*EH1689.1* April 4, 2025 ENGROSSED HOUSE BILL No. 1689 _____ DIGEST OF HB 1689 (Updated April 2, 2025 1:10 pm - DI 104) Citations Affected: IC 12-7; IC 12-11; IC 12-15; IC 16-39; IC 34-30; IC 35-52; noncode. Synopsis: Human services matters. Provides that provisions of law concerning the statewide waiver ombudsman apply to an individual who has a disability and receives services administered by the bureau of disabilities services. (Current law specifies that these provisions apply to an individual who has a developmental disability and receives services under the federal home and community based services program.) Specifies that these provisions do not apply to an individual served by the long term care ombudsman program. Changes references from "statewide waiver ombudsman" to "statewide bureau of disabilities services ombudsman". Requires the office of the secretary of family and social services (office of the secretary) to prepare an annual report on the provision of Medicaid home and community based waiver services. Specifies the information that must be included in the report. Requires the office of the secretary to provide to the division of disability and rehabilitative services advisory council a report on the office of the secretary's plans to provide services to individuals who require extraordinary care. Effective: Upon passage; July 1, 2025. Clere, Porter, Behning, Pryor (SENATE SPONSORS — GOODE, FORD J.D., DEERY, YODER, QADDOURA) January 21, 2025, read first time and referred to Committee on Public Health. February 4, 2025, amended, reported — Do Pass. February 6, 2025, read second time, ordered engrossed. February 7, 2025, engrossed. February 10, 2025, read third time, passed. Yeas 92, nays 0. SENATE ACTION March 3, 2025, read first time and referred to Committee on Health and Provider Services. April 3, 2025, amended, reported favorably — Do Pass. EH 1689—LS 7675/DI 147 April 4, 2025 First Regular Session of the 124th General Assembly (2025) PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type. Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution. Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2024 Regular Session of the General Assembly. ENGROSSED HOUSE BILL No. 1689 A BILL FOR AN ACT to amend the Indiana Code concerning human services. Be it enacted by the General Assembly of the State of Indiana: 1 SECTION 1. IC 12-7-2-135.3 IS AMENDED TO READ AS 2 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 135.3. (a) 3 "Ombudsman", for purposes of IC 12-10-13, has the meaning set forth 4 in IC 12-10-13-4.5. 5 (b) "Ombudsman", for purposes of IC 12-11-13, has the 6 meaning set forth in IC 12-11-13-2. 7 SECTION 2. IC 12-7-2-149.1, AS AMENDED BY P.L.10-2019, 8 SECTION 55, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE 9 JULY 1, 2025]: Sec. 149.1. "Provider" means the following: 10 (1) For purposes of IC 12-10-7, the meaning set forth in 11 IC 12-10-7-3. 12 (2) For purposes of the following statutes, an individual, a 13 partnership, a corporation, or a governmental entity that is 14 enrolled in the Medicaid program under rules adopted under 15 IC 4-22-2 by the office of Medicaid policy and planning: 16 (A) IC 12-14-1 through IC 12-14-8. 17 (B) IC 12-15, except IC 12-15-32, IC 12-15-33, and EH 1689—LS 7675/DI 147 2 1 IC 12-15-34. 2 (C) IC 12-17.6. 3 (3) Except as provided in subdivisions (4) and (6), for purposes 4 of IC 12-17.2, a person who operates a child care center or child 5 care home under IC 12-17.2. 6 (4) For purposes of IC 12-17.2-3.5, a person that: 7 (A) provides child care; and 8 (B) is directly paid for the provision of the child care under the 9 federal Child Care and Development Fund voucher program 10 administered under 45 CFR 98 and 45 CFR 99. 11 The term does not include an individual who provides services to 12 a person described in clauses (A) and (B), regardless of whether 13 the individual receives compensation. 14 (5) For purposes of IC 12-21-1 through IC 12-29-2, an 15 organization: 16 (A) that: 17 (i) provides mental health services, as defined under 42 18 U.S.C. 300x-2(c); 19 (ii) provides addiction services; or 20 (iii) provides children's mental health services; 21 (B) that has entered into a provider agreement with the 22 division of mental health and addiction under IC 12-21-2-7 to 23 provide services in the least restrictive, most appropriate 24 setting; and 25 (C) that is operated by one (1) of the following: 26 (i) A city, town, county, or other political subdivision of the 27 state. 