Indiana 2022 Regular Session

Indiana Senate Bill SB0284 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	ES0284.2
	2	+	Reprinted
	3	+	February 15, 2022
	4	+	ENGROSSED
	5	+	SENATE BILL No. 284
	6	+	_____
	7	+	DIGEST OF SB 284 (Updated February 14, 2022 2:42 pm - DI 92)
	8	+	Citations Affected: IC 12-7; IC 12-15; IC 25-1.
	9	+	Synopsis: Telehealth matters. Consolidates Medicaid telehealth
	10	+	language. Provides that "health care services" does not include certain
	11	+	case management services, care management services, service
	12	+	coordination services, or care coordination services for purposes of
	13	+	telehealth. Adds school psychologists, specified developmental
	14	+	therapists, peers, clinical fellows, students and graduates of certain
	15	+	professional programs, physical therapist assistants, and certain
	16	+	community mental health center providers to the definition of
	17	+	"practitioner" for purposes of practicing telehealth. Allows behavior
	18	+	health analysts to temporarily perform telehealth during the time when
	19	+	the professional licensing agency is preparing to implement licensure
	20	+	for the profession.
	21	+	Effective: July 1, 2022.
	22	+	Charbonneau, Doriot, Bassler,
	23	+	Becker, Breaux, Pol Jr.
	24	+	(HOUSE SPONSOR — BARRETT)
	25	+	January 10, 2022, read first time and referred to Committee on Health and Provider
	26	+	Services.
	27	+	January 20, 2022, amended, reported favorably — Do Pass.
	28	+	January 24, 2022, read second time, ordered engrossed. Engrossed.
	29	+	January 25, 2022, read third time, passed. Yeas 46, nays 0.
	30	+	HOUSE ACTION
	31	+	February 1, 2022, read first time and referred to Committee on Public Health.
	32	+	February 10, 2022, amended, reported — Do Pass.
	33	+	February 14, 2022, read second time, amended, ordered engrossed.
	34	+	ES 284—LS 6719/DI 104 Reprinted
	35	+	February 15, 2022
1	36		Second Regular Session of the 122nd General Assembly (2022)
2	37		PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
3	38		Constitution) is being amended, the text of the existing provision will appear in this style type,
4	39		additions will appear in this style type, and deletions will appear in this style type.
5	40		Additions: Whenever a new statutory provision is being enacted (or a new constitutional
6	41		provision adopted), the text of the new provision will appear in this style type. Also, the
7	42		word NEW will appear in that style type in the introductory clause of each SECTION that adds
8	43		a new provision to the Indiana Code or the Indiana Constitution.
9	44		Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
10	45		between statutes enacted by the 2021 Regular Session of the General Assembly.
11		-	SENATE ENROLLED ACT No. 284
12		-	AN ACT to amend the Indiana Code concerning professions and
13		-	occupations.
	46	+	ENGROSSED
	47	+	SENATE BILL No. 284
	48	+	A BILL FOR AN ACT to amend the Indiana Code concerning
	49	+	professions and occupations.
14	50		Be it enacted by the General Assembly of the State of Indiana:
15		-	SECTION 1. IC 12-7-2-190.3, AS AMENDED BY P.L.85-2021,
16		-	SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
17		-	JULY 1, 2022]: Sec. 190.3. (a) "Telehealth activities", for purposes of
18		-	IC 12-15-5-11, has the meaning set forth in IC 12-15-5-11(a).
19		-	(b) "Telehealth services", for purposes of IC 12-15-5-11, has the
20		-	meaning set forth in IC 12-15-5-11(b). IC 12-15-5-11(a).
21		-	SECTION 2. IC 12-15-5-11, AS AMENDED BY P.L.207-2021,
22		-	SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
23		-	JULY 1, 2022]: Sec. 11. (a) As used in this section, "telehealth
24		-	activities" means the use of telecommunications and information
25		-	technology to provide access to:
26		-	(1) health assessment;
27		-	(2) diagnosis;
28		-	(3) intervention;
29		-	(4) consultation;
30		-	(5) supervision; and
31		-	(6) information;
32		-	across a distance.
33		-	(b) As used in this section, "telehealth services" has the meaning set
34		-	forth for "telehealth" in IC 25-1-9.5-6.
35		-	(c) The office shall reimburse a Medicaid provider who is licensed
36		-	SEA 284 — CC 1 2
37		-	as a home health agency under IC 16-27-1 for telehealth activities.
38		-	(d) (b) The office shall reimburse the following Medicaid providers
39		-	for medically necessary telehealth services:
40		-	(1) A federally qualified health center (as defined in 42 U.S.C.
41		-	1396d(l)(2)(B)).
