Indiana 2023 Regular Session

Indiana Senate Bill SB0213 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	Introduced Version
3	3	SENATE BILL No. 213
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 12-15-5-14; IC 16-41-6-1; IC 25-1-9-6.8;
7	7	IC 25-23-1; IC 34-30-2.1-374; IC 35-48-3-11.
8	8	Synopsis: Advanced practice registered nurses. Removes the
9	9	requirements that an advanced practice registered nurse (APRN) have
10	10	a practice agreement with a collaborating physician. Removes a
11	11	provision requiring an APRN to operate under a collaborative practice
12	12	agreement or the privileges granted by a hospital governing board.
13	13	Repeals law concerning the audit of practice agreements. Allows an
14	14	APRN with prescriptive authority to prescribe a schedule II controlled
15	15	substance for weight reduction or to control obesity. Makes conforming
16	16	changes.
17	17	Effective: July 1, 2023.
18	18	Breaux
19	19	January 10, 2023, read first time and referred to Committee on Health and Provider
20	20	Services.
21	21	2023 IN 213—LS 6417/DI 77 Introduced
22	22	First Regular Session of the 123rd General Assembly (2023)
23	23	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
24	24	Constitution) is being amended, the text of the existing provision will appear in this style type,
25	25	additions will appear in this style type, and deletions will appear in this style type.
26	26	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
27	27	provision adopted), the text of the new provision will appear in this style type. Also, the
28	28	word NEW will appear in that style type in the introductory clause of each SECTION that adds
29	29	a new provision to the Indiana Code or the Indiana Constitution.
30	30	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
31	31	between statutes enacted by the 2022 Regular Session of the General Assembly.
32	32	SENATE BILL No. 213
33	33	A BILL FOR AN ACT to amend the Indiana Code concerning
34	34	professions and occupations.
35	35	Be it enacted by the General Assembly of the State of Indiana:
36	36	1 SECTION 1. IC 12-15-5-14, AS AMENDED BY P.L.129-2018,
37	37	2 SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
38	38	3 JULY 1, 2023]: Sec. 14. (a) As used in this section, "advanced practice
39	39	4 registered nurse" means:
40	40	5 (1) a nurse practitioner; or
41	41	6 (2) a clinical nurse specialist;
42	42	7 who is a registered nurse licensed under IC 25-23 and qualified to
43	43	8 practice nursing in a specialty role based upon the additional
44	44	9 knowledge and skill gained through a formal organized program of
45	45	10 study and clinical experience, or the equivalent as determined by the
46	46	11 Indiana state board of nursing.
47	47	12 (b) As used in this section, "office" includes the following:
48	48	13 (1) The office of the secretary of family and social services.
49	49	14 (2) A managed care organization that has contracted with the
50	50	15 office of Medicaid policy and planning under this article.
51	51	16 (3) A person that has contracted with a managed care organization
52	52	17 described in subdivision (2).
53	53	2023 IN 213—LS 6417/DI 77 2
54	54	1 (c) The office shall reimburse eligible Medicaid claims for the
55	55	2 following services provided by an advanced practice registered nurse
56	56	3 employed by a community mental health center if the services are part
57	57	4 of the advanced practice registered nurse's scope of practice:
58	58	5 (1) Mental health services.
59	59	6 (2) Behavioral health services.
60	60	7 (3) Substance abuse treatment.
61	61	8 (4) Primary care services.
62	62	9 (5) Evaluation and management services for inpatient or
63	63	10 outpatient psychiatric treatment.
64	64	11 (6) Prescription drugs.
65	65	12 (d) The office shall include an advanced practice registered nurse
66	66	13 as an eligible provider for the supervision of a plan of treatment for a
67	67	14 patient's outpatient mental health or substance abuse treatment
68	68	15 services, if the supervision is in the advanced practice registered
69	69	16 nurse's scope of practice, education, and training.