28 (ii) An agency of the state or of the United States. 29 (iii) A political subdivision of another state. 30 (iv) A hospital owned or operated by a unit of government 31 or a building authority that is organized for the purpose of 32 constructing facilities to be leased to units of government. 33 (v) A corporation incorporated under IC 23-7-1.1 (before its 34 repeal August 1, 1991) or IC 23-17. 35 (vi) An organization that is exempt from federal income 36 taxation under Section 501(c)(3) of the Internal Revenue 37 Code. 38 (vii) A university or college. 39 (6) For purposes of IC 12-17.2-2-10, the following: 40 (A) A person described in subdivision (4). 41 (B) A child care center licensed under IC 12-17.2-4. 42 (C) A child care home licensed under IC 12-17.2-5. EH 1689—LS 7675/DI 147 3 1 (7) For purposes of IC 12-11-13, an authorized provider entity 2 that delivers services administered by the bureau of 3 disabilities services. 4 SECTION 3. IC 12-11-13-1 IS AMENDED TO READ AS 5 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 1. (a) Except as 6 provided in subsection (b), this chapter applies only to an individual 7 who: 8 (1) has a developmental disability; and 9 (2) receives services under a waiver under the federal home and 10 community based services program. administered by the 11 bureau. 12 (b) This chapter does not apply to an individual served by the 13 long term care ombudsman program established under 14 IC 12-10-13. 15 SECTION 4. IC 12-11-13-2 IS AMENDED TO READ AS 16 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 2. As used in this 17 chapter, "ombudsman" refers to the statewide waiver bureau of 18 disabilities services ombudsman established by section 3 of this 19 chapter. The term includes individuals approved to act in the capacity 20 of ombudsmen by the statewide waiver bureau of disabilities services 21 ombudsman. 22 SECTION 5. IC 12-11-13-3 IS AMENDED TO READ AS 23 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 3. The statewide waiver 24 bureau of disabilities services ombudsman position is established 25 within the division. 26 SECTION 6. IC 12-11-13-7 IS AMENDED TO READ AS 27 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 7. (a) An ombudsman 28 must be provided access to the following: 29 (1) An individual described in section 1 of this chapter. 30 (2) An entity that provides waiver services to an individual 31 described in section 1 of this chapter. 32 (3) Records of an individual described in section 1 of this chapter, 33 including records held by an entity that provides services to the 34 individual. 35 (4) If an individual described in section 1 of this chapter is 36 incapable of giving consent, as determined by the attending 37 physician or as otherwise determined under state law, the name, 38 address, and telephone number of the individual's legal 39 representative. 40 Except as provided in subsections (c) and (d), the ombudsman must 41 obtain consent under subsection (b) before having access to the records 42 described in subdivision (3). EH 1689—LS 7675/DI 147 4 1 (b) Consent to have access to an individual's records shall be given 2 in one (1) of the following forms: 3 (1) In writing by the individual. 4 (2) Orally by the individual in the presence of a witness. 5 (3) In writing by the legal representative of the individual if: 6 (A) the individual is incapable of giving consent, as 7 determined by the attending physician or as otherwise 8 determined under state law; and 9 (B) the legal representative has the authority to give consent. 10 (c) If consent to have access to an individual's records cannot be 11 obtained under subsection (b), an ombudsman may inspect the records 12 of the individual if the individual is incapable of giving consent, as 13 determined by the attending physician or as otherwise determined 14 under state law, and: 15 (1) has no legal representative; 16 (2) has a legal representative but the legal representative cannot 17 be contacted within three (3) days; or 18 (3) has a legal representative but the legal representative does not 19 have the authority to give consent to have access to the records. 