42		-	(2) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)).
43		-	(3) A community mental health center certified under
44		-	IC 12-21-2-3(5)(C).
45		-	(4) A critical access hospital that meets the criteria under 42 CFR
46		-	485.601 et seq.
47		-	(5) A home health agency licensed under IC 16-27-1.
48		-	(5) (6) A provider, as determined by the office to be eligible,
49		-	providing a covered telehealth service.
50		-	(e) (c) The office may not impose any distance restrictions on
51		-	providers of telehealth activities or telehealth services. Before
52		-	December 31, 2017, the office shall do the following:
53		-	(1) Submit a Medicaid state plan amendment with the United
54		-	States Department of Health and Human Services that eliminates
55		-	distance restrictions for telehealth activities or telehealth services
56		-	in the state Medicaid plan.
57		-	(2) Issue a notice of intent to adopt a rule to amend any
58		-	administrative rules that include distance restrictions for the
59		-	provision of telehealth activities or telehealth services.
60		-	(f) (d) Subject to federal law, the office may not impose any location
61		-	requirements concerning the originating site or distant site in which a
62		-	telehealth service is provided to a Medicaid recipient.
63		-	(g) (e) A Medicaid recipient waives confidentiality of any medical
64		-	information discussed with the health care provider that is:
65		-	(1) provided during a telehealth visit; and
66		-	(2) heard by another individual in the vicinity of the Medicaid
67		-	recipient during a health care service or consultation.
68		-	(h) (f) For purposes of a community mental health center, telehealth
69		-	services satisfy any face to face meeting requirement between a
70		-	clinician and consumer.
71		-	(i) (g) The office shall implement any part of this section that is
72		-	approved by the United States Department of Health and Human
73		-	Services.
74		-	(j) (h) The office may adopt rules under IC 4-22-2 necessary to
75		-	implement and administer this section.
76		-	SECTION 3. IC 25-1-9.5-2.5, AS ADDED BY P.L.85-2021,
77		-	SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
78		-	JULY 1, 2022]: Sec. 2.5. (a) As used in this chapter, "health care
79		-	SEA 284 — CC 1 3
80		-	services" includes the following:
81		-	(1) The following concerning a patient:
82		-	(A) Assessment.
83		-	(B) Diagnosis.
84		-	(C) Evaluation.
85		-	(D) Consultation.
86		-	(E) Treatment. and
87		-	(F) Monitoring of a patient.
88		-	(2) Transfer of medical data.
89		-	(3) Patient health related education.
90		-	(4) Health administration.
91		-	(b) The term does not include case management services, care
	51	+	1 SECTION 1. IC 12-7-2-190.3, AS AMENDED BY P.L.85-2021,
	52	+	2 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	53	+	3 JULY 1, 2022]: Sec. 190.3. (a) "Telehealth activities", for purposes of
	54	+	4 IC 12-15-5-11, has the meaning set forth in IC 12-15-5-11(a).
	55	+	5 (b) "Telehealth services", for purposes of IC 12-15-5-11, has the
	56	+	6 meaning set forth in IC 12-15-5-11(b). IC 12-15-5-11(a).
	57	+	7 SECTION 2. IC 12-15-5-11, AS AMENDED BY P.L.207-2021,
	58	+	8 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	59	+	9 JULY 1, 2022]: Sec. 11. (a) As used in this section, "telehealth
	60	+	10 activities" means the use of telecommunications and information
	61	+	11 technology to provide access to:
	62	+	12 (1) health assessment;
	63	+	13 (2) diagnosis;
	64	+	14 (3) intervention;
	65	+	15 (4) consultation;
	66	+	16 (5) supervision; and
	67	+	17 (6) information;
	68	+	ES 284—LS 6719/DI 104 2
	69	+	1 across a distance.
	70	+	2 (b) As used in this section, "telehealth services" has the meaning set
	71	+	3 forth for "telehealth" in IC 25-1-9.5-6.
	72	+	4 (c) The office shall reimburse a Medicaid provider who is licensed
	73	+	5 as a home health agency under IC 16-27-1 for telehealth activities.
	74	+	6 (d) (b) The office shall reimburse the following Medicaid providers
	75	+	7 for medically necessary telehealth services:
	76	+	8 (1) A federally qualified health center (as defined in 42 U.S.C.
	77	+	9 1396d(l)(2)(B)).
	78	+	10 (2) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)).
	79	+	11 (3) A community mental health center certified under
	80	+	12 IC 12-21-2-3(5)(C).
	81	+	13 (4) A critical access hospital that meets the criteria under 42 CFR
	82	+	14 485.601 et seq.