70	70	17 (e) This section
71	71	18 (1) may not be construed to expand an advanced practice
72	72	19 registered nurse's scope of practice. and
73	73	20 (2) is subject to IC 25-23-1-19.4(c) and applies only if the service
74	74	21 is included in the advanced practice registered nurse's practice
75	75	22 agreement with a collaborating physician.
76	76	23 SECTION 2. IC 16-41-6-1, AS AMENDED BY P.L.112-2020,
77	77	24 SECTION 19, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
78	78	25 JULY 1, 2023]: Sec. 1. (a) As used in this section, "physician's
79	79	26 authorized representative" means:
80	80	27 (1) an advanced practice registered nurse (as defined by
81	81	28 IC 25-23-1-1(b)); who is operating in collaboration with a
82	82	29 licensed physician; or
83	83	30 (2) an individual acting under the supervision of a licensed
84	84	31 physician and within the individual's scope of employment.
85	85	32 (b) A physician or the physician's authorized representative shall not
86	86	33 order an HIV test on an individual under the care of a physician unless
87	87	34 the physician or the physician's authorized representative does the
88	88	35 following:
89	89	36 (1) Informs the patient of the test, orally or in writing.
90	90	37 (2) Provides the patient with an explanation of the test orally, in
91	91	38 writing, by video, or by a combination of these methods.
92	92	39 (3) Informs the patient of the patient's right to ask questions and
93	93	40 to refuse the test.
94	94	41 Subject to subsection (e), if the patient refuses the test, the physician
95	95	42 or the physician's authorized representative may not perform the test
96	96	2023 IN 213—LS 6417/DI 77 3
97	97	1 and shall document the patient's refusal in the patient's medical record.
98	98	2 (c) Unless it is clearly not feasible, the information delivered to the
99	99	3 patient who is to be tested under subsection (b) must be provided in the
100	100	4 native language or other communication used by the patient. If the
101	101	5 patient is unable to read written materials, the materials must be
102	102	6 translated or read to the patient in a language the patient understands.
103	103	7 (d) After ordering an HIV test for a patient, the physician or the
104	104	8 physician's authorized representative shall notify the patient of the test
105	105	9 results and the availability of HIV and other bloodborne disease
106	106	10 prevention counseling. If a test conducted under this section indicates
107	107	11 that a patient is HIV positive, in addition to the requirements set forth
108	108	12 in IC 16-41-2, the physician or the physician's authorized
109	109	13 representative shall inform the patient of the availability of counseling
110	110	14 and of the treatment and referral options available to the patient.
111	111	15 (e) A physician or a physician's authorized representative may order
112	112	16 an HIV test to be performed without informing the patient or the
113	113	17 patient's representative (as defined in IC 16-36-1-2) of the test or
114	114	18 regardless of the patient's or the patient's representative's refusal of the
115	115	19 HIV test if any of the following conditions apply:
116	116	20 (1) If ordered by a physician, consent can be implied due to
117	117	21 emergency circumstances and the test is medically necessary to
118	118	22 diagnose or treat the patient's emergent condition.
119	119	23 (2) Under a court order based on clear and convincing evidence
120	120	24 of a serious and present health threat to others posed by an
121	121	25 individual. A patient shall be notified of the patient's right to:
122	122	26 (A) a hearing; and
123	123	27 (B) counsel;
124	124	28 before a hearing is held under this subdivision. Any hearing
125	125	29 conducted under this subdivision shall be held in camera at the
126	126	30 request of the individual.
127	127	31 (3) If the test is done on blood collected or tested anonymously as
128	128	32 part of an epidemiologic survey under IC 16-41-2-3 or
129	129	33 IC 16-41-17-10(a)(5).
130	130	34 (4) The test is ordered under section 4 of this chapter.
131	131	35 (5) The test is required or authorized under IC 11-10-3-2.5.
132	132	36 (6) The individual upon whom the test will be performed is
133	133	37 described in IC 16-41-8-6 or IC 16-41-10-2.5.