20 (d) If an ombudsman has: 21 (1) been denied access to an individual's records by the 22 individual's legal representative; 23 (2) reasonable cause to believe that the individual's legal 24 representative is not acting in the best interests of the individual; 25 and 26 (3) received written approval from the state ombudsman; 27 the ombudsman may inspect the records of the individual. 28 SECTION 7. IC 12-11-13-8 IS AMENDED TO READ AS 29 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 8. A provider of waiver 30 services or an employee of a provider of waiver services is immune 31 from: 32 (1) civil or criminal liability; and 33 (2) actions taken under a professional disciplinary procedure; 34 for the release or disclosure of records to the ombudsman under this 35 chapter. 36 SECTION 8. IC 12-11-13-10, AS AMENDED BY P.L.99-2007, 37 SECTION 86, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE 38 JULY 1, 2025]: Sec. 10. The ombudsman shall do the following: 39 (1) Promote effective coordination among the following: 40 (A) Programs that provide legal services for individuals with 41 a developmental disability. 42 (B) The division. EH 1689—LS 7675/DI 147 5 1 (C) Providers of waiver services to individuals with 2 developmental disabilities. 3 (D) Providers of other necessary or appropriate services. 4 (2) Ensure that the identity of an individual described in section 5 1 of this chapter will not be disclosed without: 6 (A) the individual's written consent; or 7 (B) a court order. 8 SECTION 9. IC 12-11-13-15 IS AMENDED TO READ AS 9 FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 15. The division shall: 10 (1) establish a statewide toll free telephone line continuously open 11 to receive complaints regarding individuals described in section 12 1 of this chapter; and 13 (2) forward all complaints received from the toll free telephone 14 line to the statewide waiver ombudsman. 15 SECTION 10. IC 12-15-1-14.5 IS ADDED TO THE INDIANA 16 CODE AS A NEW SECTION TO READ AS FOLLOWS 17 [EFFECTIVE JULY 1, 2025]: Sec. 14.5. (a) The office of the 18 secretary shall prepare a report on the provision of Medicaid home 19 and community based waiver services to recipients who have 20 medically complex conditions, including the following: 21 (1) The number of recipients who received services 22 categorized by recipients: 23 (A) less than; and 24 (B) at least; 25 eighteen (18) years of age. 26 (2) The county of residence of each recipient who received 27 services. 28 (3) The specific Medicaid state plan or Medicaid home and 29 community based waiver services used. 30 (4) A list of approved services that are not fully utilized by the 31 recipients. 32 (5) Any reason the services described in subdivision (4) are 33 not fully utilized. 34 (6) The cost of providing services categorized by: 35 (A) the type of service; and 36 (B) a recipient's medical diagnosis or condition, if known. 37 (7) Outcomes and performance metrics, including quality of 38 care. 39 (8) Recommendations to ensure the delivery of appropriate 40 high quality services to recipients, including the following: 41 (A) An evaluation of models of care for complex care 42 assistants utilized in other states, including the cost EH 1689—LS 7675/DI 147 6 1 effectiveness and outcomes. 2 (B) The feasibility of establishing a complex care assistant 3 program in Indiana. 4 (C) An analysis of the complex care assistant program 5 described in clause (B), including: 6 (i) potential benefits and risks to recipients and family 7 caregivers; 8 (ii) anticipated fiscal impact; 9 (iii) training and certification requirements; and 10 (iv) implementation challenges and strategies to address 11 the challenges. 12 (b) In developing the recommendations described in subsection 13 (a)(8), the office of the secretary shall consult with the office of 14 Medicaid policy and planning. 15 (c) Not later than September 1, 2025, and each September 1 16 thereafter, the office of the secretary shall submit the report 17 described in subsection (a) to the following: 18 (1) The Medicaid advisory commission, established by 19 IC 12-15-33-2. 20 (2) The Medicaid oversight committee, in an electronic format 21 under IC 5-14-6. 22 (3) The state budget committee. 23 (4) The legislative council, in an electronic format under 24 IC 5-14-6. 