	83	+	15 (5) A home health agency licensed under IC 16-27-1.
	84	+	16 (5) (6) A provider, as determined by the office to be eligible,
	85	+	17 providing a covered telehealth service.
	86	+	18 (e) (c) The office may not impose any distance restrictions on
	87	+	19 providers of telehealth activities or telehealth services. Before
	88	+	20 December 31, 2017, the office shall do the following:
	89	+	21 (1) Submit a Medicaid state plan amendment with the United
	90	+	22 States Department of Health and Human Services that eliminates
	91	+	23 distance restrictions for telehealth activities or telehealth services
	92	+	24 in the state Medicaid plan.
	93	+	25 (2) Issue a notice of intent to adopt a rule to amend any
	94	+	26 administrative rules that include distance restrictions for the
	95	+	27 provision of telehealth activities or telehealth services.
	96	+	28 (f) (d) Subject to federal law, the office may not impose any location
	97	+	29 requirements concerning the originating site or distant site in which a
	98	+	30 telehealth service is provided to a Medicaid recipient.
	99	+	31 (g) (e) A Medicaid recipient waives confidentiality of any medical
	100	+	32 information discussed with the health care provider that is:
	101	+	33 (1) provided during a telehealth visit; and
	102	+	34 (2) heard by another individual in the vicinity of the Medicaid
	103	+	35 recipient during a health care service or consultation.
	104	+	36 (h) (f) For purposes of a community mental health center, telehealth
	105	+	37 services satisfy any face to face meeting requirement between a
	106	+	38 clinician and consumer.
	107	+	39 (i) (g) The office shall implement any part of this section that is
	108	+	40 approved by the United States Department of Health and Human
	109	+	41 Services.
	110	+	42 (j) (h) The office may adopt rules under IC 4-22-2 necessary to
	111	+	ES 284—LS 6719/DI 104 3
	112	+	1 implement and administer this section.
	113	+	2 SECTION 3. IC 25-1-9.5-2.5, AS ADDED BY P.L.85-2021,
	114	+	3 SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	115	+	4 JULY 1, 2022]: Sec. 2.5. (a) As used in this chapter, "health care
	116	+	5 services" includes the following:
	117	+	6 (1) The following concerning a patient:
	118	+	7 (A) Assessment.
	119	+	8 (B) Diagnosis.
	120	+	9 (C) Evaluation.
	121	+	10 (D) Consultation.
	122	+	11 (E) Treatment. and
	123	+	12 (F) Monitoring of a patient.
	124	+	13 (2) Transfer of medical data.
	125	+	14 (3) Patient health related education.
	126	+	15 (4) Health administration.
	127	+	16 (b) The term does not include case management services, care
	128	+	17 management services, service coordination services, or care
	129	+	18 coordination services:
	130	+	19 (1) as defined in IC 12-7-2-25;
	131	+	20 (2) provided to individuals under the Indiana Medicaid
	132	+	21 program or Medicaid waivers; or
	133	+	22 (3) provided to individuals under any other programs
	134	+	23 administered by the office of the secretary of family and social
	135	+	24 services or the Indiana department of health.
	136	+	25 SECTION 4. IC 25-1-9.5-3.5, AS AMENDED BY P.L.207-2021,
	137	+	26 SECTION 25, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	138	+	27 JULY 1, 2022]: Sec. 3.5. (a) As used in this chapter, "practitioner"
	139	+	28 means an individual who holds an unlimited license to practice as any
	140	+	29 of the following in Indiana:
	141	+	30 (1) An athletic trainer licensed under IC 25-5.1.
	142	+	31 (2) A chiropractor licensed under IC 25-10.
	143	+	32 (3) A dental hygienist licensed under IC 25-13.
	144	+	33 (4) The following:
	145	+	34 (A) A dentist licensed under IC 25-14.
	146	+	35 (B) An individual who holds a dental residency permit issued
	147	+	36 under IC 25-14-1-5.
	148	+	37 (C) An individual who holds a dental faculty license under
	149	+	38 IC 25-14-1-5.5.
	150	+	39 (5) A diabetes educator licensed under IC 25-14.3.
	151	+	40 (6) A dietitian licensed under IC 25-14.5.
	152	+	41 (7) A genetic counselor licensed under IC 25-17.3.
	153	+	42 (8) The following:
	154	+	ES 284—LS 6719/DI 104 4
	155	+	1 (A) A physician licensed under IC 25-22.5.
	156	+	2 (B) An individual who holds a temporary permit under
	157	+	3 IC 25-22.5-5-4.
	158	+	4 (9) A nurse licensed under IC 25-23.
	159	+	5 (10) The following:
	160	+	6 (A) An occupational therapist licensed under IC 25-23.5.
