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 6157 NOTE PREPARED: Nov 8, 2023
BILL NUMBER: HB 1011 BILL AMENDED:
SUBJECT: End of Life Options.
FIRST AUTHOR: Rep. Pierce M BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: Request: The bill allows individuals with a terminal illness who meet certain
requirements to make a request to an attending provider for medication that the individual may
self-administer to bring about death. It specifies requirements a provider must meet in order to prescribe the
medication to a patient.
Life Insurance Policy: The bill prohibits an insurer from denying payment of benefits under a life insurance
policy based upon a suicide clause in the life insurance policy if the death of the insured individual is the
result of medical aid in dying.
Criminal Penalties: It establishes a Level 1 felony if a person:
(1) without authorization of the patient, willfully alters, forges, conceals, or destroys a
request for medication or a rescission of a request for medication with the intent or effect
of causing the individual's death; or
(2) knowingly or intentionally coerces or exerts undue influence on an individual to request
medication to bring about death or to destroy a rescission of a request for medication to
bring about death.
It also establishes a Class A misdemeanor if a person, without authorization of the patient, willfully alters,
forges, conceals, or destroys a request for medication or a rescission of a request for medication in order to
affect a health care decision by the individual.
Immunity: The bill establishes certain criminal and civil immunity for health care providers.
HB 1011 1 Effective Date: July 1, 2024.
Explanation of State Expenditures: Indiana Department of Health (IDOH): The bill will increase the
workload for the IDOH to adopt rules, develop forms, and review records submitted to produce a report. The
bill’s requirements are within the IDOH’s routine administrative functions and should be able to be
implemented with no additional appropriations, assuming near customary agency staffing and resource levels.
[Administrative expenses of the IDOH are paid from the Tobacco Master Settlement Fund, a dedicated fund.]
Medicaid: In Oregon and Washington State, 80% of individuals who requested prescriptions were over 65
years old, making them potentially Medicare eligible. In Indiana about 13.2% residents over age 65 are
Medicaid recipients and may receive full Medicaid benefits or assistance with Medicare costs, including
premiums, copayments, or coinsurance. Any change in state Medicaid costs is expected to be minimal.
Penalty Provision: A Level 1 felony is punishable by a prison term ranging from 20 to 40 years, with an
advisory sentence of 30 years. The sentence depends on mitigating and aggravating circumstances. Assuming
offenders can be housed in existing facilities with no additional staff, the marginal cost for medical care,
food, and clothing is approximately $4,456 annually, or $12.21 daily, per prisoner. However, any additional
expenditures are likely to be small.
Additional Information - The health departments in the states of Oregon and Washington produce annual
reports similar to the report required in this bill. In 2021, 383 individuals had prescriptions for lethal
medications in Oregon. In Washington, 340 individuals were dispensed such medication during 2020. In both
states, the number of prescriptions has increased almost every year since the legislation was enacted.
Oregon’s statute has been in effect since 1997 and Washington’s since 2009. [Nine states have similar acts
with enactment dates between 2013 and 2021.]
There were no physician referrals made to the Oregon Medical Board for failure to comply with the
legislation’s requirements in 2021. Washington does not report this information.
Explanation of State Revenues: Penalty Provision: If additional court cases occur and fines are collected,
revenue to both the Common School Fund (from criminal fines) and the state General Fund (from court fees)
would increase. The maximum fine for a Level 1 felony is $10,000 and for a Class A misdemeanor is $5,000.
The total fee revenue per case would range between $113 and $135. The amount of court fees deposited will
vary depending on whether the case is filed in a court of record or a municipal court. The following linked
document describes the fees and distribution of the revenue: Court fees imposed in criminal, juvenile, and
civil violation cases.
Explanation of Local Expenditures: Penalty Provision: If more defendants are detained in county jails
prior to their court hearings, local expenditures for jail operations may increase. A Class A misdemeanor is
punishable by up to one year in jail. However, any additional expenditures would likely be small.
Explanation of Local Revenues: Penalty Provision: If additional court actions occur and a guilty verdict
is entered, more revenue will be collected by certain local units. If the case is filed in a court of record, the
county general fund will receive $47.40 and qualifying municipalities will receive a share of $3.60. If the
case is filed in a municipal court, the county receives $30, and the municipality will receive $46. The
following linked document describes the fees and distribution of the revenue: Court fees imposed in criminal,
juvenile, and civil violation cases.
HB 1011 2 State Agencies Affected: Indiana Department of Health; Family and Social Services Administration, Office
of Medicaid Policy and Planning; Department of Correction.
Local Agencies Affected: Trial courts, local law enforcement agencies.
Information Sources: Indiana Supreme Court, Indiana Trial Court Fee Manual; IHCP Bulletin BT202290,
October 11, 2022; Oregon Public Health Division, Death with Dignity Act, 2021 Data Summary; Washington
State Department of Health, Washington State Department of Health 2020 Death with Dignity Act Report.
Fiscal Analyst: Karen Rossen, 317-234-2106.
HB 1011 3