134	134	38 (7) A court has ordered the individual to undergo testing for HIV
135	135	39 under IC 35-38-1-10.5(a) or IC 35-38-2-2.3(a)(17).
136	136	40 (f) The state department shall make HIV testing and treatment
137	137	41 information from the federal Centers for Disease Control and
138	138	42 Prevention available to health care providers.
139	139	2023 IN 213—LS 6417/DI 77 4
140	140	1 (g) The state department may adopt rules under IC 4-22-2 necessary
141	141	2 to implement this section.
142	142	3 SECTION 3. IC 25-1-9-6.8, AS AMENDED BY P.L.129-2018,
143	143	4 SECTION 23, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
144	144	5 JULY 1, 2023]: Sec. 6.8. (a) This section applies to a practitioner who
145	145	6 is:
146	146	7 (1) licensed to practice medicine or osteopathic medicine under
147	147	8 IC 25-22.5; or
148	148	9 (2) an advanced practice registered nurse granted prescriptive
149	149	10 authority under IC 25-23. and whose practice agreement with a
150	150	11 collaborating physician reflects the conditions specified in
151	151	12 subsection (b).
152	152	13 (b) Before prescribing a stimulant medication for a child for the
153	153	14 treatment of attention deficit disorder or attention deficit hyperactivity
154	154	15 disorder, a practitioner described in subsection (a) shall follow the most
155	155	16 recent guidelines adopted by the American Academy of Pediatrics or
156	156	17 the American Academy of Child and Adolescent Psychiatry for the
157	157	18 diagnosis and evaluation of a child with attention deficit disorder or
158	158	19 attention deficit hyperactivity disorder.
159	159	20 SECTION 4. IC 25-23-1-1, AS AMENDED BY P.L.129-2018,
160	160	21 SECTION 28, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
161	161	22 JULY 1, 2023]: Sec. 1. As used in this chapter:
162	162	23 (a) "Board" means the Indiana state board of nursing.
163	163	24 (b) "Advanced practice registered nurse" means:
164	164	25 (1) a nurse practitioner;
165	165	26 (2) a certified nurse midwife;
166	166	27 (3) a clinical nurse specialist; or
167	167	28 (4) a certified registered nurse anesthetist;
168	168	29 who is a registered nurse qualified to practice nursing in a specialty
169	169	30 role based upon the additional knowledge and skill gained through a
170	170	31 formal organized program of study and clinical experience, or the
171	171	32 equivalent as determined by the board, which does not limit but
172	172	33 extends or expands the function of the nurse which may be initiated by
173	173	34 the client or provider. in settings that shall include hospital outpatient
174	174	35 clinics and health maintenance organizations. Notwithstanding any
175	175	36 other law, this subsection does not add to the powers and duties or
176	176	37 scope of practice of certified registered nurse anesthetists as described
177	177	38 in section 30 of this chapter.
178	178	39 (c) "Human response" means those signs, symptoms, behaviors, and
179	179	40 processes that denote the individual's interaction with the environment.
180	180	41 SECTION 5. IC 25-23-1-7, AS AMENDED BY P.L.69-2022,
181	181	42 SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
182	182	2023 IN 213—LS 6417/DI 77 5
183	183	1 JULY 1, 2023]: Sec. 7. (a) The board shall do the following:
184	184	2 (1) Adopt under IC 4-22-2 rules necessary to enable it to carry
185	185	3 into effect this chapter.
186	186	4 (2) Prescribe standards and approve curricula for nursing
187	187	5 education programs preparing persons for licensure under this
188	188	6 chapter.
189	189	7 (3) Provide for surveys of such programs at such times as it
190	190	8 considers necessary.
191	191	9 (4) Accredit such programs as meet the requirements of this
192	192	10 chapter and of the board.
193	193	11 (5) Deny or withdraw accreditation from nursing education
194	194	12 programs for failure to meet prescribed curricula or other
195	195	13 standards.
