Indiana State Medical Association Public Policy

Advertising
(6/10/84, BOT) Reaffirmed its position that the ISMA continue to use the American Medical Association's guidelines pertaining to advertising as contained in its "Reference Guide to Policy & official Statements" and its "Current Opinions of the Council on Ethical and Judicial Affairs."

AIDS ( Acquired Immune Deficiency Syndrome)

(RESOLUTION 01-23) RESOLVED, that the ISMA support legislative change to exempt health care workers from having to obtain consent for HIV testing in situations where a health care worker is inadvertently exposed to blood or other biological contamination from patients in the course of medical care. All other statutes of the law must remain in effect.

(RESOLUTION 01-22) RESOLVED, that the ISMA advocate to the Indiana General Assembly and the Indiana State Department of Health mandatory HIV testing for all pregnant women and the newborn infant if the mother is HIV positive. (Passed 2003, HB 1630).

(READOPTED 99, HOD; RESOLUTION 89-42) RESOLVED, that: (1) the ISMA support and endorse a program that requires more broad-based testing for HIV; (2) upon reporting of a positive result (confirmatory), the State Board of Health would be required to begin case-finding and case-contacting activities with those individuals who have been reported as testing positive as with many other STD’s; and (3) hospital admittees should be appropriately tested for HIV; and be it further,

RESOLVED, that the disease be treated as an infectious disease so that we may maintain control until a cure is found.

(RESOLUTION 98-10) RESOLVED, that the ISMA endorse and support HIV testing as a part of routine testing during the first trimester of pregnancy; and be it further,

RESOLVED, that the ISMA support the concept that all pregnant mothers be given material about and counseling for HIV disease. (2nd Resolved passed 2003, HB 1630.)

(RESOLUTION 97-19A) RESOLVED, that the ISMA initiate legislative action that would modify current Indiana statutes to allow all physicians to practice appropriate medical care and order HIV testing on any patient as medically indicated.

(8/25/91, BOT) Approved the CDC guidelines and AMA policy on HIV/HBV infected health care workers.

(8/13/89, BOT) 1989 HOD filed the following Supplementary Board Report:

Delivery of care - While the ISMA recognizes that physicians have an ethical obligation to treat all patients, it believes physicians should recognize any limitations of their training and expertise and refer an AIDS patient to a specialist if the patient would receive better treatment.

Discrimination - the ISMA recognizes that the cause of AIDS is a virus, not aberrant social behavior, and condemns discrimination of any sort against AIDS/HIV positive patients. the ISMA applauds the position adopted by the Indiana Civil Liberties Union making AIDS discrimination an unlawful activity in this state.

Education - Supported mandatory sex education and drug education, beginning in kindergarten and continuing through elementary and secondary schools. While the ISMA encourages physician education, it finds no evidence to support imposing mandatory AIDS education on physicians. the ISMA supports the concept of the Indiana State Board of Health funding regional AIDS treatment and educational centers.

Health care workers - the ISMA believes that the decision for HIV-infected health care workers to continue patient contact is a decision that must be determined on an individual basis, based on the opinions of the worker's personal physicians and the medical directors of the employing institution.

Testing - While the ISMA recognizes that the testing issue raises a variety of ethical, legal and financial concerns, it believes the following principles should be observed in the design of testing procedures:

Testing should be an individual physician/patient decision, not a regulatory issue; there should not be legal impediments to testing when a treating physician feels it is appropriate;

For epidemiological purposes, the ISMA supports an increase in the prevalence of anonymous testing; and the ISMA supports the development of anonymous and confidential testing mechanisms.

Alcohol

(RESOLUTION 00-27) RESOLVED, that the ISMA seek a legislative study to determine the current and desired status of police and court records being filed in a timely manner and the accessibility of such information to governmental agencies, especially of arrests and convictions of driving under the influence of alcohol; and be it further,

RESOLVED, that blood alcohol testing be mandated for all drivers involved in all motor vehicle accidents with fatalities.

