LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington, Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 7067 NOTE PREPARED: Jan 9, 2022
BILL NUMBER: HB 1158 BILL AMENDED:
SUBJECT: Various Health and Human Services Matters.
FIRST AUTHOR: Rep. Clere BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: Advanced Practice Registered Nurses (APRN): It allows an APRN to sign certain
individualized family service plans (IFSP).
Disability and Rehabilitative Services Advisory Council (DRS Advisory Council): It changes the composition
and duties of the DRS Advisory Council.
Services for Individuals with Intellectual and Other Developmental Disabilities Task Force (Task Force):
The bill requires the Task Force to establish a subcommittee to make recommendations to the Task Force
regarding:
(1) ways to minimize health and safety risks of individuals with intellectual and
developmental disabilities; and
(2) the feasibility of the Division of Disability and Rehabilitative Services (DDRS)
establishing a pilot program to create special service review teams to assist families or
individuals in a crisis situation to identify available resources and sources of assistance.
Modification: The bill modifies provisions concerning records and information about the human
immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS).
Repeals: The bill repeals provisions concerning the following:
(1) Reports to a health officer about a person who is believed to be a serious and present risk
to the health of others.
(2) Physician notification to:
(A) a patient with a serious communicable disease;
HB 1158 1 (B) a health officer; and
(C) a person at risk.
The bill repeals certain offenses concerning: (1) notification, reporting, and investigation related to
communicable diseases; and (2) the donation, sale, or transfer of semen that contains antibodies for HIV.
Board of Pharmacy (IBP): The bill requires the IBP to adopt emergency rules concerning the preparation,
dispensing, and administration of clinician-administered drugs. It provides that emergency rules adopted by
the IBP shall remain in place until final rules regarding clinician-administered drugs become effective.
Pharmacists: It provides that a pharmacist may be reimbursed for health care services that are eligible
Medicaid claims. It also requires that a pharmacist be reimbursed for Medicaid covered services at a federally
qualified health center or rural health clinic.
It excludes pharmacists who are part of a health care organization from the practice of medicine.
It also removes the requirement that a qualifying pharmacist is responsible for the legal operations of a
pharmacy. The bill specifies responsibilities of pharmacists and pharmacy managers concerning duties
previously responsible by a qualifying pharmacist.
The bill allows a qualified pharmacy technician to administer immunizations delegated by the pharmacist.
(Current law allows pharmacy technicians to administer influenza and coronavirus disease immunizations.)
It also allows an insurer that issues a policy of accident and sickness insurance to reimburse a pharmacist for
a health care service provided by the pharmacist.
The bill adds pharmacists to the law concerning immunity for providing voluntary health care.
Clinician-Administered Drugs: The bill requires policies of accident and sickness insurance, health
maintenance organization (HMO) contracts, and pharmacy benefit managers (PBMs) to permit a covered
individual to obtain a clinician-administered drug from the provider or pharmacy of the covered individual's
choice. It prohibits policies of accident and sickness insurance, HMO contracts, and PBMs from interfering
with a covered individual's right to choose where to obtain a clinician-administered drug through inducement,
steering, or offering financial or other incentives.
Checkbox: The bill requires the Department of State Revenue (DOR) to add to its forms and schedules a box
for a tax filer to check to request further information regarding health care coverage under a public health
insurance program or qualified health plan.
Effective Date: Upon passage; July 1, 2022.
Explanation of State Expenditures: Pharmacist Reimbursement: Medicaid may be responsible for
reimbursing more health care costs to pay for services provided by a pharmacist within their scope of
practice. Also, Medicaid reimbursement for services will increase to pay for eligible services provided by
a pharmacist at a FQHC or RHC. Any reimbursement for services provided by pharmacists within the scope
of their duty or at a FQHC or RHC would not take place until the federal approval for these Medicaid
reimbursements is received. [Medicaid has a single professional dispensing fee of $10.48 for both specialty
and nonspecialty pharmacies. Services provided within the scope of pharmacist practice may exceed the cost
HB 1158 2 of dispensing prescriptions.]
