*ES0284.1*
February 10, 2022
ENGROSSED
SENATE BILL No. 284
_____
DIGEST OF SB 284 (Updated February 9, 2022 12:18 pm - DI 77)
Citations Affected: IC 12-7; IC 12-15; IC 25-1.
Synopsis: Telehealth matters. Consolidates Medicaid telehealth
language. Provides that "health care services" does not include certain
case management services, care management services, service
coordination services, or care coordination services for purposes of
telehealth. Adds school psychologists, specified developmental
therapists, peers, clinical fellows, students, and certain community
mental health center providers to the definition of "practitioner" for
purposes of practicing telehealth. Allows behavior health analysts to
temporarily perform telehealth during the time when the professional
licensing agency is preparing to implement licensure for the profession.
Effective: July 1, 2022.
Charbonneau, Doriot, Bassler,
Becker, Breaux, Pol Jr.
(HOUSE SPONSOR — BARRETT)
January 10, 2022, read first time and referred to Committee on Health and Provider
Services.
January 20, 2022, amended, reported favorably — Do Pass.
January 24, 2022, read second time, ordered engrossed. Engrossed.
January 25, 2022, read third time, passed. Yeas 46, nays 0.
HOUSE ACTION
February 1, 2022, read first time and referred to Committee on Public Health.
February 10, 2022, amended, reported — Do Pass.
ES 284—LS 6719/DI 104 February 10, 2022
Second Regular Session of the 122nd General Assembly (2022)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2021 Regular Session of the General Assembly.
ENGROSSED
SENATE BILL No. 284
A BILL FOR AN ACT to amend the Indiana Code concerning
professions and occupations.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 12-7-2-190.3, AS AMENDED BY P.L.85-2021,
2 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 JULY 1, 2022]: Sec. 190.3. (a) "Telehealth activities", for purposes of
4 IC 12-15-5-11, has the meaning set forth in IC 12-15-5-11(a).
5 (b) "Telehealth services", for purposes of IC 12-15-5-11, has the
6 meaning set forth in IC 12-15-5-11(b). IC 12-15-5-11(a).
7 SECTION 2. IC 12-15-5-11, AS AMENDED BY P.L.207-2021,
8 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
9 JULY 1, 2022]: Sec. 11. (a) As used in this section, "telehealth
10 activities" means the use of telecommunications and information
11 technology to provide access to:
12 (1) health assessment;
13 (2) diagnosis;
14 (3) intervention;
15 (4) consultation;
16 (5) supervision; and
17 (6) information;
ES 284—LS 6719/DI 104 2
1 across a distance.
2 (b) As used in this section, "telehealth services" has the meaning set
3 forth for "telehealth" in IC 25-1-9.5-6.
4 (c) The office shall reimburse a Medicaid provider who is licensed
5 as a home health agency under IC 16-27-1 for telehealth activities.
6 (d) (b) The office shall reimburse the following Medicaid providers
7 for medically necessary telehealth services:
8 (1) A federally qualified health center (as defined in 42 U.S.C.
9 1396d(l)(2)(B)).
10 (2) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)).
11 (3) A community mental health center certified under
12 IC 12-21-2-3(5)(C).
13 (4) A critical access hospital that meets the criteria under 42 CFR
14 485.601 et seq.
15 (5) A home health agency licensed under IC 16-27-1.
16 (5) (6) A provider, as determined by the office to be eligible,
17 providing a covered telehealth service.
18 (e) (c) The office may not impose any distance restrictions on
19 providers of telehealth activities or telehealth services. Before
20 December 31, 2017, the office shall do the following:
21 (1) Submit a Medicaid state plan amendment with the United
22 States Department of Health and Human Services that eliminates
23 distance restrictions for telehealth activities or telehealth services
24 in the state Medicaid plan.
25 (2) Issue a notice of intent to adopt a rule to amend any
26 administrative rules that include distance restrictions for the
27 provision of telehealth activities or telehealth services.
28 (f) (d) Subject to federal law, the office may not impose any location
29 requirements concerning the originating site or distant site in which a
30 telehealth service is provided to a Medicaid recipient.