	161	+	7 (B) An occupational therapy assistant licensed under
	162	+	8 IC 25-23.5.
	163	+	9 (11) Any behavioral health and human services professional
	164	+	10 licensed under IC 25-23.6.
	165	+	11 (12) An optometrist licensed under IC 25-24.
	166	+	12 (13) A pharmacist licensed under IC 25-26.
	167	+	13 (14) A physical therapist licensed under IC 25-27.
	168	+	14 (15) A physician assistant licensed under IC 25-27.5.
	169	+	15 (16) A podiatrist licensed under IC 25-29.
	170	+	16 (17) A psychologist licensed under IC 25-33.
	171	+	17 (18) A respiratory care practitioner licensed under IC 25-34.5.
	172	+	18 (19) A speech-language pathologist or audiologist licensed under
	173	+	19 IC 25-35.6.
	174	+	20 (20) A veterinarian licensed under IC 25-38.1.
	175	+	21 (21) A behavior analyst licensed under IC 25-8.5.
	176	+	22 (22) A school psychologist licensed by the department of
	177	+	23 education.
	178	+	24 (23) A physical therapist assistant certified under
	179	+	25 IC 25-27-1-6.3.
	180	+	26 (b) The term includes the following:
	181	+	27 (1) A developmental therapist enrolled by the bureau of child
	182	+	28 development services to provide special instruction, as defined
	183	+	29 in 34 CFR 303.13(b)(14), to infants and toddlers receiving
	184	+	30 early intervention services.
	185	+	31 (2) A peer as defined in IC 12-21-8-5 and certified by the
	186	+	32 division of mental health and addiction.
	187	+	33 (3) A clinical fellow in speech language pathology.
	188	+	34 (4) A student who:
	189	+	35 (A) is pursuing a course of study in, or is a graduate from,
	190	+	36 a program in a profession specified in subsection (a)(1)
	191	+	37 through (a)(22); and
	192	+	38 (B) is providing services directed by an individual who
	193	+	39 holds a license in Indiana for that profession.
	194	+	40 (5) The following providers within a community mental health
	195	+	41 center:
	196	+	42 (A) A qualified behavioral health professional.
	197	+	ES 284—LS 6719/DI 104 5
	198	+	1 (B) Other behavioral health professional.
	199	+	2 (c) The term includes a behavior analyst during the time in
	200	+	3 which the professional licensing agency is preparing to implement
	201	+	4 licensure of behavioral analysts under IC 25-8.5. This subsection
	202	+	5 expires January 1, 2025.
	203	+	6 SECTION 5. IC 25-1-9.5-6, AS AMENDED BY P.L.207-2021,
	204	+	7 SECTION 26, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	205	+	8 JULY 1, 2022]: Sec. 6. (a) As used in this chapter, "telehealth" means
	206	+	9 the delivery of health care services using interactive electronic
	207	+	10 communications and information technology, in compliance with the
	208	+	11 federal Health Insurance Portability and Accountability Act (HIPAA),
	209	+	12 including:
	210	+	13 (1) secure videoconferencing;
	211	+	14 (2) store and forward technology; or
	212	+	15 (3) remote patient monitoring technology;
	213	+	16 between a provider in one (1) location and a patient in another location.
	214	+	17 (b) The term does not include the use of the following unless the
	215	+	18 practitioner has an established relationship with the patient:
	216	+	19 (1) Electronic mail.
	217	+	20 (2) An instant messaging conversation.
	218	+	21 (3) Facsimile.
	219	+	22 (4) Internet questionnaire.
	220	+	23 (5) Internet consultation.
	221	+	24 (c) The term does not include a health care service provided by:
	222	+	25 (1) an employee of a practitioner; or
	223	+	26 (2) an individual who is employed by the same entity that
	224	+	27 employs the practitioner;
	225	+	28 who is performing a health care service listed in section 2.5(a)(1)(D)
	226	+	29 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
	227	+	30 2.5(a)(4) of this chapter under the direction and that is customarily
	228	+	31 within the specific area of practice of the practitioner.
	229	+	32 SECTION 6. IC 25-1-9.5-7, AS AMENDED BY P.L.85-2021,
	230	+	33 SECTION 17, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	231	+	34 JULY 1, 2022]: Sec. 7. (a) A practitioner who:
	232	+	35 (1) provides health care services through telehealth; or
	233	+	36 (2) directs an employee of the practitioner to perform a health
	234	+	37 care service listed in section 2.5(2), 2.5(3), 2.5(a)(2), 2.5(a)(3),
	235	+	38 or 2.5(4) 2.5(a)(4) of this chapter;
	236	+	39 shall be held to the same standards of appropriate practice as those
	237	+	40 standards for health care services provided at an in-person setting.