(RESOLUTION 00-26) RESOLVED, that the ISMA introduce legislation or support legislation that would lower the acceptable BAC level in Indiana so that .08 percent BAC level constitutes prima facie evidence of intoxication and seek harsher penalties for driving while intoxicated.

(RESOLUTION 00-25) RESOLVED, that the ISMA reaffirm its policy passed in RESOLUTION 98-29 regarding underage drinking; and be it further,

RESOLVED, that the ISMA seek legislation increasing the minimum age of sellers of alcoholic beverages to 21; and be it further,

RESOLVED, that the ISMA seek legislation to require responsible beverage service training for all servers of alcoholic beverages.

(READOPTED 99, HOD; RESOLUTION 89-1) RESOLVED, that the ISMA introduce and support legislation that would lower the blood alcohol level in Indiana so that .08% blood alcohol level constitutes prima facie evidence of intoxication.

(RESOLUTION 98-29) RESOLVED, that the ISMA support legislation in the 1999 session of the Indiana General Assembly to:

Enforce stricter penalties for those who violate the “no sales to minors” law.
Require establishments that sell alcohol to pass random and unannounced compliance checks.
Ensure proper training in responsible beverage service for those who serve alcohol.
Raise the minimum selling age from 18 to 21.
Register keg purchases.
Require valid identification (ID) for home delivered alcohol products.
Raise the excise tax on alcohol.

(RESOLUTION 98-12) RESOLVED, that the ISMA attempt to introduce legislation or support legislation that would reduce the acceptable blood alcohol content to at least .08.

Alternative Medicine

(1/20/99, BOT) Accepted the ISMA Alternative Medicine Task Force’s recommendations for non-licensure of the following activities. Specific recommendations for these activities are noted below.

Therapeutic Touch - the use of hands to restore areas of blockage in a patient’s energy field.

Recommendation: Specific guidelines for therapeutic touch are neither recommended nor necessary.

Body-Mind Intervention - the practice of influencing the body’s own healing response through psychological interventions.

Recommendation: Body-mind intervention is broad in spectrum and used in everyday practices of many traditional practitioners and therapists. Appropriate training and certification in the underlying disciplines are recommended. Mind-body interventions are, in general, supported by the scientific literature. However, some mind-body interventions are less studied and not as well documented.

Chelation - Incorporation of a metal ion into a heterocyclic ring structure -- in alternative medicine practices, chelation refers to the use of chelating agents to reverse atherosclerotic vascular disease and thus decrease angina pectoris and claudication.

Recommendation: the use of chelation solution for the treatment of atherosclerosis is an off-label use and not approved by the U.S. Food and Drug Administration (FDA). there are no valid scientific studies showing beneficial effects using chelating agents to reverse atherosclerosis. the Task Force recommends chelating agents only be used for FDA approved conditions (e.g. heavy metal poisoning).

Reflexology – the physical act of applying pressure to the feet and hands with techniques that do not utilize oil, cream or lotion. It is based on the principle that there are no more than seven thousand nerve endings in the feet relative to every organ, gland, tissue or muscle in the body.

Recommendation: Reflexology seems to be considered most often by people seeking pain relief, but there is no hard data substantiating the claims of the practitioners of reflexology. However, there does not appear to be any substantial harm that could result from treatment.

Homeopathy – A natural pharmaceutical science utilizing plants, minerals or animals in very small doses to stimulate the sick person’s natural defenses. the fundamental belief is that by giving a small amount of the offending substance, the patient’s body seeks to reestablish balance. Thus, the homeopathic substances are felt to work with the patient’s natural defense mechanisms.

Recommendation: Homeopathy has limited data supporting its efficacy and safety, though little risk has been identified. Homeopathic principles and treatments may compliment allopathic treatment in certain conditions.

