LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6278 NOTE PREPARED: Nov 30, 2021
BILL NUMBER: HB 1018 BILL AMENDED:
SUBJECT: Mental Health and Addiction Matters.
FIRST AUTHOR: Rep. Shackleford BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: Temporary Cessation: The bill specifies that an individual's incarceration,
hospitalization, or other temporary cessation in substance or chemical use may not be used as a factor in
determining the individual's eligibility for coverage in:
(1) a state employee health care plan;
(2) Medicaid;
(3) the Healthy Indiana Plan;
(4) a policy of accident and sickness insurance; or
(5) a health maintenance health care contract.
Opioid Treatment Program (OTP):The bill also requires an OTP to: (1) provide a patient of the facility
appropriate referrals for continuing care before releasing the patient from care by the facility; and (2) counsel
female patients concerning the effects of the program treatment if the female is or becomes pregnant and
provide to the patient birth control if requested by the patient. It requires the Division of Mental Health and
Addiction (DMHA) to annually perform an audit of 20% of an OTP facility's patient plans to ensure
compliance with federal and state laws and regulations.
Mental Health and Addiction Program: It requires the DMHA to establish a mental health and addiction
program to reduce the stigma of mental illness and addiction.
Emergency Room Treatment Protocols: The bill requires hospitals to establish emergency room treatment
protocols concerning treatment of a patient who is overdosing, has been provided an overdose intervention
drug, or is otherwise identified as having a substance use disorder.
HB 1018 1 Effective Date: July 1, 2022.
Explanation of State Expenditures: The DMHA audit of additional OTP records and development of a
Mental Health and Addiction Program represents an increase in workload that is outside of the agency’s
routine administrative functions, and existing staffing and resource levels, if currently being used to capacity,
may be insufficient for full implementation. The additional funds and resources required could be supplied
through existing staff and resources currently being used in another program or with new appropriations.
Ultimately, the source of funds and resources required to satisfy the requirements of this bill will depend on
legislative and administrative actions.
Additionally, the bill may increase workload for the Department of Insurance (DOI) to enforce provisions
concerning temporary cessation and for the Indiana Department of Health (IDOH) to verify emergency room
policies are adopted and implemented. [The DOI’s expenses are paid from an agency fund.]
Excluding temporary cessation as a factor in determination of eligibility for substance use disorder treatment
could expand the number of individuals eligible for reimbursement or payment of treatment through the state
employee health plans and Medicaid. The fiscal impact on these programs is indeterminate; the policies of
the state health plans or Medicaid do not preclude eligibility for substance use treatment after treatment
cessation, but the type and cost of program approved may be affected.
Additional Information - Mental Health and Addiction Program: To develop a public health awareness
campaign similar to the one assigned to the DMHA in the bill, the IDOH anticipates spending $25,000 on
programming expenses, development and distribution of digital and/or printed education materials, potential
travel or virtual meetings to engage the community, and development of an education and training network.
[This section may be updated with information specific to the DMHA when information is received from
FSSA.]
Opioid Treatment Program (OTP): The DMHA visits each of the OTPs annually, with a Clinical and an OTP
coordinator spending one or two days to review the facilities and policies and to interview patients. The
Clinical OTP coordinator reviews patient charts and treatment plans by sampling, which is on average about
10 files per OTP reviewed. In FY 2021, 22 OTPs were certified in Indiana, for an estimated review of 220
files. If the DMHA reviewed 20% of the files of the 16,130 individuals served by the programs in FY 2021,
they would review an additional 3,006 files annually.
Program Referrals and Counseling: Program costs may increase to provide birth control for female patients
who request it. From FY 2017 to FY 2020, between 14.7% and 52.5% of program participants were Medicaid
enrollees with family planning services coverage suggesting any additional cost is likely to be minimal.
Health Facilities: State or university owned facilities will have increased workload to create and implement
visitation policies and maintain certain policies during an emergency.
Explanation of State Revenues: Emergency Room Treatment Protocols: If an emergency room treatment
protocol were not adopted, the State Health Commissioner may take an action that could impact state
revenue. If the violator has a license denied or revoked, fee revenue would be foregone from the General
Fund. License fees range between $1,000 and $5,000 for hospital. The State Health Commissioner or
Professional Licensing Board/Commission may also impose a civil penalty of up to $10,000 for licensed
hospitals which would be deposited in the state General Fund.
HB 1018 2 Temporary Cessation: If an insurer or health maintenance organization fails to provide coverage after a
temporary cessation, the DOI Commissioner may impose a civil penalty of $10,000. [Most civil penalties
imposed by the DOI are deposited in the DOI’s agency fund.]
Additionally, if the cost of substance use treatment increases due to more approvals without regard to
temporary cessations and the upward pressure increases premiums overall, revenues to the state General Fund
could increase from either corporate adjusted gross income tax or insurance premium tax collections.
Explanation of Local Expenditures: Emergency Room Treatment Protocols: Locally owned health
facilities will also incur additional workload to develop and implement emergency room treatment protocols.
Temporary Cessation: The bill potentially impacts local units of government who offer health insurance
coverage for employees through a nonERISA plan. Added local health coverage costs may be mitigated with
adjustments to other benefits or to the total employee compensation packages, or through the division of costs
between the local unit and employees.
Explanation of Local Revenues:
State Agencies Affected: DMHA, IDOH, DOI, State Personnel Department for the state health plans,
Medicaid.
Local Agencies Affected: Locally owned health facilities, local units providing health insurance coverage.
Information Sources: Amy Kent, ISDH; Gus Habig, FSSA; Division of Mental Health and Addiction
Opiate Treatment Program Report SFY2020, Executive Summary accessed at
https://iga.in.gov/legislative/2021/publications/agency/reports/fssa/#document-ab9179ab;
https://www.in.gov/medicaid/files/family%20planning%20services.pdf.
Fiscal Analyst: Karen Rossen, 317-234-2106.
HB 1018 3