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 6486 NOTE PREPARED: Dec 20, 2023
BILL NUMBER: SB 142 BILL AMENDED:
SUBJECT: Coverage for Mobile Integrated Healthcare Services.
FIRST AUTHOR: Sen. Buchanan BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
FEDERAL
Summary of Legislation: The bill provides that a state employee health plan that provides coverage for
emergency medical services must provide reimbursement, subject to applicable deductible and coinsurance,
for a covered individual for emergency medical services that are performed or provided during a response
initiated as part of a mobile integrated healthcare program. It provides that a policy of accident and sickness
insurance that provides coverage for emergency medical services must provide reimbursement for emergency
medical services that are performed or provided during a response initiated as part of a mobile integrated
healthcare program. The bill provides that an individual contract and a group contract that provide coverage
for emergency medical services must provide reimbursement for emergency medical services that are
performed or provided during a response initiated as part of a mobile integrated healthcare program.
Effective Date: July 1, 2024.
Explanation of State Expenditures: State Employee Health Plan: The bill could result in increased costs
for the state health plan. Any resulting increase in plan premiums may be mitigated with adjustments to other
benefits or to employee compensation packages, or through the division of premium costs between the state
and state employees. In the past 2 years, the SEHP had 55 claims for mobile integrated healthcare (MIH)
emergencies. Of these 55 claims, 49 were paid and 6 were denied.
Department of Insurance (DOI): To the extent that the DOI has oversight of the provider and insured
contracts of insurers and HMOs, the DOI’s workload may increase to evaluate and resolve complaints of
noncompliance based on the provisions of the bill.[The DOI is funded through a dedicated agency fund.]
Additional Information: MIH is a patient-centered model that focuses on delivering needs-based care and
SB 142 1 preventative services in the patient’s home or mobile environment. The main focus of MIH is to better
coordinate care, reduce unnecessary medical spending, and improve quality while reducing the number of
911 calls, emergency room visits, and hospital admissions. In 2019, Indiana passed SEA 498-2019 which
established MIH/community paramedicine (CP) programs and provided MIH/CP reimbursement for
Medicaid recipients. In 2020, Indiana passed HEA 1209-2020 which required health plans to reimburse for
the specified emergency medical services.
The Department of Homeland Security (DHS) established a MIH program dashboard which filters by service,
and county/provider. Out of 92 counties, 20 have established MIH/CP programs. Offered services include:
hospital dismissal/post-discharge follow up, post response follow-up for certain emergencies, diabetic
counseling, chronic disease management, mental illness mitigation, OB/newborn management, elderly
management, substance abuse management, immunization and vaccination, and decreased utilization of EMS
by high frequency patients.
The DHS does not require MIH providers to report the number of calls received and does not track the
number of 911 calls that are mitigated by the MIH system.
Explanation of State Revenues: Insurance Premium Tax Revenue: If utilization were to increase as a result
of the bill, claims costs would increase, potentially translating into an increase in health care premiums. If
overall premiums collected in the state increase, revenue to the state General Fund could increase from either
corporate Adjusted Gross Income (AGI) Tax or Insurance Premium Tax collections.
Additional Information: Domestic insurers have the option to pay taxes on insurance premiums written in
the state or to pay the AGI tax. Foreign insurers are required to pay taxes on premiums written in the state,
and some foreign insurers are assessed additional retaliatory taxes. In these cases, the minimum tax rate
would be 1.3% of written premiums. Revenue received from the AGI and insurance premium tax is deposited
in the state General Fund.
To the extent the bill affects total insurance premiums paid in the state, revenue to the state General Fund
could change from taxes paid on insurance premiums. Any impact on state General Fund revenue is
indeterminable, but expected to be minor. For FY 2023, the insurance premium tax generated approximately
$261.8 M in revenue.
Explanation of Local Expenditures: The bill impacts local units of government that offer health insurance
coverage for employees. An increase in the cost of premiums may be mitigated with adjustments to other
benefits or employee compensation packages, or through the division of premium costs between a local unit
and its employees.
Explanation of Local Revenues: Reimbursement of medical services for runs that do not end in hospital
transport will increase revenue for local units that operate emergency medical services.
State Agencies Affected: State Personnel Department; Department of Insurance; Department of Homeland
Security.
Local Agencies Affected: Local units that offer health insurance.
Information Sources: Christy Tittle, State Personnel Department; Alyssa Schroeder, Department of
Homeland Security;
SB 142 2 Legislative Services Agency, Indiana Handbook of Taxes, Revenues, and Appropriations, FY 2023;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161318/;
https://www.ncsl.org/state-legislatures-news/details/community-paramedicine-connecting-patients-to-car
e-and-reducing-costs;
https://ingov.maps.arcgis.com/apps/dashboards/95ad27d611a74212bc992d5c72d6a17b;
https://www.chcf.org/wp-content/uploads/2019/11/LeftBehindCaliforniaComparingCommunityParamedi
cine.pdf.
Fiscal Analyst: Jasmine Noel, 317-234-1360.
SB 142 3