Massage therapy – the act of treating the body by rubbing the body to stimulate the circulation, to induce suppleness or to release endorphins. Massage therapy is currently a recognized alternative therapy by the Office of Alternative therapies under the National Institutes of Health. Practitioners are eligible for certification through the American Massage therapy Association.

Recommendation: Consumers should verify certification when using this alternative therapy.

(8/25/85, BOT) Support the position of the AMA that there is no scientific documentation that the use of chelation therapy is effective in the treatment of cardiovascular disease, rteriosclerosis, rheumatoid arthritis or cancer; and further, if chelation therapy is to be considered a useful medical treatment for anything other than heavy metal poisoning, hyper-calcemia, or digitalis toxicity, it is the responsibility of its proponents to: (1) conduct properly controlled scientific studies; (2) adhere to U.S. Food and Drug Administration (FDA) guidelines for the investigation of drugs; and (3) disseminate results of scientific studies in the usual, accepted channels.

Ambulatory Surgical Centers

(RESOLUTION 03-20) RESOLVED, that the ISMA support the right of patients to choose the setting in which their care is delivered; and be it further,

RESOLVED, that the ISMA oppose any legislation that would restrict a patient’s right to choose a facility including one in which the physician has an ownership interest.

Any Willing Provider

(RESOLUTION 03-7) RESOLVED, that the ISMA continue to support “Any Willing Provider” language at the conceptual, contractual and legal levels.

Autopsies

(RESOLUTION 01-26) RESOLVED, that the ISMA support changes to Indiana law regarding the confidentiality of autopsy information to ensure that:

The statute allows for reasonable efforts to remove identifiable information in cases where physicians in possession of autopsy images use them for the purposes allowed by the law.
Violating this statute is not a felony under the law.
The statute make allowances for other professional uses of autopsy information besides training and educational purposes, such as submission of articles for medical journals and other legitimate activities related to the medical profession.
The statute specifically defines what identifying information cannot be in an image or recording when used for educational purposes.

Blood Donations

(4/10/88, BOT) Approved the following Blood Bank Task Force recommendations:

Since directed donors are no safer than volunteer donors, directed donor units should not be expected to be processed for emergency situations. Emergency care should not be delayed because of lack of directed donor units.
Under usual circumstances, three days should be expected from the time the donor unit is drawn until the time that the donor unit arrives at the hospital.
In order to maintain the integrity of the centralized blood system, the primary responsibility for autologous and directed donations should remain with the blood centers and not with individual hospitals. the blood centers in cooperation with the hospitals should continue to provide ready access and donor convenience for these services.

Cancer Prevention

(RESOLUTION 04-09) RESOLVED, that the ISMA endorse and support the Indiana Cancer Coalition’s Cancer Control Plan; and be it further,

RESOLVED, that the ISMA refer the Indiana Cancer Coalition’s Cancer Control Plan to its component societies; and be it further,

RESOLVED, that the ISMA support legislative or administrative efforts to accomplish the goals articulated in the Indiana Cancer Coalition’s Cancer Control Plan.

(6/7/87, BOT) Approved the ISMA's participation in the Indiana State Board of Health's Breast Screening Awareness Project.

Cemeteries, Destruction of

(RESOLUTION 99-49) RESOLVED, that physicians recognize the emotional family health issues involved in cemetery destruction; and be it further,

RESOLVED, that physicians be aware of community issues such as the protection of rural cemeteries from destruction by real estate developers.

Certificate of Need

(1/13/80, BOT) Supported the ISMA continuing to vigorously oppose any certificate of need legislation and seeking the exclusion of physician Offices should certificate of need legislation become inevitable.

Clinical Laboratory Improvement Amendments (CLIA)

(RESOLUTION 03-8) RESOLVED, that the ISMA continue to support beneficial modification and/or repeal of CLIA legislation at both the state and national levels.