196	196	14 (6) Examine, license, and renew the license of qualified
197	197	15 applicants.
198	198	16 (7) Issue subpoenas, compel the attendance of witnesses, and
199	199	17 administer oaths to persons giving testimony at hearings.
200	200	18 (8) Cause the prosecution of all persons violating this chapter and
201	201	19 have power to incur necessary expenses for these prosecutions.
202	202	20 (9) Adopt rules under IC 4-22-2 that do the following:
203	203	21 (A) Prescribe standards for the competent practice of
204	204	22 registered, practical, and advanced practice registered nursing.
205	205	23 (B) Establish with the approval of the medical licensing board
206	206	24 created by IC 25-22.5-2-1 requirements that advanced practice
207	207	25 registered nurses must meet to be granted authority to
208	208	26 prescribe legend drugs and to retain that authority.
209	209	27 (C) Establish, with the approval of the medical licensing board
210	210	28 created by IC 25-22.5-2-1, requirements for the renewal of a
211	211	29 practice agreement under section 19.4 of this chapter, which
212	212	30 shall expire on October 31 in each odd-numbered year.
213	213	31 (10) Keep a record of all its proceedings.
214	214	32 (11) Collect and distribute annually demographic information on
215	215	33 the number and type of registered nurses and licensed practical
216	216	34 nurses employed in Indiana.
217	217	35 (12) Adopt rules and administer the interstate nurse licensure
218	218	36 compact under IC 25-42.
219	219	37 (13) Adopt or amend rules to implement the nursing licensure by
220	220	38 endorsement available for foreign nursing school graduates under
221	221	39 sections 11 and 12 of this chapter.
222	222	40 (b) The board may do the following:
223	223	41 (1) Create ad hoc subcommittees representing the various nursing
224	224	42 specialties and interests of the profession of nursing. Persons
225	225	2023 IN 213—LS 6417/DI 77 6
226	226	1 appointed to a subcommittee serve for terms as determined by the
227	227	2 board.
228	228	3 (2) Utilize the appropriate subcommittees so as to assist the board
229	229	4 with its responsibilities. The assistance provided by the
230	230	5 subcommittees may include the following:
231	231	6 (A) Recommendation of rules necessary to carry out the duties
232	232	7 of the board.
233	233	8 (B) Recommendations concerning educational programs and
234	234	9 requirements.
235	235	10 (C) Recommendations regarding examinations and licensure
236	236	11 of applicants.
237	237	12 (3) Appoint nurses to serve on each of the ad hoc subcommittees.
238	238	13 (c) Nurses appointed under subsection (b) must:
239	239	14 (1) be committed to advancing and safeguarding the nursing
240	240	15 profession as a whole; and
241	241	16 (2) represent nurses who practice in the field directly affected by
242	242	17 a subcommittee's actions.
243	243	18 SECTION 6. IC 25-23-1-19.4, AS AMENDED BY P.L.127-2020,
244	244	19 SECTION 8, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
245	245	20 JULY 1, 2023]: Sec. 19.4. (a) This section does not apply to certified
246	246	21 registered nurse anesthetists.
247	247	22 (b) As used in this section, "practitioner" has the meaning set forth
248	248	23 in IC 16-42-19-5. However, the term does not include the following:
249	249	24 (1) A veterinarian.
250	250	25 (2) An advanced practice registered nurse.
251	251	26 (3) A physician assistant.
252	252	27 (c) An advanced practice registered nurse shall operate:
253	253	28 (1) in collaboration with a licensed practitioner as evidenced by
254	254	29 a practice agreement;
255	255	30 (2) by privileges granted by the governing board of a hospital
256	256	31 licensed under IC 16-21 with the advice of the medical staff of the
257	257	32 hospital that sets forth the manner in which an advanced practice
258	258	33 registered nurse and a licensed practitioner will cooperate,
259	259	34 coordinate, and consult with each other in the provision of health
260	260	35 care to their patients; or
261	261	36 (3) by privileges granted by the governing body of a hospital
262	262	37 operated under IC 12-24-1 that sets forth the manner in which an
263	263	38 advanced practice registered nurse and a licensed practitioner will
264	264	39 cooperate, coordinate, and consult with each other in the
265	265	40 provision of health care to their patients.