State Health Plans: Insurers, including Medicaid, the Children’s Health Insurance Plan (CHIP), and the
State Employee Health Plans, may experience greater expenditures on specialty drugs due to the bill's
restrictions on specialty drug agreements between health plans and hospitals. The bill would limit the ability
of the state employee health plans' administrator to require hospitals to purchase specialty drugs at contract
pharmacies or to use a contract pharmacy's price schedule to determine reimbursement. Also, the state health
plans may be responsible for reimbursing providers for additional vaccine administration fees to the extent
that covered individuals receiving the vaccine at a pharmacy would not have otherwise received the vaccine.
[Under Indiana’s Medicaid and CHIP programs, reimbursement rates for immunization administration are
typically between $8.90 and $17.61 per dose. The typical state share of these costs would be between $3 and
$6 per dose.]
Advanced Practice Registered Nurses (APRN): If APRN authority to sign IFSP results in more children
receiving early intervention services, expenditures under the First Steps program, Medicaid, and state
employee and state educational institution (SEI) health plans may increase. Total additional expenditures as
a result of the bill are indeterminable but expected to be minor. Expenditures within the state Medicaid, state
employee, and SEI health care plans could increase to the extent that services provided under IFSPs become
more accessible to plan members due to APRN’s expanded authority to sign the plans. However, there may
also be savings if APRNs provide services that otherwise would have been rendered by a physician due to
lower professional fees charged by APRNs compared to physicians. APRN services are reimbursed at 75%
of physician rates for Medicaid fee-for-service claims. The overall impact to General Fund and dedicated
fund spending for health plan benefits is indeterminable but likely to be small.
Disability and Rehabilitative Services Advisory Council (DRS Advisory Council): With five additional
members of the DRS Advisory Council, per diem and traveling expense reimbursement will increase.
However, the number of statutorily required meetings will decrease from 12 to 6, potentially mitigating the
added member cost.
Services for Individuals with Intellectual and Other Developmental Disabilities Task Force (Task Force):
The bill requires the Task Force to establish two subcommittees to make recommendations to the full Task
Force prior to September 1, 2022. Members of the Task Force receive salary per diem and traveling expenses.
Felony Repeal: The bill repeals a Level 5 felony concerning recklessly, knowingly, or intentionally selling
or transferring HIV infected blood or seaman. The crime may be enhanced to a Level 4 or Level 3 felony
(with different enhanced penalties in different parts of the Indiana Code). The repeal is expected to have very
minimal fiscal impact or reduction of the prison population.
Department of Insurance (DOI): To the extent that the DOI has oversight between an insurer and insured,
and the provider and insurers or HMOs, the DOI’s workload may increase to evaluate and resolve complaints
of noncompliance with the provisions of the bill. Additionally, the DOI may investigate allegations and
provide adjudicative proceedings to determine if an unfair or deceptive act occurred concerning PBMs. The
bill includes pharmacists as health care providers in the Medical Malpractice Act, requiring additional
workload for the DOI to receive documents concerning qualified pharmacists, collect surcharges for the
Indiana Patient’s Compensation Fund (IPCF), and to make payments from the IPCF for a medical malpractice
claim against a pharmacist. All together these requirements represent an additional workload on the DOI
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
HB 1158 3 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. [The DOI is funded through a dedicated
agency fund.]
Checkbox: The DOR must add a box for a tax filer to check to request further information regarding coverage
under a public health insurance program or qualified health plan during its first routine update of forms and
schedules in FY 2023. The bill requires the DOR to report the contact information of those tax filers
checking the box to the Family and Social Services Administration (FSSA), which then provides that contact
information to 211 services in order to connect those filers with an application organization. Not later than
July 1 of each year, the FSSA must provide a report to the General Assembly with information about the
health insurance enrollment rates of taxpayers who checked the box for information. The requirements of
the bill represent an additional workload on these agencies, but could likely be accomplished within existing
resources.
DDRS: The DDRS will have additional reporting to the DDRS Advisory Council, including quarterly and
annual reports and prior to submission of Medicaid waivers. Any increase will be within the agency’s
existing resources.
Rules Adoption: The bill specifies that the IBP may adopt emergency rules to establish requirement
concerning clinician-administered drugs that will be effect until final rules are adopted. These rules can likely
be adopted under existing appropriations within IBP’s regularly scheduled meetings.