Clinics

(RESOLUTION 02-10) RESOLVED, that the ISMA encourage the state of Indiana to make available to eligible physicians any grants or awards that would be available to nurse-managed clinics to provide similar health care services; and be it further,

RESOLVED, that the Indiana AMA Delegation submit a resolution to the AMA to seek a change in federal rules that would allow physicians to apply for and receive grants or other awards to provide medical services now reserved for only nurse-managed clinics or other limited license providers.

(READOPTED 99, HOD; RESOLUTION 89-28A) RESOLVED, that the ISMA, in cooperation with interested governmental Offices and organizations, such as the State Department of Education, the State Board of Health, the Indiana State Teachers Association, the Indiana School Board Association and others, establish a mechanism to assure sound and reasonably available medical advice to elementary and secondary schools for development and interpretation of health policies and curricula.

(7/7/87, BOT) Endorsed opposition to school-based health clinics.

(3/5/78, BOT; 3/28/79, EC) Agreed with the Indiana Medical Licensing Board's interpretation of the Medical Practice Act which opposes independent practice of medicine by non-physicians, including the use of protocols for nurse practitioners and physicians' assistants as a substitute for close physician supervision. Additionally, ISMA opposes the concept of peripheral clinics, which utilize minimal supervision.

Collective Bargaining

(RESOLUTION 99-29A) RESOLVED, that the ISMA study the voluntary, patient-oriented provisions of collective bargaining based on the AMA model legislation for collective bargaining.

(RESOLUTION 99-23) RESOLVED, that the ISMA work to educate members concerning a physician negotiating organization and solicit members’ input concerning such an organization.

Copying Fees

(RESOLUTION 05-39) RESOLVED, that the ISMA shall support legislation or administrative rules that propose that copying fees for legal documents shall be at the same rate as mandated by statute for copying of medical documents.

Corporal Punishment

(RESOLUTION 04-33) RESOLVED, that current ISMA policy on prohibiting corporal punishment be reaffirmed; and be it further,

RESOLVED, that the ISMA encourage schools and licensed daycare facilities to develop and implement effective, innovative, appropriate and positive behavioral management programs.

Corporate Responsibility

(RESOLUTION 02-15) RESOLVED, that the ISMA support changes in the corporate bankruptcy process to include the corporate obligation of direct interaction with employees regarding health insurance options when the bankruptcy process begins, and coverage of preexisting medical claims before executive parachutes and compensations are paid.

Data Collection

(RESOLUTION 03-37) RESOLVED, that the ISMA encourage physicians and physician groups to calculate total costs for mandated requirements of CLIA, OSHA, HIPAA, Medicare, Medicaid, private carriers, etc.; and be it further,

RESOLVED, that the ISMA collect such data; and be it further,

RESOLVED, that the ISMA use the data to encourage fairer reimbursement from public and private payers; and be it further,

RESOLVED, that the ISMA use the data to discourage additional unfunded requirements (mandates).

Death, Definition of

(READOPTED 99, HOD; RESOLUTION 85-16) Endorsed the Indiana Uniform Determination of Death Act.

Dietary Supplements

(RESOLUTION 04-30) RESOLVED, that the ISMA work with legislators to encourage passage of legislation that would lead to government supervision to ensure content and purity of over-the-counter supplements while continuing to otherwise support the Dietary Supplement Health and Education Act passed by Congress that does not evaluate product safety or efficacy.

(RESOLUTION 02-11) RESOLVED, that the ISMA oppose the over-the-counter sale of ephedrine, Pseudoephedrine and ephedra; and be it further,

RESOLVED, that the ISMA inform its members and the citizens of Indiana of the potential dangers of ephedrine, Pseudoephedrine and ephedra; and be it further,

RESOLVED, that the ISMA collaborate with other agencies and organizations to ban the over-the-counter sales of ephedrine, Pseudoephedrine and ephedra in Indiana.