31 (g) (e) A Medicaid recipient waives confidentiality of any medical
32 information discussed with the health care provider that is:
33 (1) provided during a telehealth visit; and
34 (2) heard by another individual in the vicinity of the Medicaid
35 recipient during a health care service or consultation.
36 (h) (f) For purposes of a community mental health center, telehealth
37 services satisfy any face to face meeting requirement between a
38 clinician and consumer.
39 (i) (g) The office shall implement any part of this section that is
40 approved by the United States Department of Health and Human
41 Services.
42 (j) (h) The office may adopt rules under IC 4-22-2 necessary to
ES 284—LS 6719/DI 104 3
1 implement and administer this section.
2 SECTION 3. IC 25-1-9.5-2.5, AS ADDED BY P.L.85-2021,
3 SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
4 JULY 1, 2022]: Sec. 2.5. (a) As used in this chapter, "health care
5 services" includes the following:
6 (1) The following concerning a patient:
7 (A) Assessment.
8 (B) Diagnosis.
9 (C) Evaluation.
10 (D) Consultation.
11 (E) Treatment. and
12 (F) Monitoring of a patient.
13 (2) Transfer of medical data.
14 (3) Patient health related education.
15 (4) Health administration.
16 (b) The term does not include case management services, care
17 management services, service coordination services, or care
18 coordination services:
19 (1) as defined in IC 12-7-2-25;
20 (2) provided to individuals under the Indiana Medicaid
21 program or Medicaid waivers; or
22 (3) provided to individuals under any other programs
23 administered by the office of the secretary of family and social
24 services or the Indiana department of health.
25 SECTION 4. IC 25-1-9.5-3.5, AS AMENDED BY P.L.207-2021,
26 SECTION 25, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
27 JULY 1, 2022]: Sec. 3.5. (a) As used in this chapter, "practitioner"
28 means an individual who holds an unlimited license to practice as any
29 of the following in Indiana:
30 (1) An athletic trainer licensed under IC 25-5.1.
31 (2) A chiropractor licensed under IC 25-10.
32 (3) A dental hygienist licensed under IC 25-13.
33 (4) The following:
34 (A) A dentist licensed under IC 25-14.
35 (B) An individual who holds a dental residency permit issued
36 under IC 25-14-1-5.
37 (C) An individual who holds a dental faculty license under
38 IC 25-14-1-5.5.
39 (5) A diabetes educator licensed under IC 25-14.3.
40 (6) A dietitian licensed under IC 25-14.5.
41 (7) A genetic counselor licensed under IC 25-17.3.
42 (8) The following:
ES 284—LS 6719/DI 104 4
1 (A) A physician licensed under IC 25-22.5.
2 (B) An individual who holds a temporary permit under
3 IC 25-22.5-5-4.
4 (9) A nurse licensed under IC 25-23.
5 (10) The following:
6 (A) An occupational therapist licensed under IC 25-23.5.
7 (B) An occupational therapy assistant licensed under
8 IC 25-23.5.
9 (11) Any behavioral health and human services professional
10 licensed under IC 25-23.6.
11 (12) An optometrist licensed under IC 25-24.
12 (13) A pharmacist licensed under IC 25-26.
13 (14) A physical therapist licensed under IC 25-27.
14 (15) A physician assistant licensed under IC 25-27.5.
15 (16) A podiatrist licensed under IC 25-29.
16 (17) A psychologist licensed under IC 25-33.
17 (18) A respiratory care practitioner licensed under IC 25-34.5.
18 (19) A speech-language pathologist or audiologist licensed under
19 IC 25-35.6.
20 (20) A veterinarian licensed under IC 25-38.1.
21 (21) A behavior analyst licensed under IC 25-8.5.
22 (22) A school psychologist licensed by the department of
23 education.
24 (b) The term includes the following:
25 (1) A developmental therapist enrolled by the bureau of child
26 development services to provide special instruction, as defined
27 in 34 CFR 303.13(b)(14), to infants and toddlers receiving
28 early intervention services.
29 (2) A peer as defined in IC 12-21-8-5 and certified by the
30 division of mental health and addiction.