	238	+	41 (b) A practitioner who uses telehealth shall, if such action would
	239	+	42 otherwise be required in the provision of the same health care services
	240	+	ES 284—LS 6719/DI 104 6
	241	+	1 in a manner other than telehealth, ensure that a proper provider-patient
	242	+	2 relationship is established. The provider-patient relationship by a
	243	+	3 practitioner who uses telehealth must at a minimum include the
	244	+	4 following:
	245	+	5 (1) Obtain the patient's name and contact information and:
	246	+	6 (A) a verbal statement or other data from the patient
	247	+	7 identifying the patient's location; and
	248	+	8 (B) to the extent reasonably possible, the identity of the
	249	+	9 requesting patient.
	250	+	10 (2) Disclose the practitioner's name and disclose the practitioner's
	251	+	11 licensure, certification, or registration.
	252	+	12 (3) Obtain informed consent from the patient.
	253	+	13 (4) Obtain the patient's medical history and other information
	254	+	14 necessary to establish a diagnosis.
	255	+	15 (5) Discuss with the patient the:
	256	+	16 (A) diagnosis;
	257	+	17 (B) evidence for the diagnosis; and
	258	+	18 (C) risks and benefits of various treatment options, including
	259	+	19 when it is advisable to seek in-person care.
	260	+	20 (6) Create and maintain a medical record for the patient. If a
	261	+	21 prescription is issued for the patient, and subject to the consent of
	262	+	22 the patient, the prescriber shall notify the patient's primary care
	263	+	23 provider of any prescriptions the prescriber has issued for the
	264	+	24 patient if the primary care provider's contact information is
	265	+	25 provided by the patient. The requirements in this subdivision do
	266	+	26 not apply when any of the following are met:
	267	+	27 (A) The practitioner is using an electronic health record
	268	+	28 system that the patient's primary care provider is authorized to
	269	+	29 access.
	270	+	30 (B) The practitioner has established an ongoing
	271	+	31 provider-patient relationship with the patient by providing care
	272	+	32 to the patient at least two (2) consecutive times through the use
	273	+	33 of telehealth services. If the conditions of this clause are met,
	274	+	34 the practitioner shall maintain a medical record for the patient
	275	+	35 and shall notify the patient's primary care provider of any
	276	+	36 issued prescriptions.
	277	+	37 (7) Issue proper instructions for appropriate follow-up care.
	278	+	38 (8) Provide a telehealth visit summary to the patient, including
	279	+	39 information that indicates any prescription that is being
	280	+	40 prescribed.
	281	+	41 (c) The medical records under subsection (b)(6) must be created and
	282	+	42 maintained by the practitioner under the same standards of appropriate
	283	+	ES 284—LS 6719/DI 104 7
	284	+	1 practice for medical records for patients in an in-person setting.
	285	+	2 (d) A patient waives confidentiality of any medical information
	286	+	3 discussed with the practitioner that is:
	287	+	4 (1) provided during a telehealth visit; and
	288	+	5 (2) heard by another individual in the vicinity of the patient
	289	+	6 during a health care service or consultation.
	290	+	7 (e) An employer may not require a practitioner, by an employment
	291	+	8 contract, an agreement, a policy, or any other means, to provide a
	292	+	9 health care service through telehealth if the practitioner believes that
	293	+	10 providing a health care service through telehealth would:
	294	+	11 (1) negatively impact the patient's health; or
	295	+	12 (2) result in a lower standard of care than if the health care service
	296	+	13 was provided in an in-person setting.
	297	+	14 (f) Any applicable contract, employment agreement, or policy to
	298	+	15 provide telehealth services must explicitly provide that a practitioner
	299	+	16 may refuse at any time to provide health care services if in the
	300	+	17 practitioner's sole discretion the practitioner believes:
	301	+	18 (1) that health quality may be negatively impacted; or
	302	+	19 (2) the practitioner would be unable to provide the same standards
	303	+	20 of appropriate practice as those provided in an in-person setting.
	304	+	ES 284—LS 6719/DI 104 8
	305	+	COMMITTEE REPORT
	306	+	Madam President: The Senate Committee on Health and Provider
	307	+	Services, to which was referred Senate Bill No. 284, has had the same
	308	+	under consideration and begs leave to report the same back to the
	309	+	Senate with the recommendation that said bill be AMENDED as
	310	+	follows:
	311	+	Page 3, line 38, after "(10)" insert "The following:
	312	+	(A)".