RESOLUTION 01-24A) RESOLVED, that the ISMA advocate to state or national agencies or organizations the creation of a mechanism for reporting, tracking and alerting physicians regarding adverse reactions experienced by patients using “health foods,” such as, nutritional and dietary supplements and herbal products, and that ISMA be involved in a manner that facilitates the flow of useful information on this subject to and from Indiana physicians.

Driving – Safety

(RESOLUTION 01-13) RESOLVED, that the ISMA support public and physician education that addresses all aspects of driving safety, including but not limited to, driver distraction.

(RESOLUTION 01-9) RESOLVED, that the ISMA petition the Indiana General Assembly to enact legislation that would:

Under age 15: Delay/suspend any and all driving privileges by one year from the onset of eligibility for any youth found guilty in a court of law of harboring a weapon at school or using a weapon to commit a violent act;
Age 15 and over: Immediately suspend all current driving privileges or eligibility for one year by any youth found guilty in a court of law of harboring a weapon to commit a violent act.
Delay/suspend all driving privileges to age 21 for any youth if a second offense/violation is committed.

(RESOLUTION 00-58) RESOLVED, that ISMA seek a proper study be made of accidents that have occurred while drivers’ attention has been distracted by the use of electronic communication devices .

(RESOLUTION 00-1) RESOLVED, that the ISMA support legislation requiring that Indiana should adopt graduated licensing requirements for young drivers consistent with recommendations from the National Highway Traffic Safety Administration; and be it further,

RESOLVED, that restrictions on carrying passengers shall be included in graduated licensing systems for young drivers.

(RESOLUTION 97-51A) RESOLVED, that the ISMA encourage investigation and education regarding the dangers of operating a telephone device while driving.

(3/75, BOT) That physicians be willing to submit data and do physical examinations for third parties but not be responsible for judging a person's insurability or ability to drive.

Emergencies, Medical

(RESOLUTION 04-23) RESOLVED, that the ISMA encourage county medical societies to work within their local school districts to see that automatic external defibrillators are placed in schools in a central and accessible location near a telephone, according to recommendations in the American Heart Association Medical Emergency Response Plan for Schools.

(RESOLUTION 04-17) RESOLVED, that the ISMA pursue legislative changes to the Good Samaritan statute that will clarify the intent of the Indiana legislature to apply the Good Samaritan statute to not only accidents but also emergency situations, regardless of locality.

(RESOLUTION 04-10) RESOLVED, that ISMA encourage county medical societies to work with their local school corporations to ensure that there are CPR-trained staff at each school; and be it further,

RESOLVED, that where no trained staff are available, the county medical society facilitate, support, arrange or encourage schools to collaborate with the local Red Cross or American Heart Association affiliate to provide CPR training for school staff members on a yearly basis.

(RESOLUTION 01-18) RESOLVED, that the ISMA seek and support legislation that requires all EMTs to be trained and authorized to appropriately administer epinephrine to patients under the age of 18 for all anaphylactic reactions.

(RESOLUTION 97-27) RESOLVED, that the ISMA support a policy stating that if a medical emergency is declared on a commercial passenger flight, the passenger physician (acting as a Good Samaritan) who has medically evaluated the situation be consulted on any decision to land, divert or continue flying; and be it further,

RESOLVED, that the leadership and members of the ISMA write to Representatives and Senators in Washington, D.C. with copies forwarded to the FAA, petitioning them to draft and submit national legislation not only mandating all commercial passenger airlines operating in U.S. airspace carry adequately equipped, compact medial kits on each flight, but also granting any physician or medical professional, acting in the role of a Good Samaritan during an in-flight medical emergency an umbrella of immunity against any legal or personal redresses by the airline, the passengers or the persons involved in the medical emergency; and be it further,

RESOLVED, that the ISMA submit a similar resolution to the next AMA House of Delegates.

(8/11/82, EC) General support for the several emergency medical identification systems (jewelry); however, no endorsement for any particular manufacturer.

