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 6053 NOTE PREPARED: Oct 25, 2021
BILL NUMBER: HB 1020 BILL AMENDED:
SUBJECT: End of Life Options.
FIRST AUTHOR: Rep. Pierce BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: The bill allows individuals with a terminal illness who meet certain requirements
to make a request to an attending provider for medication that the individual may take to bring about death.
It specifies requirements a provider must meet in order to prescribe the medication to a patient.
Insurance: The bill prohibits an insurer from denying payment of benefits under a life insurance policy based
upon a suicide clause in the life insurance policy if the death of the insured individual is the result of medical
aid in dying.
Criminal Penalties: It establishes a Level 1 felony if a person:
(1) without authorization of the patient, willfully alters, forges, conceals, or destroys a
request for medication or a rescission of a request for medication with the intent or effect
of causing the individual's death; or
(2) knowingly or intentionally coerces or exerts undue influence on an individual to request
medication to bring about death or to destroy a rescission of a request for medication to
bring about death.
It also establishes a Class A misdemeanor if a person, without authorization of the patient, willfully alters,
forges, conceals, or destroys a request for medication or a rescission of a request for medication in order to
affect a health care decision by the individual.
Immunity: The bill establishes certain criminal and civil immunity for health care providers.
Effective Date: July 1, 2022.
HB 1020 1 Explanation of State Expenditures: Indiana Department of Health (IDOH): The bill will increase the
workload for the IDOH to adopt rules, develop forms, and review records submitted to produce a report. The
bill’s requirements are within the IDOH’s routine administrative functions and should be able to be
implemented with no additional appropriations, assuming near customary agency staffing and resource levels.
Medicaid: The fiscal impact of the bill on state Medicaid spending is expected to be minimal. Of the
individuals who requested prescriptions in other states, the majority had insurance through Medicare or
Medicaid, or had a combination of private and government sponsored insurance. Also, a majority of the
people using the prescription are reported to be on hospice and die at home. [Medicaid may pay premiums,
coinsurance, or copayments for Medicare covered services for low income individuals. Per diem rates for
Medicaid-enrolled hospice providers effective October 1, 2021, through September 30, 2022, are between
$160.95 to $203.66 for routine home care and $1,463.09 for continuous home care.]
Criminal Penalties: A Level 1 felony is punishable by a prison term ranging from 20 to 40 years, with an
advisory sentence of 30 years. The sentence depends on mitigating and aggravating circumstances. Assuming
offenders can be housed in existing facilities with no additional staff, the marginal cost for medical care,
food, and clothing is approximately $4,333 annually, or $11.67 daily, per prisoner. However, any additional
expenditures are likely to be small.
Additional Information - The health departments in the states of Oregon and Washington produce annual
reports similar to the report required in this bill. In 2020, 377 prescriptions for lethal medications were made
in Oregon, and 267 in Washington were dispensed medication during 2018. In both states, the number of
prescriptions has increased almost every year since the legislation was enacted. Oregon’s statute has been
in effect since 1997 and Washington’s since 2009. [Nine states have similar acts with enactment dates
between 2013 and 2021.]
There were no physician referrals made to the Oregon Medical Board for failure to comply with the
legislation’s requirements in 2020. Washington does not report this information.
Explanation of State Revenues: Criminal Penalties: If additional court cases occur and fines are collected,
revenue to both the Common School Fund and the state General Fund would increase. The maximum fine
for a Level 1 felony is $10,000 and for a Class A misdemeanor is $5,000. However, any additional revenues
would likely be small.
Explanation of Local Expenditures: Criminal Penalties: Defendants are detained in county jails prior to
their court hearings and a Class A misdemeanor is punishable by up to one year in jail. The average cost per
day to incarcerate a prisoner is approximately $54 based on the per diem payments reported by U.S. Marshals
to house federal prisoners in 16 county jails across Indiana during federal FY 2017. However, any additional
revenues would likely be small.
Explanation of Local Revenues: Criminal Penalties: If additional court actions occur and a guilty verdict
is entered, local governments would receive revenue from court fees. However, the amounts would likely
be small.
State Agencies Affected: Indiana Department of Health, Family and Social Services, Medicaid, Department
of Correction.
Local Agencies Affected: Trial courts, local law enforcement agencies. Trial courts, local law enforcement
HB 1020 2 agencies.
Information Sources: Department of Correction, U.S. Department of Justice Marshals Service; IHCP
Bulletin BT202194, October 21, 2021; Oregon Public Health Division, Death with Dignity Act, 2020 Data
Summary; Washington State Department of Health, Washington State Department of Health 2018 Death with
Dignity Act Report.
Fiscal Analyst: Karen Rossen, 317-234-2106.
HB 1020 3