266	266	41 (d) (b) This subsection applies for purposes of the Medicaid
267	267	42 program to an advanced practice registered nurse who:
268	268	2023 IN 213—LS 6417/DI 77 7
269	269	1 (1) is licensed pursuant to IC 25-23-1-19.5; and
270	270	2 (2) has been educated and trained to work with patients with
271	271	3 addiction and mental health needs.
272	272	4 An advanced practice registered nurse who meets the requirements of
273	273	5 this subsection has all of the supervisory rights and responsibilities,
274	274	6 including prior authorization, that are available to a licensed physician
275	275	7 or a health service provider in psychology (HSPP) operating in a
276	276	8 community mental health center certified under IC 12-21-2-3(5)(C).
277	277	9 (e) (c) Before January 1, 2021, the office of the secretary shall apply
278	278	10 to the United States Department of Health and Human Services for any
279	279	11 state plan amendment necessary to implement subsection (d). (b).
280	280	12 SECTION 7. IC 25-23-1-19.6, AS AMENDED BY P.L.28-2019,
281	281	13 SECTION 14, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
282	282	14 JULY 1, 2023]: Sec. 19.6. (a) When the board grants authority to an
283	283	15 advanced practice registered nurse to prescribe legend drugs under this
284	284	16 chapter, the board shall assign an identification number to the
285	285	17 advanced practice registered nurse.
286	286	18 (b) An advanced practice registered nurse who is granted authority
287	287	19 by the board to prescribe legend drugs must do the following:
288	288	20 (1) Enter on each prescription form that the advanced practice
289	289	21 registered nurse uses to prescribe a legend drug:
290	290	22 (A) the signature of the advanced practice registered nurse;
291	291	23 (B) initials indicating the credentials awarded to the advanced
292	292	24 practice registered nurse under this chapter; and
293	293	25 (C) the identification number assigned to the advanced
294	294	26 practice registered nurse under subsection (a).
295	295	27 (2) Transmit the prescription in an electronic format for an
296	296	28 electronically transmitted prescription.
297	297	29 (3) Comply with all applicable state and federal laws concerning
298	298	30 prescriptions for legend drugs, including the requirement to issue
299	299	31 electronically transmitted prescriptions under IC 25-1-9.3.
300	300	32 (c) An advanced practice registered nurse may be granted authority
301	301	33 to prescribe legend drugs under this chapter only within the scope of
302	302	34 practice of the advanced practice registered nurse. and the scope of the
303	303	35 licensed collaborating health practitioner.
304	304	36 SECTION 8. IC 25-23-1-19.8 IS REPEALED [EFFECTIVE JULY
305	305	37 1, 2023]. Sec. 19.8. (a) Before December 31 of an even-numbered year,
306	306	38 the Indiana professional licensing agency or the agency's designee shall
307	307	39 randomly audit at least one percent (1%) but not more than ten percent
308	308	40 (10%) of the practice agreements of advanced practice registered
309	309	41 nurses with authority to prescribe legend drugs under section 19.5 of
310	310	42 this chapter to determine whether the practice agreement meets the
311	311	2023 IN 213—LS 6417/DI 77 8
312	312	1 requirements of this chapter or rules adopted by the board.
313	313	2 (b) The Indiana professional licensing agency shall establish an
314	314	3 audit procedure, which may include the following:
315	315	4 (1) Requiring the advanced practice registered nurse to provide
316	316	5 the agency with a copy of verification of attendance at or
317	317	6 completion of a continuing education course or program the
318	318	7 advanced practice registered nurse attended during the previous
319	319	8 two (2) years.
