2019 Legislative Update

Indiana General Assembly approac​​hes final weeks of session​

As the Indiana General Assembly approaches the final weeks of the 2019 session, state lawmakers are working diligently to approve a state budget by the deadline of April 29.

The 2019 “long session” has focused primarily on teacher pay, school safety, workforce development, hate crimes legislation, and state spending for the next two years. Additional priorities of the Republican supermajorities include increased funding for K-12 education, reforming the Indiana Department of Child Services, and implementing community-based services to engage at-risk expecting mothers by offering early prenatal care to reduce infant mortality.

After weeks of lawmakers warning Hoosiers that the state budget was going to be particularly challenging, Governor Holcomb’s budget proved to be tight but not to the degree initially expected. According to budget projections, the State is expected to have enough money to fund all its top priorities without any major cuts. This proves challenging for an increase in Indiana’s cigarette tax, which was not included in the House version of the state biennial budget due to these projections. The upcoming April revenue forecast will be a key milestone that will ultimately determine priorities and revenue needs for the final iteration of the next biennial state budget, including any opportunity for a cigarette tax increase and HAF relief for Indiana hospitals.

Overall, the 2019 legislative session has been productive for the Indiana Hospital Association and its members on many fronts. IHA was successful in moving member priority legislation forward as well as fighting off various costly and burdensome bills proposed earlier in the session. IHA’s conversations with lawmakers focused on key issues impacting hospitals, including the need to address eligibility and denials of claims in the Medicaid managed care environment, protecting providers from INSPECT criminal penalties, studying the topic of hospital licensure, and advancing legislation to allow Indiana to join the Nurse Licensure Compact. While these bills have not yet passed into law, IHA remains optimistic that they will continue through the process.

In total, the Indiana General Assembly saw 1,348 bills introduced in 2019. The House introduced 709 bills, and the Senate introduced 639 bills. By the halfway point, only 201 House bills and 218 Senate bills remained. IHA continues to monitor these issues closely and will keep members apprised of new developments that could have a direct impact Indiana’s hospital industry in the final weeks of session. IHA thanks our members who took the time this session to advocate with their legislators for policies that strengthen hospitals and protect patients.​

Hospital Priority Legis​​lation​​​

SB 575 Hospital Licensure Study (Charbonneau) 

  • Urges the Legislative Council to assign the topic of hospital licensure to an interim study committee during the 2019 interim and sets forth requirements of the study. 
  • The study must include the following: 
    • A review of Indiana's current hospital licensing structure. 
    • Information concerning other states' hospital licensure and national trends. 
    • Information concerning the different types of hospitals and possible classifications, including subclassifications, of these hospitals through the hospital's license. 
    • An examination of state hospital licensure in the context of federal law, regulations, policies, and conditions of participation in the Medicare and Medicaid programs.​

HB 1548 Medicaid Advisory Committee (Kirchhofer) 

  • Adds appointments by the Indiana Association of Health Plans and the Indiana Primary Care Association to the Medicaid Advisory Committee (MAC).
  • Adds the following topics to the jurisdiction of the MAC:
    • Emergency department coverage and reimbursement to providers.
    • The reporting of Medicaid prior authorization denials by Medicaid managed care entities, excluding pharmacies.
    • The reporting of Medicaid denials based on:
      • Administrative and medically necessary criteria; or
      • Errors or omissions made by the managed care entity.
    • Prompt payment to providers for claims:
      • Within 30 days;
      • Within 90 days;
      • Within 180 days; and
      • Over 365 days.
    • The provider appeals process for administrative and medically necessary Medicaid denials and the resolution of appeals, including rates of reversal.
    • The central credentialing portal.
    • Policy changes to the Medicaid program with an implementation period for providers or managed care entities of more than 30 days.
    • The reporting of Medicaid denials due to retro-eligibility status.
  • Increases the membership of the committee by providing for the President Pro Tempore of the Senate and the Speaker of the House of Representatives to each appoint six members (instead of one member).
  • Provides that three of the members appointed by the President Pro Tempore and three of the members appointed by the Speaker shall serve on a standing fiscal subcommittee of the committee and provides that at least half of the legislative members be members of the minority party.
  • Requires the committee to create a standing fiscal subcommittee.
  • Requires the committee to review, study, and make advisory recommendations concerning certain subjects before July 1, 2021.​

HB 1294 INSPECT Program (Zent)

  • Moves existing language concerning the central repository for controlled substances data from Title 35 (Criminal Code) to Title 25 (Professional Licensing Agency).
  • Specifies that a practitioner may obtain information about a patient directly through the INSPECT database or through the patient's integrated health record.
  • Decreases the instances in which a Class A misdemeanor is a violation to when a practitioner discloses confidential information without authorization. (Current law provides for a Class A misdemeanor for any violation of the chapter.)
  • Provides for instances in which a practitioner is not required to obtain information from the INSPECT database.

