Second Regular Session of the 122nd General Assembly (2022)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
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between statutes enacted by the 2021 Regular Session of the General Assembly.
SENATE ENROLLED ACT No. 284
AN ACT to amend the Indiana Code concerning professions and
occupations.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 12-7-2-190.3, AS AMENDED BY P.L.85-2021,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 190.3. (a) "Telehealth activities", for purposes of
IC 12-15-5-11, has the meaning set forth in IC 12-15-5-11(a).
(b) "Telehealth services", for purposes of IC 12-15-5-11, has the
meaning set forth in IC 12-15-5-11(b). IC 12-15-5-11(a).
SECTION 2. IC 12-15-5-11, AS AMENDED BY P.L.207-2021,
SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 11. (a) As used in this section, "telehealth
activities" means the use of telecommunications and information
technology to provide access to:
(1) health assessment;
(2) diagnosis;
(3) intervention;
(4) consultation;
(5) supervision; and
(6) information;
across a distance.
(b) As used in this section, "telehealth services" has the meaning set
forth for "telehealth" in IC 25-1-9.5-6.
(c) The office shall reimburse a Medicaid provider who is licensed
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as a home health agency under IC 16-27-1 for telehealth activities.
(d) (b) The office shall reimburse the following Medicaid providers
for medically necessary telehealth services:
(1) A federally qualified health center (as defined in 42 U.S.C.
1396d(l)(2)(B)).
(2) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)).
(3) A community mental health center certified under
IC 12-21-2-3(5)(C).
(4) A critical access hospital that meets the criteria under 42 CFR
485.601 et seq.
(5) A home health agency licensed under IC 16-27-1.
(5) (6) A provider, as determined by the office to be eligible,
providing a covered telehealth service.
(e) (c) The office may not impose any distance restrictions on
providers of telehealth activities or telehealth services. Before
December 31, 2017, the office shall do the following:
(1) Submit a Medicaid state plan amendment with the United
States Department of Health and Human Services that eliminates
distance restrictions for telehealth activities or telehealth services
in the state Medicaid plan.
(2) Issue a notice of intent to adopt a rule to amend any
administrative rules that include distance restrictions for the
provision of telehealth activities or telehealth services.
(f) (d) Subject to federal law, the office may not impose any location
requirements concerning the originating site or distant site in which a
telehealth service is provided to a Medicaid recipient.
(g) (e) A Medicaid recipient waives confidentiality of any medical
information discussed with the health care provider that is:
(1) provided during a telehealth visit; and
(2) heard by another individual in the vicinity of the Medicaid
recipient during a health care service or consultation.
(h) (f) For purposes of a community mental health center, telehealth
services satisfy any face to face meeting requirement between a
clinician and consumer.
(i) (g) The office shall implement any part of this section that is
approved by the United States Department of Health and Human
Services.
(j) (h) The office may adopt rules under IC 4-22-2 necessary to
implement and administer this section.
SECTION 3. IC 25-1-9.5-2.5, AS ADDED BY P.L.85-2021,
SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 2.5. (a) As used in this chapter, "health care
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services" includes the following:
(1) The following concerning a patient:
(A) Assessment.
(B) Diagnosis.
(C) Evaluation.
(D) Consultation.
(E) Treatment. and
(F) Monitoring of a patient.
(2) Transfer of medical data.
(3) Patient health related education.
(4) Health administration.
(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.
SECTION 4. IC 25-1-9.5-3.5, AS AMENDED BY P.L.207-2021,
SECTION 25, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 3.5. (a) As used in this chapter, "practitioner"
means an individual who holds an unlimited license to practice as any
of the following in Indiana:
(1) An athletic trainer licensed under IC 25-5.1.
(2) A chiropractor licensed under IC 25-10.
(3) A dental hygienist licensed under IC 25-13.
(4) The following:
(A) A dentist licensed under IC 25-14.
(B) An individual who holds a dental residency permit issued
under IC 25-14-1-5.
(C) An individual who holds a dental faculty license under
IC 25-14-1-5.5.
(5) A diabetes educator licensed under IC 25-14.3.
(6) A dietitian licensed under IC 25-14.5.
(7) A genetic counselor licensed under IC 25-17.3.
(8) The following:
(A) A physician licensed under IC 25-22.5.
(B) An individual who holds a temporary permit under
IC 25-22.5-5-4.
(9) A nurse licensed under IC 25-23.
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(10) The following:
(A) An occupational therapist licensed under IC 25-23.5.
(B) An occupational therapy assistant licensed under
IC 25-23.5.
(11) Any behavioral health and human services professional
licensed under IC 25-23.6.
(12) An optometrist licensed under IC 25-24.
(13) A pharmacist licensed under IC 25-26.
(14) A physical therapist licensed under IC 25-27.
(15) A physician assistant licensed under IC 25-27.5.
(16) A podiatrist licensed under IC 25-29.
(17) A psychologist licensed under IC 25-33.
(18) A respiratory care practitioner licensed under IC 25-34.5.
(19) A speech-language pathologist or audiologist licensed under
IC 25-35.6.
(20) A veterinarian licensed under IC 25-38.1.
(21) A behavior analyst licensed under IC 25-8.5.
(22) A school psychologist licensed by the department of
education.
(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:
(A) is pursuing a course of study in, or is a graduate from,
a program in a profession specified in subsection (a)(1)
through (a)(22); and
(B) is 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.
(6) A physical therapist assistant certified under
IC 25-27-1-6.3.
(c) The term includes a behavior analyst during the time in
which the professional licensing agency is preparing to implement
licensure of behavioral analysts under IC 25-8.5. This subsection
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expires January 1, 2025.
SECTION 5. IC 25-1-9.5-6, AS AMENDED BY P.L.207-2021,
SECTION 26, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2022]: Sec. 6. (a) As used in this chapter, "telehealth" means
the delivery of health care services using interactive electronic
communications and information technology, in compliance with the
federal Health Insurance Portability and Accountability Act (HIPAA),
including:
(1) secure videoconferencing;
(2) store and forward technology; or
(3) remote patient monitoring technology;
between a provider in one (1) location and a patient in another location.
(b) The term does not include the use of the following unless the
practitioner has an established relationship with the patient:
(1) Electronic mail.
(2) An instant messaging conversation.
(3) Facsimile.
(4) Internet questionnaire.
(5) Internet consultation.
(c) The term does not include a health care service provided by:
(1) an employee of a practitioner; or
(2) an individual who is employed by the same entity that
employs the practitioner;
who is performing a health care service listed in section 2.5(2), 2.5(3),
or 2.5(4) 2.5(a)(2), 2.5(a)(3), or 2.5(a)(4) of this chapter under the
direction and that is customarily within the specific area of practice of
the practitioner.
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
relationship is established. The provider-patient relationship by a
practitioner who uses telehealth must at a minimum include the
following:
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(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.
(d) A patient waives confidentiality of any medical information
discussed with the practitioner that is:
(1) provided during a telehealth visit; and
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(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.
SEA 284 — CC 1 President of the Senate
President Pro Tempore
Speaker of the House of Representatives
Governor of the State of Indiana
Date: Time:
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