LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6619 NOTE PREPARED: Dec 21, 2021
BILL NUMBER: SB 317 BILL AMENDED:
SUBJECT: Art Therapy.
FIRST AUTHOR: Sen. Becker BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: Medicaid - This bill provides that art therapy services provided by a certified art
therapist or certified art therapist associate to an individual who receives mental health services or to an
individual who receives services from a community mental health center are reimbursable under Medicaid.
Art Therapy Certifications - The bill provides for the certification of professional art therapists and art
therapist associates by the Behavioral Health and Human Services (BHHS) Licensing Board through the
Professional Licensing Agency (PLA). The bill establishes qualifications and requirements for a certified
art therapist and certified art therapist associate. It defines certain terms and makes conforming amendments.
Effective Date: July 1, 2022.
Explanation of State Expenditures: Summary - To develop the new certificates, the Professional Licensing
Agency (PLA) will incur one-time startup costs estimated between $59,900 and $88,300 in staff salary in
FY 2023. Ongoing administrative workload for the PLA is likely to be small, since the new certifications will
be issued under the existing BHHS Licensing Board with a small number of initial applicants expected.
Additionally, two new Board members may receive a per diem and travel reimbursement for expenses
incurred while attending Board meetings, at an estimated cost of up to $3,300 per year beginning in FY 2024.
The PLA’s administrative expenses are paid from General Fund appropriations. The bill will also result in
an indeterminable but likely minor increase in state Medicaid expenditures, depending on administrative
actions by the Office of Medicaid Policy and Planning (OMPP) and utilization rates of art therapy services.
Medicaid expenditures relating to this bill are paid from General Fund and dedicated fund appropriations,
along with federal matching funds.
SB 317 1 If existing staffing and resource levels are insufficient for full implementation, the additional funds and
resources required could be supplied through existing staff and resources currently being used in another
program or with new appropriations. Ultimately, the source of funds and resources required to satisfy the
requirements of this bill will depend on legislative and administrative actions.
Additional Information - Certificate Development and Administration: The following table explains the
initial and ongoing estimated costs for the PLA to create and administer the new art therapy certifications.
Estimated Costs for New Professional License
Expenditure Type Explanation
Estimated Cost
Low High
Certificate Development
(FY 2023 Only)
Salary cost to PLA to develop
new certification (includes rule
development and IT
expenditures)
$59,900 $88,300
Board Member Meeting and
Travel Expenses*
Annual expenses of two new
members on the Board
$0
(Assumes all
meetings remote)
$3,300
(12 in-person
meetings per year)
*FY 2019 Board member reimbursement data is used for this estimate because a high volume of Board meetings in FY 2020 and
FY 2021 were held remotely, decreasing travel reimbursements. To the extent remote meetings continue, travel reimbursements
may be lower.
Medicaid Costs: The bill limits Medicaid reimbursement for art therapy services to children receiving mental
health services under the Children’s Health Insurance Program (CHIP) and individuals receiving services
from a community mental health center. OMPP would likely be required to request federal approval of a
State Plan Amendment (SPA) to allow reimbursement for art therapists. Submitting SPA requests is
considered a routine administrative function of OMPP and can likely be accomplished under current staffing
and resource levels.
If federal approval is granted, OMPP would be required to establish reimbursement rates for art therapy
services, update provider reference modules, and issue a provider bulletin explaining the new services. Total
Medicaid expenditures would depend on reimbursement rates established by OMPP and utilization of art
therapy services by Medicaid and CHIP enrollees. Current OMPP policy allows reimbursement for certain
mental health services rendered by mid-level practitioners licensed by the Behavioral Health and Human
Services Licensing Board. These services must be provided under the medical supervision of a licensed
physician or psychologist. Current OMPP reimbursement rates for psychotherapy services provided by these
mid-level practitioners range from $15 to $95 per session. Reimbursement rates for art therapy may be
expected to fall in this range.
Medicaid State Share: Medicaid and CHIP are jointly funded between the state and federal governments.
The standard state share of costs for most Medicaid medical services for FFY 2022 is 34%, or 10% for the
age 19 to 64 expansion population within the Healthy Indiana Plan. The standard state share of CHIP costs
is 24%. The state share for most administrative expenses is 50%. For services provided in a community
mental health center, the state share would be paid from the community mental health center’s budget.
SB 317 2 Community mental health centers are local entities but are partially funded by the Family and Social Service
Administration’s (FSSA) allocations of General Fund and dedicated fund appropriations.
Explanation of State Revenues: Certification Fees - The bill would result in a minor increase of General
Fund revenue from certification fees collected by the BHHS Licensing Board beginning in FY 2024.
Currently, all practitioners licensed by the Board pay initial application fees and biennial renewal fees of $50
each. There are currently 27 art therapy practitioners in the state of Indiana that have credentials issued by
the national Art Therapy Credentials Board. There are another 24 credentialed art therapists in the Chicago,
Cincinnati, and Louisville areas that could potentially seek reciprocal licensure under the bill. Therefore, the
Board could expect to collect between $1,350 and $2,550 in biennial revenue from art therapy practitioners
initially. However, the number of art therapists expected to seek a certification under the bill may grow by
an indeterminable amount as a result of the state recognition and Medicaid and CHIP reimbursement
provided for by the bill.
Penalty Provision - The bill imposes a Class A misdemeanor for individuals who practice art therapy
unlawfully. If additional court cases occur and fines are collected, revenue to both the Common School Fund
(from fines) and the state General Fund (from court fees) would increase. The maximum fine for a Class A
misdemeanor is $5,000. However, any additional revenue would likely be small.
Explanation of Local Expenditures: Community Mental Health Centers - Counties that operate a
community mental health center that provides art therapy services to Medicaid recipients would be
responsible for the non-federal share (typically 10% or 34%) of reimbursement costs. Community mental
health centers’ Medicaid expenses are partially funded through FSSA allocations of state appropriations.
Penalty Provision - A Class A misdemeanor is punishable by up to one year in jail.
Explanation of Local Revenues: Penalty Provision - If additional court actions occur and a guilty verdict
is entered, local governments would receive revenue from court fees. However, any change in revenue would
likely be small.
State Agencies Affected: Professional Licensing Agency, Behavioral Health and Human Services Licensing
Board; Family and Social Services Administration, Office of Medicaid Policy and Planning, Division of
Mental Health and Addiction Services.
Local Agencies Affected: Community mental health centers, trial courts, local law enforcement agencies.
Information Sources: Legislative Services Agency, Indiana Handbook of Taxes, Revenues, and
Appropriations, FY 2021;
Indiana Health Coverage Programs, Mental Health and Addiction Services Provider Reference Module;
Indiana Health Coverage Programs, Fee Schedules: https://www.in.gov/medicaid/providers/678.htm;
American Art Therapy Association, Art Therapist Locator: https://arttherapy.org/art-therapist-locator/.
Fiscal Analyst: Adam White, 317-234-1360.
SB 317 3