31 (3) A clinical fellow in speech language pathology.
32 (4) A student who is:
33 (A) pursuing a course of study or a graduate from a
34 program in a profession specified in subsection (a)(1)
35 through (a)(22); and
36 (B) providing services directed by an individual who holds
37 a license in Indiana for that profession.
38 (5) The following providers within a community mental health
39 center:
40 (A) A qualified behavioral health professional.
41 (B) Other behavioral health professional.
42 (c) The term includes a behavior analyst during the time in
ES 284—LS 6719/DI 104 5
1 which the professional licensing agency is preparing to implement
2 licensure of behavioral analysts under IC 25-8.5. This subsection
3 expires January 1, 2025.
4 SECTION 5. IC 25-1-9.5-6, AS AMENDED BY P.L.207-2021,
5 SECTION 26, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
6 JULY 1, 2022]: Sec. 6. (a) As used in this chapter, "telehealth" means
7 the delivery of health care services using interactive electronic
8 communications and information technology, in compliance with the
9 federal Health Insurance Portability and Accountability Act (HIPAA),
10 including:
11 (1) secure videoconferencing;
12 (2) store and forward technology; or
13 (3) remote patient monitoring technology;
14 between a provider in one (1) location and a patient in another location.
15 (b) The term does not include the use of the following unless the
16 practitioner has an established relationship with the patient:
17 (1) Electronic mail.
18 (2) An instant messaging conversation.
19 (3) Facsimile.
20 (4) Internet questionnaire.
21 (5) Internet consultation.
22 (c) The term does not include a health care service provided by:
23 (1) an employee of a practitioner; or
24 (2) an individual who is employed by the same entity that
25 employs the practitioner;
26 who is performing a health care service listed in section 2.5(a)(1)(D)
27 through 2.5(a)(1)(F), 2.5(2), 2.5(3), or 2.5(4) 2.5(a)(2), 2.5(a)(3), or
28 2.5(a)(4) of this chapter under the direction and that is customarily
29 within the specific area of practice of the practitioner.
30 SECTION 6. IC 25-1-9.5-7, AS AMENDED BY P.L.85-2021,
31 SECTION 17, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
32 JULY 1, 2022]: Sec. 7. (a) A practitioner who:
33 (1) provides health care services through telehealth; or
34 (2) directs an employee of the practitioner to perform a health
35 care service listed in section 2.5(2), 2.5(3), 2.5(a)(2), 2.5(a)(3),
36 or 2.5(4) 2.5(a)(4) of this chapter;
37 shall be held to the same standards of appropriate practice as those
38 standards for health care services provided at an in-person setting.
39 (b) A practitioner who uses telehealth shall, if such action would
40 otherwise be required in the provision of the same health care services
41 in a manner other than telehealth, ensure that a proper provider-patient
42 relationship is established. The provider-patient relationship by a
ES 284—LS 6719/DI 104 6
1 practitioner who uses telehealth must at a minimum include the
2 following:
3 (1) Obtain the patient's name and contact information and:
4 (A) a verbal statement or other data from the patient
5 identifying the patient's location; and
6 (B) to the extent reasonably possible, the identity of the
7 requesting patient.
8 (2) Disclose the practitioner's name and disclose the practitioner's
9 licensure, certification, or registration.
10 (3) Obtain informed consent from the patient.
11 (4) Obtain the patient's medical history and other information
12 necessary to establish a diagnosis.
13 (5) Discuss with the patient the:
14 (A) diagnosis;
15 (B) evidence for the diagnosis; and
16 (C) risks and benefits of various treatment options, including
17 when it is advisable to seek in-person care.
18 (6) Create and maintain a medical record for the patient. If a
19 prescription is issued for the patient, and subject to the consent of
20 the patient, the prescriber shall notify the patient's primary care
21 provider of any prescriptions the prescriber has issued for the
22 patient if the primary care provider's contact information is
23 provided by the patient. The requirements in this subdivision do
24 not apply when any of the following are met:
25 (A) The practitioner is using an electronic health record
26 system that the patient's primary care provider is authorized to
27 access.
