sworn in, and the respective caucuses in the House and Senate are able to meet together and plan for the upcoming session. This is also an opportunity for legislators to meet with lobbyists, stakeholders, and other members of the public to discuss legislative priorities for the upcoming year. The IHA Government Relations team had a full day of productive meetings with legislators to discuss various priorities and express the needs and goals of Indiana’s hospitals in the upcoming year.
Speaker of the House Todd Huston (R-Fishers) shared remarks during the day’s session, providing a preview of legislative priorities for 2022. These priorities included helping Hoosier communities grow, looking at ways to reduce health care costs, anti-abortion efforts, a parenting bill of rights related to education, and tax refunds, among other priorities.
Governor Holcomb Identifies for End of COVID-19 Public Health Emergency
On the same day that the legislature met for Organization Day, Governor Holcomb released a statement identifying three changes the Indiana General Assembly would need to make to state law in order for him to end Indiana’s public health emergency, as follows:
• Continuation of the federal matching funds for Medicaid expenditures;
• Continuation of the enhanced benefits for those receiving federal food assistance; and
• Extending the ability to efficiently vaccinate 5- to 11-year-olds.
The Governor’s full statement can be found
Legislative leaders are now contemplating whether to convene briefly in December to consider these items for adoption.
Take Action: Ask Federal Senators to Support Prior Authorization Reform Bill
We have heard from IHA members, and in particular, our post-acute members, that widely varying Medicare Advantage prior authorization (PA) policies are creating a tremendous burden on hospitals. This burden adds cost to our health care system, frustrates patients and families, and leads to provider burnout. Given the current health care workforce crisis, we need the federal government to act. Legislation supported by the AHA was introduced last month by Sen. Roger Marshall (R-KS), and companion legislation in the US House of Representatives was supported by some of our Congressional delegation, including Rep. Bucshon, Rep. Pence, and Rep. Walorski. We want our US Senate offices to know how important this issue is.
Please use this letter to contact Senator Young and Senator Braun and ask them to support this legislation. You may customize the message as needed to reflect how these PA policies impact your specific organization, staff, and patients.
Indiana Division of Mental Health and Addiction Funding Opportunity
Funds have been secured through the SAMHSA State GLS Youth Suicide Prevention Grant to facilitate the implementation of new or expand/continue family peer support programming in emergency room healthcare settings across Indiana. The purpose of this program is to provide peer support to family/loved ones of youth who are experiencing a mental health and/or suicidal crisis requiring emergency services. RFF proposals are due to DMHA by December 3, 2021. More information can be found
Legislative Update - October 8, 2021
Indiana's Redistricting Proposal Becomes Law
This week Governor Holcomb signed
House Bill 1581 into law, which contains the legislature's redistricting plan based on the 2020 census results. Due to the delay in releasing the final 2020 census results, the redistricting maps could not be drawn during the normal legislative session, as is normally the case. Instead, the legislature recessed in the spring rather than their normal adjournment for the year, with the expectation of coming back for a session in the autumn to address redistricting. House members returned in mid-September to begin discussions and have committee meetings to pass the House version of the new maps, including the House, Senate, and Congressional districts. The Senate then returned to the Statehouse at the end of September to vote on the maps and make some additional changes for the Senate districts. The final vote took place on October 1, after which the bill containing the finalized districts was sent to the Governor for his signature.
View maps below:
IDOH Updates Newborn Screening Rule
The Indiana Department of Health issued an Emergency Rule, LSA Document #21-438(E), to add Adrenoleukodystrophy to the list of disorders for which newborns and infants must be screened. The
Emergency Rule is effective as of September 29, 2021. The remainder of the list of disorders for which newborns and infants must be screened remains the same. The Emergency Rule also increases the newborn screening fee from $115 to $120 based on the updated cost of the program with the addition of Adrenoleukodystrophy. If you have any questions, please contact IHA's Deputy General Counsel
Federal Agencies Release Part II of No Surprises Act Regulations
On Sept. 30, Federal agencies issued Part II in a series of regulations for implementation of the No Surprises Act. This interim final rule deals with the independent dispute resolution process, which allows providers and health plans to adjudicate outstanding reimbursement disputes. The Agencies have also created a
website that focuses on general information about No Surprises Act provisions, and includes a
federal portal where organizations can apply to be certified as independent dispute resolution entities, as well as for providers to participate in the federal dispute resolution process. The rule also provides more information about the good-faith cost estimates that providers are required to share with uninsured or self-pay patients for scheduled services. Additionally, Part II identifies a process for uninsured or self-pay patients and providers to utilize regarding these cost estimates. CMS has provided a
summary of the proposed rule on their website.