25 SECTION 11. IC 16-39-2-6, AS AMENDED BY P.L.137-2021, 26 SECTION 27, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE 27 JULY 1, 2025]: Sec. 6. (a) Without the consent of the patient, the 28 patient's mental health record may only be disclosed as follows: 29 (1) To individuals who meet the following conditions: 30 (A) Are employed by: 31 (i) the provider at the same facility or agency; 32 (ii) a managed care provider (as defined in IC 12-7-2-127); 33 or 34 (iii) a health care provider or mental health care provider, if 35 the mental health records are needed to provide health care 36 or mental health services to the patient. 37 (B) Are involved in the planning, provision, and monitoring of 38 services. 39 (2) To the extent necessary to obtain payment for services 40 rendered or other benefits to which the patient may be entitled, as 41 provided in IC 16-39-5-3. 42 (3) To the patient's court appointed counsel and to the Indiana EH 1689—LS 7675/DI 147 7 1 protection and advocacy services commission. 2 (4) For research conducted in accordance with IC 16-39-5-3 and 3 the rules of the division of mental health and addiction, the rules 4 of the division of disability and rehabilitative services, the rules 5 of the provider, or the rules of the Indiana archives and records 6 administration and the oversight committee on public records. 7 (5) To the division of mental health and addiction for the purpose 8 of data collection, research, and monitoring managed care 9 providers (as defined in IC 12-7-2-127) who are operating under 10 a contract with the division of mental health and addiction. 11 (6) To the extent necessary to make reports or give testimony 12 required by the statutes pertaining to admissions, transfers, 13 discharges, and guardianship proceedings. 14 (7) To a law enforcement agency if any of the following 15 conditions are met: 16 (A) A patient escapes from a facility to which the patient is 17 committed under IC 12-26. 18 (B) The superintendent of the facility determines that failure 19 to provide the information may result in bodily harm to the 20 patient or another individual. 21 (C) A patient commits or threatens to commit a crime on 22 facility premises or against facility personnel. 23 (D) A patient is in the custody of a law enforcement officer or 24 agency for any reason and: 25 (i) the information to be released is limited to medications 26 currently prescribed for the patient or to the patient's history 27 of adverse medication reactions; and 28 (ii) the provider determines that the release of the 29 medication information will assist in protecting the health, 30 safety, or welfare of the patient. 31 Mental health records released under this clause must be 32 maintained in confidence by the law enforcement agency 33 receiving them. 34 (8) To a coroner or medical examiner, in the performance of the 35 individual's duties. 36 (9) To a school in which the patient is enrolled if the 37 superintendent of the facility determines that the information will 38 assist the school in meeting educational needs of the patient. 39 (10) To the extent necessary to satisfy reporting requirements 40 under the following statutes: 41 (A) IC 12-10-3-10. 42 (B) IC 12-24-17-5. EH 1689—LS 7675/DI 147 8 1 (C) IC 16-41-2-3. 2 (D) IC 16-50-1-8. 3 (E) IC 31-25-3-2. 4 (F) IC 31-33-5-4. 5 (G) IC 34-30-16-2. 6 (H) IC 35-46-1-13. 7 (11) To the extent necessary to satisfy release of information 8 requirements under the following statutes: 9 (A) IC 12-24-11-2. 10 (B) IC 12-24-12-3, IC 12-24-12-4, and IC 12-24-12-6. 11 (C) IC 12-26-11. 12 (12) To another health care provider in a health care emergency. 13 (13) For legitimate business purposes as described in 14 IC 16-39-5-3. 15 (14) Under a court order under IC 16-39-3. 16 (15) With respect to records from a mental health or 17 developmental disability facility, to the United States Secret 18 Service if the following conditions are met: 19 (A) The request does not apply to alcohol or drug abuse 20 records described in 42 U.S.C. 290dd-2 unless authorized by 21 a court order under 42 U.S.C. 290dd-2(b)(2)(c). 22 (B) The request relates to the United States Secret Service's 23 protective responsibility and investigative authority under 18 24 U.S.C. 3056, 18 U.S.C. 871, or 18 U.S.C. 879. 25 (C) The request specifies an individual patient. 26 (D) The director or superintendent of the facility determines 27 that disclosure of the mental health record may be necessary 28 to protect a person under the protection of the United States 29 Secret Service from serious bodily injury or death. 