28 (B) The practitioner has established an ongoing
29 provider-patient relationship with the patient by providing care
30 to the patient at least two (2) consecutive times through the use
31 of telehealth services. If the conditions of this clause are met,
32 the practitioner shall maintain a medical record for the patient
33 and shall notify the patient's primary care provider of any
34 issued prescriptions.
35 (7) Issue proper instructions for appropriate follow-up care.
36 (8) Provide a telehealth visit summary to the patient, including
37 information that indicates any prescription that is being
38 prescribed.
39 (c) The medical records under subsection (b)(6) must be created and
40 maintained by the practitioner under the same standards of appropriate
41 practice for medical records for patients in an in-person setting.
42 (d) A patient waives confidentiality of any medical information
ES 284—LS 6719/DI 104 7
1 discussed with the practitioner that is:
2 (1) provided during a telehealth visit; and
3 (2) heard by another individual in the vicinity of the patient
4 during a health care service or consultation.
5 (e) An employer may not require a practitioner, by an employment
6 contract, an agreement, a policy, or any other means, to provide a
7 health care service through telehealth if the practitioner believes that
8 providing a health care service through telehealth would:
9 (1) negatively impact the patient's health; or
10 (2) result in a lower standard of care than if the health care service
11 was provided in an in-person setting.
12 (f) Any applicable contract, employment agreement, or policy to
13 provide telehealth services must explicitly provide that a practitioner
14 may refuse at any time to provide health care services if in the
15 practitioner's sole discretion the practitioner believes:
16 (1) that health quality may be negatively impacted; or
17 (2) the practitioner would be unable to provide the same standards
18 of appropriate practice as those provided in an in-person setting.
ES 284—LS 6719/DI 104 8
COMMITTEE REPORT
Madam President: The Senate Committee on Health and Provider
Services, to which was referred Senate Bill No. 284, has had the same
under consideration and begs leave to report the same back to the
Senate with the recommendation that said bill be AMENDED as
follows:
Page 3, line 38, after "(10)" insert "The following:
(A)".
Page 3, between lines 38 and 39, begin a new line double block
indented and insert:
"(B) An occupational therapy assistant licensed under
IC 25-23.5.".
Page 4, line 7, delete "25-35.6." and insert "25-35.6, including a
clinical fellow in speech-language pathology.".
Page 5, line 7, delete "(F)," and insert "2.5(1)(F),".
and when so amended that said bill do pass.
(Reference is to SB 284 as introduced.)
CHARBONNEAU, Chairperson
Committee Vote: Yeas 12, Nays 0.
_____
COMMITTEE REPORT
Mr. Speaker: Your Committee on Public Health, to which was
referred Senate Bill 284, has had the same under consideration and
begs leave to report the same back to the House with the
recommendation that said bill be amended as follows:
Page 3, line 4, after "2.5." insert "(a)".
Page 3, between lines 15 and 16, begin a new paragraph and insert:
"(b) The term does not include case management services, care
management services, service coordination services, or care
coordination services:
(1) as defined in IC 12-7-2-25;
(2) provided to individuals under the Indiana Medicaid
program or Medicaid waivers; or
(3) provided to individuals under any other programs
administered by the office of the secretary of family and social
services or the Indiana department of health.".
ES 284—LS 6719/DI 104 9
Page 4, delete lines 10 and 11, and insert "IC 25-35.6.".
Page 4, delete lines 16 through 25, begin a new paragraph and
insert:
"(b) The term includes the following:
(1) A developmental therapist enrolled by the bureau of child
development services to provide special instruction, as defined
in 34 CFR 303.13(b)(14), to infants and toddlers receiving
early intervention services.
(2) A peer as defined in IC 12-21-8-5 and certified by the
division of mental health and addiction.
(3) A clinical fellow in speech language pathology.
(4) A student who is:
(A) pursuing a course of study or a graduate from a
program in a profession specified in subsection (a)(1)
through (a)(22); and
(B) providing services directed by an individual who holds
a license in Indiana for that profession.
(5) The following providers within a community mental health
center:
(A) A qualified behavioral health professional.
(B) Other behavioral health professional.".
