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 27, 2022
BILL NUMBER: HB 1158 BILL AMENDED: Jan 27, 2022
SUBJECT: Health and Human Services Matters.
FIRST AUTHOR: Rep. Clere BILL STATUS: 2
nd
Reading - 1
st
House
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: (Amended) Advanced Practice Registered Nurse (APRN) or Physician Assistant
(PA): The bill allows an APRN or PA 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 certain recommendations to the Task
Force.
Modification: The bill modifies provisions concerning records and information about the human
immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). It 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;
(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.
HB 1158 1 Indiana Board of Pharmacy: It changes the membership on the Indiana Board of Pharmacy.
Pharmacists, Pharmacies, and Pharmacy Technicians: It removes the requirement that a qualifying
pharmacist is responsible for the legal operations of a pharmacy. The bill specifies responsibilities of
pharmacists 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 amends requirements for remote pharmacies, and it adds exception to definition of "wholesale distribution"
for prescription drugs.
This bill makes technical and conforming changes.
Effective Date: Upon passage; July 1, 2022.
Explanation of State Expenditures: State Health Plans: Insurers, including Medicaid, the Children’s
Health Insurance Plan (CHIP), and the State Employee Health Plans for reimbursement 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.]
APRN and PA: If APRN and PA 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 an APRN’s or PA’s expanded authority to sign the plans. However, there may also
be savings if APRNs or PAs provide services that otherwise would have been rendered by a physician due
to lower professional fees charged by APRNs and PAs compared to physicians. APRN and PA 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.
(Revised) Remote Pharmacies: The Professional Licensing Agency (PLA) and the Board of Pharmacy may
have more enforcement actions based on the bill’s requirements for remote pharmacies concerning staffing,
ownership, and operations.
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.
Felonies: The bill repeals a Level 5 felony concerning recklessly, knowingly, or intentionally selling or
HB 1158 2 transferring HIV infected blood or semen. 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. Also, the bill exempts sellers of legend drugs
used for research or clinical trials from laws requiring licensure as wholesale legend drug distributors. To
the extent this prevents convictions for unlicensed wholesale drug distribution, a Level 6 felony, there would
be fewer expenditures needed for the Department of Correction to house offenders.
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.
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 HEA 1001-2021).
Reimbursement for travel is $0.39 per mile, effective March 1, 2020. 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.
Penalty Provision: 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 $11.87 daily, per
inmate.
Explanation of State Revenues: Insurance Premium Tax: If private insurance claims immunization
administration fees increase premiums tax revenue collected in the state, General Fund revenue from either
insurance premium tax collections or Adjusted Gross Income (AGI) tax collections would increase. Any
change is expected to be minimal.
Board of Pharmacy Fines and Fees: If a violation of the bill’s requirements for remote dispensing facilities
is committed by a pharmacy or pharmacists, the PLA may take an action that could impact state revenue. If
the violator has a license denied or revoked, General Fund revenue from license fees would decrease.
HB 1158 3 Pharmacy and Pharmacist biennial license fees are $200 and $160, respectively. The PLA may also impose
a fine of up to $1,000, which would be deposited in the General Fund. Additionally, there could be a minor
decrease in General Fund revenue from wholesale legend drug distributor licenses, due to the exemption
from licensure requirements for sellers of drugs used for research or clinical trials. Wholesale legend drug
distributor license fees are $100 biennially.
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. The bill may also
prevent Level 6 felony charges and convictions for unlicensed wholesale drug distribution in certain
circumstances. If fewer court cases occur, revenue to both the Common School Fund (from criminal fines)
and the state General Fund (from court fees) would decrease. The maximum fine for a Class B misdemeanor
is $1,000. The maximum fine for a Level 5 or Level 6 felony is $10,000. However, any reduction in revenue
would likely be minimal.
Explanation of Local Expenditures: Local units providing health care through certain insurance plans or
HMO contracts may have increases in services due to additional vaccines or additional services through
IFSP. (See Explanation of State Expenditures for details.) 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: Penalty Provision: If fewer court actions and guilty verdicts occur, local
governments would receive less revenue from court fees. However, any reductions would likely be small.
State Agencies Affected: Indiana Department of Health; Family and Social Services Administration;
Division of Disability and Rehabilitative Services; Indiana Board of Pharmacy; Department of Correction;
State Department of Personnel and all state agencies.
Local Agencies Affected: Local units providing health insurance; local health officers; trial courts; local
law enforcement agencies.
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; Adam White, 317-234-1360.
HB 1158 4