By Mike Brady
ISMA Director of Advocacy

Several laws passed in the 2018 legislative session will create new requirements for physicians when they take effect July 1.

The ISMA Government Relations team worked hard during the 2018 legislative session to reduce administrative requirements and ensure physicians remain the primary medical decision makers. A few new laws create mandates, but ISMA worked to make sure they would not unduly burden physicians. As these laws are implemented, we will continue to monitor any unintended consequences. If you have any questions on these new laws, please contact Mike Brady for further explanation.

Here is what Indiana physicians should know about laws taking effect July 1.

INSPECT (SEA 221): SEA 221 phases in the requirement for prescribers in various settings to check a patient’s prescription drug history in the INSPECT database each time before prescribing an opioid or benzodiazepine. However, INSPECT information for patients subject to a pain management contract need only be obtained every 90 days.

Also, beginning Jan. 1, 2019, all practitioners who distribute, dispense, prescribe, conduct research on or administer ephedrine, pseudoephedrine or a controlled substance must be certified to receive information from the INSPECT program. Waivers will be available for practitioners who don’t have access to the internet.

The new requirements take effect on the following dates.
  

July 1, 2018: All practitioners in settings where patients’ INSPECT data has been integrated into their electronic health records. Jan. 1, 2019: All practitioners who provide services to the patient in the emergency department of a hospital or a pain management clinic. Jan. 1, 2020: All practitioners providing services to the patient in a hospital. Jan. 1, 2021: All practitioners.

To register for INSPECT and to check patients’ records, go to https://indiana.pmpaware.net/login.

Continuing medical education (SEA 225): SEA 225 is effective from July 1, 2018, until July 1, 2025. It requires physicians to complete two hours of continuing medical education on best practices for opioid prescribing every two years. The Indiana Professional Licensing Agency will maintain a schedule of approved courses on its website.

Newborn screening (HEA 1017 and HEA 1287): HEA 1017 took effect April 1. It adds spinal muscular atrophy and severe combined immunodeficiency to the list of conditions for which all newborns must be tested. HEA 1287, which takes effect July 1, requires that blood not be drawn from infants for screening until 24 hours after birth, except for preterm infants or newborns who receive a total exchange blood transfusion. If an infant is discharged within 24 hours of birth, the blood must be drawn immediately before discharge, with a second sample taken two to five days after birth.

Physician order for scope of treatment (HEA 1119): HEA 1119 identifies family members and other individuals who may (and may not) consent to health care treatment for someone who cannot consent for themselves, and assigns them priority levels. Once health care providers determine a patient cannot consent to care, the law directs them to try to identify high-priority-level individuals who can give consent, including by examining the patient’s medical records and personal effects, and to try to contact them by telephone or other means. If multiple decision-makers at the same priority level are available, they are to try to agree on health care decisions for the patient; if they cannot reach consensus, the majority controls. The law does not create a duty to provide treatment if the patient has executed a POST form.

Prior authorization (HEA 1143): HEA 1143 provides doctors with more certainty about health plans’ processing of prior authorization (PA) requests. Starting Sept. 1, a health plan must disclose any new requirement for PA to providers at least 45 days before the requirement becomes effective, including publishing the disclosure conspicuously on the health plan’s website.

For any PA requests delivered to a health plan after Dec. 21, 2019:

• A health plan must respond to an urgent care PA request within 72 hours of receiving it and respond to a non-urgent request no more than seven days after receipt. If a request for PA is denied, the health plan must state the specific reason for the denial.
• If a health plan has granted a PA request for a service, it cannot deny payment on a claim for that service unless the claim or request contains fraudulent or materially incorrect information or the patient was not covered under the health plan on the date the service was provided.

Suspected human trafficking (HEA 1191): HEA 1191 removes a disincentive for victims of human trafficking to seek medical care. It removes the requirement that physicians and other licensed health practitioners report suspicions that an adult patient is a victim of human trafficking to the Department of Child Services or a local law enforcement agency. It also requires licensed health practitioners to provide information on available resources and services, including the telephone number for the National Human Trafficking Hotline, 1 (888) 373-7888, to any patient who is a suspected victim of human trafficking.

Scleral tattooing (SEA 158): SEA 158 defines scleral tattooing and permits only licensed health care professionals acting within the scope of their practice to perform it. Violators may be assessed a civil penalty of up to $10,000.

Issues referred for summer study
The following issues were referred for summer study.

1. Issues related to use of medical marijuana

2. The impact that opioid treatment programs have on the neighborhoods and communities in the immediate area of the programs as it relates to:

• Criminal activity
• Emergency medical services
• Local economy
• Quality of life
• Other issues

3. The impact that joining the nurse licensure compact would have on the delivery of nursing services to residents of Indiana

4. Supplemental Nutrition Assistance Program (SNAP)

5. The fiscal, economic and workforce development impact of Indiana smoking rates