320	320	9 (2) Requiring the advanced practice registered nurse and the
321	321	10 licensed practitioner who have entered into a practice agreement
322	322	11 to submit information on a form prescribed by the agency that
323	323	12 must include a sworn statement signed by the advanced practice
324	324	13 registered nurse and the licensed practitioner that the parties are
325	325	14 operating within the terms of the practice agreement and the
326	326	15 requirements under this chapter or rules adopted by the board.
327	327	16 (3) Reviewing patient health records and other patient information
328	328	17 at the practice location or by requiring the submission of accurate
329	329	18 copies to determine if the parties are operating within the terms
330	330	19 of the practice agreement and the requirements under this chapter
331	331	20 or rules adopted by the board.
332	332	21 (4) After a reasonable determination that the advanced practice
333	333	22 registered nurse and the licensed practitioner who have entered
334	334	23 into a practice agreement are not operating within the terms of the
335	335	24 practice agreement, requiring the parties to appear before the
336	336	25 agency or the agency's designee to provide evidence of
337	337	26 compliance with the practice agreement.
338	338	27 (c) Not more than sixty (60) days after the completion of the audit
339	339	28 required in subsection (a), the Indiana professional licensing agency
340	340	29 shall provide the board with the following:
341	341	30 (1) A summary of the information obtained in the audit.
342	342	31 (2) A statement regarding whether an advanced practice
343	343	32 registered nurse and a licensed practitioner who have entered into
344	344	33 a practice agreement that is audited under subsection (a) are
345	345	34 operating within the terms of the practice agreement.
346	346	35 The agency shall also provide a copy of the information described in
347	347	36 this subsection to the board that regulates the licensed practitioner.
348	348	37 (d) The Indiana professional licensing agency may cause to be
349	349	38 served upon the advanced practice registered nurse an order to show
350	350	39 cause to the board as to why the board should not impose disciplinary
351	351	40 sanctions under IC 25-1-9-9 on the advanced practice registered nurse
352	352	41 for the advanced practice registered nurse's failure to comply with:
353	353	42 (1) an audit conducted under this section; or
354	354	2023 IN 213—LS 6417/DI 77 9
355	355	1 (2) the requirements of a practice agreement under this chapter.
356	356	2 (e) Except for a violation concerning continuing education
357	357	3 requirements under IC 25-1-4, the board shall hold a hearing in
358	358	4 accordance with IC 4-21.5 and state the date, time, and location of the
359	359	5 hearing in the order served under subsection (d).
360	360	6 (f) The board that regulates the licensed practitioner may cause to
361	361	7 be served upon the licensed practitioner an order to show cause to the
362	362	8 board as to why the board should not impose disciplinary sanctions
363	363	9 under IC 25-1-9-9 on the licensed practitioner for the licensed
364	364	10 practitioner's failure to comply with:
365	365	11 (1) an audit conducted under this section; or
366	366	12 (2) the requirements of a practice agreement under this chapter.
367	367	13 (g) The board that regulates the licensed practitioner shall hold a
368	368	14 hearing in accordance with IC 4-21.5 and state the date, time, and
369	369	15 location of the hearing in the order served under subsection (f).
370	370	16 (h) An order to show cause issued under this section must comply
371	371	17 with the notice requirements of IC 4-21.5.
372	372	18 (i) The licensed practitioner may divulge health records and other
373	373	19 patient information to the Indiana professional licensing agency or the
374	374	20 agency's designee. The licensed practitioner is immune from civil
375	375	21 liability for any action based upon release of the patient information
376	376	22 under this section.
377	377	23 SECTION 9. IC 34-30-2.1-374 IS REPEALED [EFFECTIVE JULY
378	378	24 1, 2023]. Sec. 374. IC 25-23-1-19.8(i) (Concerning licensed
379	379	25 practitioners who release health records and patient information to the
380	380	26 Indiana professional licensing agency).