Page 4, line 26, delete "(b)" and insert "(c)".
Page 5, line 10, delete "2.5(1)(D)" and insert "2.5(a)(1)(D)".
Page 5, line 11, delete "2.5(1)(F)," and insert "2.5(a)(1)(F),".
Page 5, line 11, strike "2.5(2), 2.5(3), or 2.5(4)" and insert
"2.5(a)(2), 2.5(a)(3), or 2.5(a)(4)".
Page 5, line 13, delete "In order to be excluded from the term under
this".
Page 5, delete lines 14 through 19, begin a new paragraph and
insert:
"SECTION 6. IC 25-1-9.5-7, AS AMENDED BY P.L.85-2021,
SECTION 17, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 7. (a) A practitioner who:
(1) provides health care services through telehealth; or
(2) directs an employee of the practitioner to perform a health
care service listed in section 2.5(2), 2.5(3), 2.5(a)(2), 2.5(a)(3),
or 2.5(4) 2.5(a)(4) of this chapter;
shall be held to the same standards of appropriate practice as those
standards for health care services provided at an in-person setting.
(b) A practitioner who uses telehealth shall, if such action would
otherwise be required in the provision of the same health care services
in a manner other than telehealth, ensure that a proper provider-patient
ES 284—LS 6719/DI 104 10
relationship is established. The provider-patient relationship by a
practitioner who uses telehealth must at a minimum include the
following:
(1) Obtain the patient's name and contact information and:
(A) a verbal statement or other data from the patient
identifying the patient's location; and
(B) to the extent reasonably possible, the identity of the
requesting patient.
(2) Disclose the practitioner's name and disclose the practitioner's
licensure, certification, or registration.
(3) Obtain informed consent from the patient.
(4) Obtain the patient's medical history and other information
necessary to establish a diagnosis.
(5) Discuss with the patient the:
(A) diagnosis;
(B) evidence for the diagnosis; and
(C) risks and benefits of various treatment options, including
when it is advisable to seek in-person care.
(6) Create and maintain a medical record for the patient. If a
prescription is issued for the patient, and subject to the consent of
the patient, the prescriber shall notify the patient's primary care
provider of any prescriptions the prescriber has issued for the
patient if the primary care provider's contact information is
provided by the patient. The requirements in this subdivision do
not apply when any of the following are met:
(A) The practitioner is using an electronic health record
system that the patient's primary care provider is authorized to
access.
(B) The practitioner has established an ongoing
provider-patient relationship with the patient by providing care
to the patient at least two (2) consecutive times through the use
of telehealth services. If the conditions of this clause are met,
the practitioner shall maintain a medical record for the patient
and shall notify the patient's primary care provider of any
issued prescriptions.
(7) Issue proper instructions for appropriate follow-up care.
(8) Provide a telehealth visit summary to the patient, including
information that indicates any prescription that is being
prescribed.
(c) The medical records under subsection (b)(6) must be created and
maintained by the practitioner under the same standards of appropriate
practice for medical records for patients in an in-person setting.
ES 284—LS 6719/DI 104 11
(d) A patient waives confidentiality of any medical information
discussed with the practitioner that is:
(1) provided during a telehealth visit; and
(2) heard by another individual in the vicinity of the patient
during a health care service or consultation.
(e) An employer may not require a practitioner, by an employment
contract, an agreement, a policy, or any other means, to provide a
health care service through telehealth if the practitioner believes that
providing a health care service through telehealth would:
(1) negatively impact the patient's health; or
(2) result in a lower standard of care than if the health care service
was provided in an in-person setting.
(f) Any applicable contract, employment agreement, or policy to
provide telehealth services must explicitly provide that a practitioner
may refuse at any time to provide health care services if in the
practitioner's sole discretion the practitioner believes:
(1) that health quality may be negatively impacted; or
(2) the practitioner would be unable to provide the same standards
of appropriate practice as those provided in an in-person setting.".
and when so amended that said bill do pass.
(Reference is to SB 284 as printed January 21, 2022.)
BARRETT
Committee Vote: yeas 12, nays 0.
ES 284—LS 6719/DI 104