30 (E) The United States Secret Service agrees to only use the 31 mental health record information for investigative purposes 32 and not disclose the information publicly. 33 (F) The mental health record information disclosed to the 34 United States Secret Service includes only: 35 (i) the patient's name, age, and address; 36 (ii) the date of the patient's admission to or discharge from 37 the facility; and 38 (iii) any information that indicates whether or not the patient 39 has a history of violence or presents a danger to the person 40 under protection. 41 (16) To the statewide waiver bureau of disabilities services 42 ombudsman established under IC 12-11-13, in the performance EH 1689—LS 7675/DI 147 9 1 of the ombudsman's duties. 2 (b) If a licensed mental health professional, a licensed paramedic, 3 a representative of a mobile integrated healthcare program (as 4 described in IC 16-31-12), or a representative of a mental health 5 community paramedicine program in the course of rendering a 6 treatment intervention, determines that a patient may be a harm to 7 himself or herself or others, the licensed mental health professional, the 8 licensed paramedic, the representative of the mobile integrated 9 healthcare program (as described in IC 16-31-12), or the representative 10 of the mental health community paramedicine program may request a 11 patient's individualized mental health safety plan from a psychiatric 12 crisis center, psychiatric inpatient unit, or psychiatric residential 13 treatment provider. Each psychiatric crisis center, psychiatric inpatient 14 unit, and psychiatric residential treatment provider shall, upon request 15 and without the consent of the patient, share a patient's individualized 16 mental health safety plan that is in the standard format established by 17 the division of mental health and addiction under IC 12-21-5-6 with the 18 following individuals who demonstrate proof of licensure and commit 19 to protecting the information in compliance with state and federal 20 privacy laws: 21 (1) A licensed mental health professional. 22 (2) A licensed paramedic. 23 (3) A representative of a mobile integrated healthcare program (as 24 described in IC 16-31-12). 25 (4) A representative of a mental health community paramedicine 26 program. 27 An individualized mental health safety plan disclosed under this 28 subsection may be used only to support a patient's welfare and safety 29 and is considered otherwise confidential information under applicable 30 state and federal laws. 31 (c) After information is disclosed under subsection (a)(15) and if the 32 patient is evaluated to be dangerous, the records shall be interpreted in 33 consultation with a licensed mental health professional on the staff of 34 the United States Secret Service. 35 (d) A person who discloses information under subsection (a)(7), 36 (a)(15), or (b) in good faith is immune from civil and criminal liability. 37 SECTION 12. IC 34-30-2.1-137, AS ADDED BY P.L.105-2022, 38 SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE 39 JULY 1, 2025]: Sec. 137. IC 12-11-13-8 (Concerning disclosure of 40 records to the statewide waiver bureau of disabilities services 41 ombudsman by providers of waiver services and employees of 42 providers). EH 1689—LS 7675/DI 147 10 1 SECTION 13. IC 34-30-2.1-138, AS ADDED BY P.L.105-2022, 2 SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE 3 JULY 1, 2025]: Sec. 138. IC 12-11-13-12 (Concerning the statewide 4 waiver bureau of disabilities services ombudsman). 5 SECTION 14. IC 35-52-12-2, AS ADDED BY P.L.169-2014, 6 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE 7 JULY 1, 2025]: Sec. 2. IC 12-11-13-16 defines a crime concerning 8 statewide waiver bureau of disabilities services ombudsman. 9 SECTION 15. [EFFECTIVE UPON PASSAGE] (a) As used in this 10 SECTION, "advisory council" refers to the division of disability 11 and rehabilitative services advisory council established under 12 IC 12-9-4. 13 (b) As used in this SECTION, "office" refers to the office of the 14 secretary of family and social services established by IC 12-8-1.5-1. 15 (c) The office shall provide to the advisory council a report, at 16 the advisory council's meetings, on the office's plan to provide 17 services to individuals who require extraordinary care as follows: 18 (1) Not later than June 1, 2025, the office shall: 19 (A) present to the advisory council the office's proposed: 20 (i) definition of "extraordinary care"; and 21 (ii) method for determining whether an individual 22 requires extraordinary care; and 23 (B) receive feedback from the advisory council on the 24 proposals described in clause (A). 