	313	+	Page 3, between lines 38 and 39, begin a new line double block
	314	+	indented and insert:
	315	+	"(B) An occupational therapy assistant licensed under
	316	+	IC 25-23.5.".
	317	+	Page 4, line 7, delete "25-35.6." and insert "25-35.6, including a
	318	+	clinical fellow in speech-language pathology.".
	319	+	Page 5, line 7, delete "(F)," and insert "2.5(1)(F),".
	320	+	and when so amended that said bill do pass.
	321	+	(Reference is to SB 284 as introduced.)
	322	+	CHARBONNEAU, Chairperson
	323	+	Committee Vote: Yeas 12, Nays 0.
	324	+	_____
	325	+	COMMITTEE REPORT
	326	+	Mr. Speaker: Your Committee on Public Health, to which was
	327	+	referred Senate Bill 284, has had the same under consideration and
	328	+	begs leave to report the same back to the House with the
	329	+	recommendation that said bill be amended as follows:
	330	+	Page 3, line 4, after "2.5." insert "(a)".
	331	+	Page 3, between lines 15 and 16, begin a new paragraph and insert:
	332	+	"(b) The term does not include case management services, care
92	333		management services, service coordination services, or care
93	334		coordination services:
94	335		(1) as defined in IC 12-7-2-25;
95	336		(2) provided to individuals under the Indiana Medicaid
96	337		program or Medicaid waivers; or
97	338		(3) provided to individuals under any other programs
98	339		administered by the office of the secretary of family and social
99		-	services or the Indiana department of health.
100		-	SECTION 4. IC 25-1-9.5-3.5, AS AMENDED BY P.L.207-2021,
101		-	SECTION 25, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
102		-	JULY 1, 2022]: Sec. 3.5. (a) As used in this chapter, "practitioner"
103		-	means an individual who holds an unlimited license to practice as any
104		-	of the following in Indiana:
105		-	(1) An athletic trainer licensed under IC 25-5.1.
106		-	(2) A chiropractor licensed under IC 25-10.
107		-	(3) A dental hygienist licensed under IC 25-13.
108		-	(4) The following:
109		-	(A) A dentist licensed under IC 25-14.
110		-	(B) An individual who holds a dental residency permit issued
111		-	under IC 25-14-1-5.
112		-	(C) An individual who holds a dental faculty license under
113		-	IC 25-14-1-5.5.
114		-	(5) A diabetes educator licensed under IC 25-14.3.
115		-	(6) A dietitian licensed under IC 25-14.5.
116		-	(7) A genetic counselor licensed under IC 25-17.3.
117		-	(8) The following:
118		-	(A) A physician licensed under IC 25-22.5.
119		-	(B) An individual who holds a temporary permit under
120		-	IC 25-22.5-5-4.
121		-	(9) A nurse licensed under IC 25-23.
122		-	SEA 284 — CC 1 4
123		-	(10) The following:
124		-	(A) An occupational therapist licensed under IC 25-23.5.
125		-	(B) An occupational therapy assistant licensed under
126		-	IC 25-23.5.
127		-	(11) Any behavioral health and human services professional
128		-	licensed under IC 25-23.6.
129		-	(12) An optometrist licensed under IC 25-24.
130		-	(13) A pharmacist licensed under IC 25-26.
131		-	(14) A physical therapist licensed under IC 25-27.
132		-	(15) A physician assistant licensed under IC 25-27.5.
133		-	(16) A podiatrist licensed under IC 25-29.
134		-	(17) A psychologist licensed under IC 25-33.
135		-	(18) A respiratory care practitioner licensed under IC 25-34.5.
136		-	(19) A speech-language pathologist or audiologist licensed under
137		-	IC 25-35.6.
138		-	(20) A veterinarian licensed under IC 25-38.1.
139		-	(21) A behavior analyst licensed under IC 25-8.5.
140		-	(22) A school psychologist licensed by the department of
141		-	education.
142		-	(b) The term includes the following:
	340	+	services or the Indiana department of health.".
	341	+	ES 284—LS 6719/DI 104 9
	342	+	Page 4, delete lines 10 and 11, and insert "IC 25-35.6.".
	343	+	Page 4, delete lines 16 through 25, begin a new paragraph and
	344	+	insert:
	345	+	"(b) The term includes the following:
143	346		(1) A developmental therapist enrolled by the bureau of child
144	347		development services to provide special instruction, as defined
145	348		in 34 CFR 303.13(b)(14), to infants and toddlers receiving
146	349		early intervention services.
147	350		(2) A peer as defined in IC 12-21-8-5 and certified by the
148	351		division of mental health and addiction.
149	352		(3) A clinical fellow in speech language pathology.