HB 1344/SB 436 Nurse Licensure Compact (Clere/Zay)

  • Specifies requirements for participation by the state in a multistate Nurse Licensure Compact (NLC) including provisions concerning:
    • Nurse qualifications, practice, and participation;
    • A compact commission;
    • Interstate commission and state board of nursing authority and rulemaking;
    • A coordinated licensure information system;
    • Oversight and enforcement; and
    • Termination or withdrawal from the compact.

SB 394 Advanced Practice Registered Nurses (Charbonneau)

  • Provides that an advanced practice registered nurse (APRN) with prescriptive authority and who has operated under a practice agreement with a practitioner for at least three years may operate without a practice agreement if certain conditions are met.
  • Amends the hospital governing board requirements for the manner in which an APRN who operates in the hospital will interact with other practitioners. Makes a conforming change.
  • Requires the Indiana State Board of Nursing to study and report to the General Assembly before October 1, 2019, concerning the clinical training of APRNs and information concerning implementation of allowing APRNs to operate without a practice agreement.

DSH Language in HB 1001 State Budget (Huston)

  • Includes language establishing a process for revising Indiana’s DSH program only if the scheduled federal cuts are implemented for SFY 2020.​

Defending Bur​​​densome Changes to Hospitals 

IHA was successful in defending against the following burdensome bills, which did not advance this session.​

SB 573 Hospital Facility Certificate of Need (Ruckelshaus) 

  • Establishes a hospital certificate of need administered by the Indiana State Department of Health.
  • Sets forth requirements of the program and requirements for owners of hospital construction projects.


HB 1357 Noncompete Clauses Prohibited in Physician Contracts (Morris) 

  • Provides that an employer hospital may not require that an employee physician or a prospective employee physician sign a covenant not to compete against the employer hospital for any period of time after the termination of employment with the employer hospital.
  • Provides that an employer hospital may not enforce any covenant not to compete against the employer hospital that is signed by the employer hospital and a former employee physician who is separated from employment under any circumstances.
  • Provides that an employee physician, a prospective employee physician, or a former employee physician may bring a civil action against an employer hospital that attempts to enforce a covenant not to compete.


SB 153 Health Facility Employee Criminal Background Check (Randolph)

  • Requires a health facility to obtain a national criminal history background check or an expanded criminal history check for the health facility's employees.
  • Provides immunity to persons:
    • For denying or terminating employment because of another person's criminal history; or
    • For reporting to or participating in the proceedings of the Indiana State Department of Health or the registry of nurse aides.


SB 384 Occupational Licensing (Koch) 
  • Provides that the small business ombudsman shall review a proposed rule that is an occupational regulation and imposes requirements or costs on persons subject to the occupational regulation.
  • Requires the Attorney General to disapprove a proposed rule if it violates federal antitrust laws.
  • Requires that an agency file a statement concerning the economic impact of the proposed occupational regulation on persons who are subject to the occupational regulation.
  • Requires the ombudsman to approve or deny the occupational regulation after determining if the least restrictive regulation is used.
  • Requires a regulatory flexibility analysis that considers any less intrusive or less costly alternative methods of achieving the purpose of the proposed occupational regulation, including the establishment of the least restrictive regulation that is necessary to regulate the occupation or protect consumers.
  • Establishes guidelines to analyze an occupational regulation to determine if it is the least restrictive regulation.
  • Makes conforming changes to include regulated occupations in the laws that affect the adoption of rules that affect small businesses.
  • Provides that an occupational regulation that is adopted by an agency during:
    • An odd-numbered year may not become effective until March 15 during the subsequent year; and
    • An even-numbered year may not become effective until May 1 during the subsequent year.