25 (2) Not later than July 1, 2025, the office shall: 26 (A) present to the advisory council the office's proposed 27 Medicaid waiver amendment for the provision of services 28 for individuals who require extraordinary care, including 29 any information in the proposed amendment concerning: 30 (i) a structured family caregiving service arrangement; 31 or 32 (ii) reimbursement for the provision of services by 33 legally responsible individuals; and 34 (B) receive feedback from the advisory council on the 35 proposed amendment described in clause (A). 36 (3) Not later than August 1, 2025, the office shall present to 37 the advisory council any changes the office made to the 38 proposed amendment described in subdivision (2)(A) based on 39 feedback from: 40 (A) the advisory council; and 41 (B) public comments. 42 (d) At least five (5) days before each meeting described in EH 1689—LS 7675/DI 147 11 1 subsection (c), the office shall provide to the advisory council 2 written information the office intends to present at the meeting. 3 (e) This SECTION expires July 1, 2026. 4 SECTION 16. An emergency is declared for this act. EH 1689—LS 7675/DI 147 12 COMMITTEE REPORT Mr. Speaker: Your Committee on Public Health, to which was referred House Bill 1689, has had the same under consideration and begs leave to report the same back to the House with the recommendation that said bill be amended as follows: Page 6, delete lines 25 through 42. Delete page 7. Page 8, delete lines 1 through 37. Page 12, after line 21, begin a new paragraph and insert: "SECTION 15. [EFFECTIVE UPON PASSAGE] (a) As used in this SECTION, "advisory council" refers to the division of disability and rehabilitative services advisory council established under IC 12-9-4. (b) As used in this SECTION, "office" refers to the office of the secretary of family and social services established by IC 12-8-1.5-1. (c) The office shall provide to the advisory council a report, at the advisory council's meetings, on the office's plan to provide services to individuals who require extraordinary care as follows: (1) Not later than June 1, 2025, the office shall: (A) present to the advisory council the office's proposed: (i) definition of "extraordinary care"; and (ii) method for determining whether an individual requires extraordinary care; and (B) receive feedback from the advisory council on the proposals described in clause (A). (2) Not later than July 1, 2025, the office shall: (A) present to the advisory council the office's proposed Medicaid waiver amendment for the provision of services for individuals who require extraordinary care, including any information in the proposed amendment concerning: (i) a structured family caregiving service arrangement; or (ii) reimbursement for the provision of services by legally responsible individuals; and (B) receive feedback from the advisory council on the proposed amendment described in clause (A). (3) Not later than August 1, 2025, the office shall present to the advisory council any changes the office made to the proposed amendment described in subdivision (2)(A) based on feedback from: (A) the advisory council; and (B) public comments. EH 1689—LS 7675/DI 147 13 (d) At least five (5) days before each meeting described in subsection (c), the office shall provide to the advisory council written information the office intends to present at the meeting. (e) This SECTION expires July 1, 2026. SECTION 16. An emergency is declared for this act.". Renumber all SECTIONS consecutively. and when so amended that said bill do pass. (Reference is to HB 1689 as introduced.) BARRETT Committee Vote: yeas 12, nays 0. _____ COMMITTEE REPORT Mr. President: The Senate Committee on Health and Provider Services, to which was referred House Bill No. 1689, has had the same under consideration and begs leave to report the same back to the Senate with the recommendation that said bill be AMENDED as follows: Page 3, line 8, strike "developmental". Page 5, line 2, strike "developmental". and when so amended that said bill do pass. (Reference is to HB 1689 as printed February 4, 2025.) CHARBONNEAU, Chairperson Committee Vote: Yeas 12, Nays 0. EH 1689—LS 7675/DI 147