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 7145 NOTE PREPARED: Feb 28, 2022
BILL NUMBER: HB 1169 BILL AMENDED: Feb 28, 2022
SUBJECT: Department of Health Matters.
FIRST AUTHOR: Rep. Clere BILL STATUS: 2
nd
Reading - 2
nd
House
FIRST SPONSOR: Sen. Crider
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: (Amended) This bill has the following provisions:
Advanced Practice Registered Nurse (APRN): The bill prohibits certain health insurance plans from requiring
authorization for covered early intervention services under an individualized family service plan signed by
an APRN. The bill authorizes an APRN to sign an order or referral for physical therapy. It requires a health
insurance plan to provide coverage for diabetes self-management training ordered by an APRN.
Repeal and or Relocate - The bill repeals and relocates laws concerning:
(1) rules regulating the sanitary operation of tattoo parlors and body piercing facilities;
(2) allowing the executive board of the State Department of Health (Board) to adopt rules
on behalf of the State Department of Health (IDOH);
(3) allowing the Board to adopt emergency rules;
(4) sanitation of public buildings and institutions; and
(5) authority to adopt rules concerning the federal Clinical Laboratory Improvement
Amendments.
The bill repeals laws concerning:
(1) safety guidelines for children during bad weather conditions;
(2) automated external defibrillator rules in health clubs;
(3) requiring the State Health Commissioner (Commissioner) to comment on certain rules;
(4) fees for serological tests;
(5) the administrative unit for special institutions;
(6) protection and regulation of IDOH property; and
(7) the registry of blind persons.
HB 1169 1 Removal of Local Health Officers - The bill removes intemperance as a reason to remove a local health
officer.
Administrative Law Proceedings - The bill specifies that the IDOH may request the Office of Administrative
Law Proceedings to designate a person to administer a proceeding.
Office of Oral Health - The bill requires the IDOH to provide facilities and disseminate information to the
public concerning oral public health.
Poison Control - The bill allows the IDOH to have a designee to maintain a 24-hour poisons answering
service.
Prenatal Care Information - The bill adds information on prenatal care to the IDOH’s telephone information
service concerning children with long term health care needs.
Substance Use Disorder - The bill changes the reference from "illegal drug use" to "substance abuse
disorder" for purposes of partnership and joint ventures with the IDOH.
Chief Medical Officer - The bill requires the IDOH to employ a licensed physician as the Chief Medical
Officer. It allows the Chief Medical Officer to perform the functions of the Commissioner when the
Commissioner is not available.
State Health Laboratory - The bill specifies that the laboratory must be used to support public health. It
changes the title of the person who manages the laboratory. It removes certain requirements concerning the
appointment of the laboratory director and chemist. It also removes a requirement that a director must report
to the Commissioner.
Certificate of Public Advantage (COPA) - The bill requires holders of a COPA to pay for reasonable charges
incurred by the IDOH.
Chronic Disease Registry - The bill changes the requirement that the IDOH "shall" to "may" use information
compiled by a public or private entity to the greatest extent possible to develop a chronic disease registry.
Certificate of Free Sale - The bill allows the IDOH to issue a certificate of free sale to a business that meets
certain requirements.
Health Improvement Grants - The bill amends the definition of "person" for purposes of the State Health
Improvement Plan and Grant Program.
Deaf or Hard of Hearing Definition - The bill amends the definition of "deaf or hard of hearing" for purposes
of the laws governing language development for children who are deaf or hard of hearing.
County Coroners - The bill provides that a county coroner may not certify the cause of death for certain
infants as a sudden unexplained infant death until a comprehensive death investigation is performed.
The bill makes technical and conforming changes.
Effective Date: Upon passage; July 1, 2022.
HB 1169 2 Explanation of State Expenditures: Certificate of Free Sale: The IDOH may issue a certificate of free sale
to Indiana food manufacturers that meet certain requirements. These requirements may increase workload,
yet these activities are currently undergone within the IDOH Food Protection Division and in collaboration
with the FDA. The IDOH reports approximately 5,000 to 6,000 certificates are currently issued annually. The
workload impact is anticipated to be minimal.
Health Improvement Grants: The bill expands the definition of eligible applicants for the Health Issues and
Challenges Grant Program to include counties. This could increase applications and the rate of approved
grant awards, yet is not anticipated to impact total funding or expenditures. HEA 1001-2021 appropriated
$25 M in each year of the FY 2022 - FY 2023 biennium from the Federal American Rescue Plan Act
(ARPA).
(Revised) Advanced Practice Registered Nurse (APRN): The bill authorizes APRNs to perform certain duties
that are currently required to be performed by a physician or another practitioner. These changes in APRN
authority could potentially result in an indeterminable but likely small impact on state expenditures related
to the First Steps Program, worker’s compensation claims, as well as for medical claims within the Medicaid,
state employee, and state educational institution (SEI) health plans.
Miscellaneous and Technical Provisions - The bill has many provisions that repeal, move, clarify, or update
sections of code that have no measurable fiscal impact and conform to IDOH practice and current activities.
Additional Information -
(Revised) First Steps Program: The First Steps program is the FSSA’s early intervention program for young
children with developmental delays or disabilities. If APRN authority to sign individualized family service
plans results in more children receiving First Steps services, expenditures under the program may increase.
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 service provided under the First Steps program. Any additional First
Steps expenditures as a result of the bill are expected to be minor.
(Revised) State Health Care Programs: Expenditures within the state Medicaid, state employee, and SEI
health care plans could increase to the extent that certain services become more accessible to plan members
due to APRNs’ expanded authority to sign orders for certain services. 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.
(Revised) 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%.
(Revised) 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
HB 1169 3 and state employees.
Explanation of State Revenues: Certificates of Public Advantage (COPA) - The bill strengthens the
language in existing statute requiring COPA applicants and holders to pay fees assessed by the IDOH to fund
the agency’s costs for COPA review and monitoring activities. The bill also adds a requirement for COPA
applicants to pay additional charges for expenses incurred by the IDOH in excess of application fees
collected. All COPA fees collected would be deposited in the General Fund.
Explanation of Local Expenditures: School Corporations - The bill amends the definition of "deaf or hard
of hearing" for purposes of the laws governing language development for children who are deaf or hard of
hearing. These changes are for clarification purposes only and are not expected to impact expenditures
related to individualized education plans (IEPs).
(Revised) Local Health Plans: Local units of government that offer health insurance coverage for employees
could have added health care costs if the authority given APRNs increases the number of services provided.
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.
[See Explanation of State Expenditures.]
Explanation of Local Revenues: Local Health Departments - The bill expands the definition of eligible
applicants for the Health Issues and Challenges Grant Program to include counties. This could increase
revenue to local units specific to receipt of grant funds from the Federal ARPA for eligible projects to
improve public health.
State Agencies Affected: Department of Health, Department of Education, State Educational Institutions,
Family and Social Services Administration.
Local Agencies Affected: Counties, local health departments, school corporations.
Information Sources: Micha Burkert, Indiana Department of Health.
Fiscal Analyst: Karen Rossen, 317-234-2106; Allison Leeuw, 317-234-9465.
HB 1169 4