Additional Information -
APRN First Steps: The First Steps program is the Family and Social Services Administration’s (FSSA) early
intervention program for young children with developmental delays or disabilities. The program is funded
through General Fund appropriations and federal Individuals with Disabilities Education Act (IDEA)
funding. Additionally, certain health plans are required under existing law to reimburse the FSSA at a
monthly fee for services provided under the First Steps program.
Medicaid State Share: Medicaid is jointly funded between the state and federal governments. The standard
state share of costs for most Medicaid medical services for FFY 2022 is 34%. The standard state share of
Children’s Health Insurance Plan (CHIP) costs is 24%.
State Employee Health Plans: Costs for the state health plans are shared between the state and state
employees covered by the plan as determined in the plans’ designs, including premiums, coinsurance,
copayments, and deductibles. An increase in premiums cost may be mitigated with adjustments to other
benefits or to employee compensation packages, or through the division of premium costs between the state
and state employees.
Salary Per Diem and Traveling Expenses: Lay members of executive boards, commissions and councils, who
are entitled to receive a salary per diem, receive $100 per day (as specified in Section 15, of the budget bill-
HEA 1001-2021). Reimbursement for travel is $0.39 per mile, effective March 1, 2020. (Set by DOA with
SBA approval in July.) Members who are state employees receive traveling expenses and other expenses
incurred. Members who are also members of the General Assembly receive a per diem of $196 per day (as
of Oct. 1, 2021) and personal automobile mileage of $0.585 per mile beginning January 1, 2022.
HB 1158 4 Explanation of State Revenues: Insurance Premium Tax: Increases in private insurance claims
expenditures from restrictions on specialty drugs, requiring reimbursement of pharmacists for duties within
their scope of practice, and immunization administration fees may increase premiums tax revenue collected
in the state. Any increase in insurance company premiums will increase General Fund revenue from either
insurance premium tax collections or Adjusted Gross Income (AGI) tax collections.
Violations: If a PBM violates the provisions concerning clinician-administered drugs, the DOI Commissioner
may seek enforcement as an unfair or deceptive act or practice in the business of insurance. The penalty for
engaging in an unfair and deceptive act is one or more of the following: (1) a civil penalty between $25,000
and $50,000 for each act or violation and (2) revocation of a a license. Actual increases in revenue are
unknown.
IPCF: Qualifying pharmacists will pay $100 for the surcharge to the IPCF.
Criminal Penalties and Civil Actions: The bill repeals a Class B misdemeanor for recklessly violating a duty
or authority to inform or notify concerning a communicable disease. The bill repeals a cause for civil action,
which may reduce revenue deposited in the state General Fund from the $100 court fee. Any change in
revenue is likely to be minimal.
Explanation of Local Expenditures: The pharmacist and pharmacy technician provisions on local units
providing group health plans or HMO contracts to provide health care is indeterminate. (See Explanation
of State Expenditures for details.) An increase in premiums cost may be mitigated with adjustments to other
benefits or to employee compensation packages, or through the division of premium costs between a local
unit and its employees.
Advanced Practice Registered Nurses (APRN): The bill potentially impacts local units of government that
offer non-ERISA health insurance coverage for employees. 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.
Local Health Officers: Local health officers’ workload will minimally increase to submit advisory guidelines
to the IDOH for formulation of its rules on communicable disease control, monitoring, inspection, and
quarantine.
Explanation of Local Revenues:
State Agencies Affected: Department of State Revenue; Indiana Department of Health; Family and Social
Services Administration; Division of Disability and Rehabilitative Services; Indiana Board of Pharmacy;
Department of Insurance; Department of Correction; State Department of Personnel and all state agencies;
Local Agencies Affected: Local units providing health insurance; local health officers; courts.
Information Sources: FSSA, Pharmacy Services Procedures, Library Reference Number: PROMOD00042,
Published: August 24, 2021, Policies and procedures as of June 1, 2021, Version: 6.0; Professional Fee
Schedule, last updated: January 1, 2022.
Fiscal Analyst: Karen Rossen, 317-234-2106; Olivia Smith, 317-232-9869; Adam White, 317-234-1360.
HB 1158 5