Interim Committee on Public Policy Releases Recommendations
Interim Committee on Public Policy released their
Draft Final Report and
Proposed Findings and Recommendations on Tuesday. The committee made multiple recommendations to the legislature regarding telehealth and licensure of various health care professionals. The committee recommends that Indiana maximize the use of health care compacts where possible, including enacting the Interstate Medical Licensing Compact. The committee also recommends that the General Assembly adopt universal reciprocity legislation for health care providers. Additionally, the committee recommends appropriating money to the Indiana Professional Licensing Agency to provide technological improvements to make management of reciprocity and compacts more straightforward. Regarding telehealth, the committee recommends that the legislature amend the state's telehealth laws to allow physical therapy assistants and all mental health and behavioral health professionals to use telehealth. These recommendations are sent to the legislature for consideration as future legislation.
The full report can be found
Legislative Update - October 1, 2021
Governor Holcomb Extends Executive Orders on COVID-19
Governor Holcomb's Executive Orders (EO) 21-26 and 21-27 took effect today, October 1, 2021. The EOs extends the state's public health emergency for an additional 30 days due to the surge related to the Delta variant. EO 21-27 contains extends and adds multiple provisions aimed at providing flexibility and relief to the healthcare community:
Extends temporary licensure of health workers and students through the end of the year
Hospitals are directed to continue 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 continue 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.
Extends licensure expirations for MD, DO, RN, APRN, and Midwives 30 days past the October 31st, 2021 deadline.
Governor Holcomb stressed in the EO that unvaccinated individuals are most at risk for serious illness, hospitalization, and death related to COVID-19, and 1,701 of 1,721 of new hospitalized COVID-19 patients were unvaccinated individuals. The Governor urged Hoosiers to be vaccinated to be protected against hospitalization and serious illness from COVID-19.
A full text of the EOs can be found
Trent Fox, IHA Vice President of Government Relations, Sworn in as Attorney
Trent Fox, Vice President of Government Relations for the Indiana Hospital Association, was sworn in today as an attorney on Friday in Fort Wayne, Indiana to become a member of the Indiana Bar Association. Although attorneys may choose to participate in a State Bar Association swearing-in ceremony, Trent chose to have former State Representative Casey Cox (R-Fort Wayne) administer the oath of office in the Allen County Courthouse. While Trent was in law school, he served as Rep. Cox's legislative aide when Rep. Cox was a member of the General Assembly. Along with Trent’s family, Ben Miles, President of Health Plan Services and Chief Advocacy Officer at Parkview Health, and Beth Lock, Director of Governmental and Legislative Affairs at Parkview Health, also attended the ceremony (pictured below along with IHA Director of Advocacy & Federal Relations Kristin Schwartz). As members of Parkview Health’s government relations team, both have worked closely with Trent in his role at IHA. Trent
serves as the lead legislative representative at the Indiana Statehouse for the association.
Prior to joining IHA, he served as Chief of Staff to the Indiana State Health Commissioner, Dr. Kristina Box. He has also served as Director of Communications and Legislative Affairs at the Indiana Professional Licensing Agency, where he worked closely with Indiana’s prescription drug monitoring program, health profession regulatory bodies, and served as spokesman for the agency’s 38 boards and commissions. His experience also includes serving as Deputy Director of Legislative Operations for the Indiana House of Representatives and as Legislative Assistant to Speaker of the House Brian Bosma. He received his law degree at Indiana University Robert H. McKinney School of Law and a Bachelor of Science in legal studies from Indiana State University. Please join IHA in congratulating Trent Fox on this impressive accomplishment.
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) announced 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.
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.