LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
FISCAL IMPACT STATEMENT
LS 6330 NOTE PREPARED: Dec 13, 2024
BILL NUMBER: SB 185 BILL AMENDED:
SUBJECT: Coverage for Parkinson's and Alzheimer's Patients.
FIRST AUTHOR: Sen. Dernulc BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
FEDERAL
Summary of Legislation: This bill prohibits a health plan from requiring a participating provider to obtain
prior authorization for a health care service that is used to diagnose or treat Alzheimer's disease, dementia
or a related cognitive disorder, or Parkinson's disease.
Effective Date: July 1, 2025.
Explanation of State Expenditures: The bill will increase workload for the Indiana Department of
Insurance (DOI) to ensure compliance with the bill’s prior authorization requirements, but should be able
to be implemented using existing staffing and resources. [The DOI is funded through a dedicated agency
fund.]
The bill is expected to have minimal impact on expenditures for the state employee health plan (SEHP) and
the state Medicaid program.
Additional Information: When an individual is eligible for both Medicare and Medicaid (dual eligible),
Medicare is considered the primary coverage, meaning it pays first, while Medicaid acts as the secondary
payer, only covering costs not covered by Medicare. Currently, Medicare covers visits for the review of
cognitive functions, to establish or confirm a diagnosis of dementia, and to develop a care plan. It also covers
outpatient prescription drugs for Alzheimer's and other forms of dementia.
Roughly 95% of individuals age 65 and older in the U.S. are covered by Medicare. An estimated 95% of all
individuals diagnosed with a form of dementia are age 65 or older, meaning they are likely to be covered by
Medicare. Approximately 121,000 adults age 65 and older in Indiana are living with a form of dementia
(including those diagnosed with Alzheimer's or Parkinson's disease). There are approximately 1.37 M
Hoosiers enrolled in Medicare.
Currently, the SEHP does not require prior authorization for the diagnosis of diseases that result in dementia,
such as Alzheimer’s and Parkinson’s, nor for imaging such as an MRI or PET/CT scan (under certain
circumstances).
SB 185 1 Explanation of State Revenues:
Explanation of Local Expenditures: The bill is expected to have minimal impact on expenditures for local
units offering certain types of health plans. [See Explanation of State Expenditures.]
Explanation of Local Revenues:
State Agencies Affected: Indiana Department of Insurance; State Personnel Department; Family and Social
Services Administration.
Local Agencies Affected: Local units offering certain types of health plans.
Information Sources: Christy Tittle, SPD; Alzheimer's Association, 2024 Facts and Figures,
https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf;
https://www.medicare.gov/coverage/cognitive-assessment-care-plan-services;
https://www.kff.org/statedata/election-state-fact-sheets/indiana;
https://www.census.gov/library/stories/2024/04/older-adults-health-coverage.html.
Fiscal Analyst: Jason Barrett, 317-232-9809.
SB 185 2