150		-	(4) A student who:
151		-	(A) is pursuing a course of study ~~in,~~ or is a graduate from,
152		-	a program in a profession specified in subsection (a)(1)
	353	+	(4) A student who is:
	354	+	(A) pursuing a course of study or a graduate from a
	355	+	program in a profession specified in subsection (a)(1)
153	356		through (a)(22); and
154		-	(B) is providing services directed by an individual who
155		-	~~holds~~ a license in Indiana for that profession.
	357	+	(B) providing services directed by an individual who holds
	358	+	a license in Indiana for that profession.
156	359		(5) The following providers within a community mental health
157	360		center:
158	361		(A) A qualified behavioral health professional.
159		-	(B) Other behavioral health professional.
160		-	(6) A physical therapist assistant certified under
161		-	IC 25-27-1-6.3.
162		-	(c) The term includes a behavior analyst during the time in
163		-	which the professional licensing agency is preparing to implement
164		-	licensure of behavioral analysts under IC 25-8.5. This subsection
165		-	SEA 284 — CC 1 5
166		-	expires January 1, 2025.
167		-	SECTION 5. IC 25-1-9.5-6, AS AMENDED BY P.L.207-2021,
168		-	SECTION 26, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
169		-	JULY 1, 2022]: Sec. 6. (a) As used in this chapter, "telehealth" means
170		-	the delivery of health care services using interactive electronic
171		-	communications and information technology, in compliance with the
172		-	federal Health Insurance Portability and Accountability Act (HIPAA),
173		-	including:
174		-	(1) secure videoconferencing;
175		-	(2) store and forward technology; or
176		-	(3) remote patient monitoring technology;
177		-	between a provider in one (1) location and a patient in another location.
178		-	(b) The term does not include the use of the following unless the
179		-	practitioner has an established relationship with the patient:
180		-	(1) Electronic mail.
181		-	(2) An instant messaging conversation.
182		-	(3) Facsimile.
183		-	(4) Internet questionnaire.
184		-	(5) Internet consultation.
185		-	(c) The term does not include a health care service provided by:
186		-	(1) an employee of a practitioner; or
187		-	(2) an individual who is employed by the same entity that
188		-	employs the practitioner;
189		-	who is performing a health care service listed in section 2.5(2), 2.5(3),
190		-	or 2.5(4) 2.5(a)(2), 2.5(a)(3), or 2.5(a)(4) of this chapter under the
191		-	direction and that is customarily within the specific area of practice of
192		-	the practitioner.
193		-	SECTION 6. IC 25-1-9.5-7, AS AMENDED BY P.L.85-2021,
	362	+	(B) Other behavioral health professional.".
	363	+	Page 4, line 26, delete "(b)" and insert "(c)".
	364	+	Page 5, line 10, delete "2.5(1)(D)" and insert "2.5(a)(1)(D)".
	365	+	Page 5, line 11, delete "2.5(1)(F)," and insert "2.5(a)(1)(F),".
	366	+	Page 5, line 11, strike "2.5(2), 2.5(3), or 2.5(4)" and insert
	367	+	"2.5(a)(2), 2.5(a)(3), or 2.5(a)(4)".
	368	+	Page 5, line 13, delete "In order to be excluded from the term under
	369	+	this".
	370	+	Page 5, delete lines 14 through 19, begin a new paragraph and
	371	+	insert:
	372	+	"SECTION 6. IC 25-1-9.5-7, AS AMENDED BY P.L.85-2021,
194	373		SECTION 17, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
195	374		JULY 1, 2022]: Sec. 7. (a) A practitioner who:
196	375		(1) provides health care services through telehealth; or
197	376		(2) directs an employee of the practitioner to perform a health
198	377		care service listed in section 2.5(2), 2.5(3), 2.5(a)(2), 2.5(a)(3),
199	378		or 2.5(4) 2.5(a)(4) of this chapter;
200	379		shall be held to the same standards of appropriate practice as those
201	380		standards for health care services provided at an in-person setting.
202	381		(b) A practitioner who uses telehealth shall, if such action would
203	382		otherwise be required in the provision of the same health care services
204	383		in a manner other than telehealth, ensure that a proper provider-patient
	384	+	ES 284—LS 6719/DI 104 10
205	385		relationship is established. The provider-patient relationship by a
206	386		practitioner who uses telehealth must at a minimum include the
207	387		following:
208		-	SEA 284 — CC 1 6
209	388		(1) Obtain the patient's name and contact information and:
210	389		(A) a verbal statement or other data from the patient
211	390		identifying the patient's location; and
212	391		(B) to the extent reasonably possible, the identity of the
213	392		requesting patient.