381	381	27 SECTION 10. IC 35-48-3-11, AS AMENDED BY P.L.129-2018,
382	382	28 SECTION 45, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
383	383	29 JULY 1, 2023]: Sec. 11. (a) Only a physician licensed under
384	384	30 IC 25-22.5, a physician assistant licensed under IC 25-27.5, or an
385	385	31 advanced practice registered nurse licensed under IC 25-23 with
386	386	32 prescriptive authority may treat a patient with a Schedule III or
387	387	33 Schedule IV controlled substance for the purpose of weight reduction
388	388	34 or to control obesity.
389	389	35 (b) A physician licensed under IC 25-22.5, a physician assistant
390	390	36 licensed under IC 25-27.5, or an advanced practice registered nurse
391	391	37 licensed under IC 25-23 with prescriptive authority may not prescribe,
392	392	38 dispense, administer, supply, sell, or give any amphetamine,
393	393	39 sympathomimetic amine drug, or compound designated as a Schedule
394	394	40 III or Schedule IV controlled substance under IC 35-48-2-8 and
395	395	41 IC 35-48-2-10 for a patient for purposes of weight reduction or to
396	396	42 control obesity, unless the physician, physician assistant, or advanced
397	397	2023 IN 213—LS 6417/DI 77 10
398	398	1 practice registered nurse does the following:
399	399	2 (1) Determines:
400	400	3 (A) through review of:
401	401	4 (i) the physician's records of prior treatment of the patient;
402	402	5 or
403	403	6 (ii) the records of prior treatment of the patient provided by
404	404	7 a previous treating physician or weight loss program;
405	405	8 that the physician's patient has made a reasonable effort to lose
406	406	9 weight in a treatment program using a regimen of weight
407	407	10 reduction based on caloric restriction, nutritional counseling,
408	408	11 behavior modification, and exercise without using controlled
409	409	12 substances; and
410	410	13 (B) that the treatment described in clause (A) has been
411	411	14 ineffective for the physician's patient.
412	412	15 (2) Obtains a thorough history and performs a thorough physical
413	413	16 examination of the physician's patient before initiating a treatment
414	414	17 plan using a Schedule III or Schedule IV controlled substance for
415	415	18 purposes of weight reduction or to control obesity.
416	416	19 (c) A physician licensed under IC 25-22.5, a physician assistant
417	417	20 licensed under IC 25-27.5, or an advanced practice registered nurse
418	418	21 licensed under IC 25-23 with prescriptive authority may not begin and
419	419	22 shall discontinue using a Schedule III or Schedule IV controlled
420	420	23 substance for purposes of weight reduction or to control obesity after
421	421	24 the physician, physician assistant, or advanced practice registered nurse
422	422	25 determines in the physician's, physician assistant's, or advanced
423	423	26 practice registered nurse's professional judgment that:
424	424	27 (1) the physician's patient has failed to lose weight using a
425	425	28 treatment plan involving the controlled substance;
426	426	29 (2) the controlled substance has provided a decreasing
427	427	30 contribution toward further weight loss for the patient unless
428	428	31 continuing to take the controlled substance is medically necessary
429	429	32 or appropriate for maintenance therapy;
430	430	33 (3) the physician's patient:
431	431	34 (A) has a history of; or
432	432	35 (B) shows a propensity for;
433	433	36 alcohol or drug abuse; or
434	434	37 (4) the physician's patient has consumed or disposed of a
435	435	38 controlled substance in a manner that does not strictly comply
436	436	39 with a treating physician's, physician assistant's, or advanced
437	437	40 practice registered nurse's direction.
438	438	41 (d) A physician assistant licensed under IC 25-27.5 or an advanced
439	439	42 practice registered nurse licensed under IC 25-23 with prescriptive
440	440	2023 IN 213—LS 6417/DI 77 11
441	441	1 authority may not prescribe a schedule II controlled substance for the
442	442	2 purpose of weight reduction or to control obesity.
443	443	2023 IN 213—LS 6417/DI 77