214	393		(2) Disclose the practitioner's name and disclose the practitioner's
215	394		licensure, certification, or registration.
216	395		(3) Obtain informed consent from the patient.
217	396		(4) Obtain the patient's medical history and other information
218	397		necessary to establish a diagnosis.
219	398		(5) Discuss with the patient the:
220	399		(A) diagnosis;
221	400		(B) evidence for the diagnosis; and
222	401		(C) risks and benefits of various treatment options, including
223	402		when it is advisable to seek in-person care.
224	403		(6) Create and maintain a medical record for the patient. If a
225	404		prescription is issued for the patient, and subject to the consent of
226	405		the patient, the prescriber shall notify the patient's primary care
227	406		provider of any prescriptions the prescriber has issued for the
228	407		patient if the primary care provider's contact information is
229	408		provided by the patient. The requirements in this subdivision do
230	409		not apply when any of the following are met:
231	410		(A) The practitioner is using an electronic health record
232	411		system that the patient's primary care provider is authorized to
233	412		access.
234	413		(B) The practitioner has established an ongoing
235	414		provider-patient relationship with the patient by providing care
236	415		to the patient at least two (2) consecutive times through the use
237	416		of telehealth services. If the conditions of this clause are met,
238	417		the practitioner shall maintain a medical record for the patient
239	418		and shall notify the patient's primary care provider of any
240	419		issued prescriptions.
241	420		(7) Issue proper instructions for appropriate follow-up care.
242	421		(8) Provide a telehealth visit summary to the patient, including
243	422		information that indicates any prescription that is being
244	423		prescribed.
245	424		(c) The medical records under subsection (b)(6) must be created and
246	425		maintained by the practitioner under the same standards of appropriate
247	426		practice for medical records for patients in an in-person setting.
	427	+	ES 284—LS 6719/DI 104 11
248	428		(d) A patient waives confidentiality of any medical information
249	429		discussed with the practitioner that is:
250	430		(1) provided during a telehealth visit; and
251		-	SEA 284 — CC 1 7
252	431		(2) heard by another individual in the vicinity of the patient
253	432		during a health care service or consultation.
254	433		(e) An employer may not require a practitioner, by an employment
255	434		contract, an agreement, a policy, or any other means, to provide a
256	435		health care service through telehealth if the practitioner believes that
257	436		providing a health care service through telehealth would:
258	437		(1) negatively impact the patient's health; or
259	438		(2) result in a lower standard of care than if the health care service
260	439		was provided in an in-person setting.
261	440		(f) Any applicable contract, employment agreement, or policy to
262	441		provide telehealth services must explicitly provide that a practitioner
263	442		may refuse at any time to provide health care services if in the
264	443		practitioner's sole discretion the practitioner believes:
265	444		(1) that health quality may be negatively impacted; or
266	445		(2) the practitioner would be unable to provide the same standards
267		-	of appropriate practice as those provided in an in-person setting.
268		-	SEA 284 — CC 1 President of the Senate
269		-	President Pro Tempore
270		-	Speaker of the House of Representatives
271		-	Governor of the State of Indiana
272		-	Date: Time:
273		-	SEA 284 — CC 1
	446	+	of appropriate practice as those provided in an in-person setting.".
	447	+	and when so amended that said bill do pass.
	448	+	(Reference is to SB 284 as printed January 21, 2022.)
	449	+	BARRETT
	450	+	Committee Vote: yeas 12, nays 0.
	451	+	_____
	452	+	HOUSE MOTION
	453	+	Mr. Speaker: I move that Engrossed Senate Bill 284 be amended to
	454	+	read as follows:
	455	+	Page 4, between lines 23 and 24, begin a new line block indented
	456	+	and insert:
	457	+	"(23) A physical therapist assistant certified under
	458	+	IC 25-27-1-6.3.".
	459	+	(Reference is to ESB 284 as printed February 10, 2022.)
	460	+	VERMILION
	461	+	ES 284—LS 6719/DI 104 12
	462	+	HOUSE MOTION
	463	+	Mr. Speaker: I move that Engrossed Senate Bill 284 be amended to
	464	+	read as follows:
	465	+	Page 4, delete lines 32 through 37, begin a new line block indented
	466	+	and insert:
	467	+	"(4) A student who:
	468	+	(A) is pursuing a course of study in, or is a graduate from,
	469	+	a program in a profession specified in subsection (a)(1)
	470	+	through (a)(22); and
	471	+	(B) is providing services directed by an individual who
	472	+	holds a license in Indiana for that profession.".
	473	+	(Reference is to ESB 284 as printed February 10, 2022.)
	474	+	BARRETT
	475	+	ES 284—LS 6719/DI 104