(8/15/79, EC) Discourages the use of hospital emergency rooms for non-emergency problems.

Firearms

(RESOLUTION 05-19) RESOLVED, that the ISMA support efforts to prohibit individuals from being granted a firearm license who have been (1) convicted of a crime of domestic violence (unless the courts have restored the person’s right to possess a firearm) or (2) issued a court order not to possess a firearm.

(RESOLUTION 04-40) RESOLVED, that the ISMA support legislation to curtail the flow of weapons for use in criminal activity by requiring the sale of guns at gun shows to meet the same background check requirements as sales by licensed gun dealers.

(RESOLUTION 01-11A) RESOLVED, that the House of Delegates reaffirm its support of current ISMA Public Policy, which states as follows:

FIREARMS (RESOLUTION 00-30A) RESOLVED, that the ISMA advocate educational programs for the responsible use and storage of firearms; advocate comprehensive health education as a means of addressing social issues such as violence and urge incorporation of such health education into our societal framework; support scientific research and objective discussion aimed at identifying causes and of finding solutions to the crime and violence problem; and support vigorous enforcement of existing gun laws and support free enjoyment of rights granted under the Constitution to law-abiding citizens.

(RESOLUTION 01-10) RESOLVED, that the ISMA petition the Indiana General Assembly to enact legislation charging an adult with a misdemeanor who:

Knowingly, intentionally or recklessly stores or leaves a gun where a child can gain access to it, and if

That child threatens or harms himself or herself or another person, the crime should be considered a felony if the events above result in serious bodily injury or death.

(RESOLUTION 00-30A) RESOLVED, that the ISMA advocate educational programs for the responsible use and storage of firearms; advocate comprehensive health education as a means of addressing social issues such as violence and urge incorporation of such health education into our societal framework; support scientific research and objective discussion aimed at identifying causes and of finding solutions to the crime and violence problem; and support vigorous enforcement of existing gun laws and support free enjoyment of rights granted under the Constitution to law-abiding citizens .

(2000, HOD) Approved an ISMA BOT report that recommended the ISMA support a state ban on “Saturday Night Specials” to be implemented by legislation by the year 2002.

Health Care Interpreters

(RESOLUTION 04-04) RESOLVED, that the ISMA continue to strive for legislation allowing translators to bill Medicare, Medicaid or private insurance directly when medical translation is necessary.

Health Care System

(RESOLUTION 04-35) RESOLVED, that the ISMA support the need for development and oversight of a statewide trauma system, including the legislative designation of the Indiana State Department of Health as the lead state agency for such oversight and development.

(RESOLUTION 03-22) RESOLVED, that the ISMA support a concept of a voluntary plan to provide medical care to the uninsured.

(READOPTED 99, HOD; RESOLUTION 86-45) RESOLVED, that ISMA constantly support and promote the concept of the private practice of medicine on a fee-for-service basis regardless of any other methodology embraced by members of the organizations, and be it further,

RESOLVED, that organized medicine should and does support a pluralistic system of health care delivery; nevertheless the ISMA should stand ever ready to vigorously defend the traditional private practice, fee-for-service method or any other legitimate system when such is attacked from within or without organized medicine.

(READOPTED 99, HOD; RESOLUTION 86-7) RESOLVED, that physicians of Indiana will not compromise the quality of medical care because of financial incentives.

(READOPTED 99, HOD; 1978, HOD) Any ancillary screening group should be encouraged to submit a plan to the local medical society where the program is going to take place for the society's approval and assistance to ensure there is no overlap of services and general waste of funds at the local, state or federal levels.

(7/15/79, BOT) That the optimal patient-physician relationship is founded in freedom of choice and mutual responsibility--a relationship best achieved under a fee-for-service system for the delivery of medical services.

Health Commissioner, Office of

(RESOLUTION 98-26) RESOLVED, that the ISMA strongly advise and encourage the legislators of the state of Indiana to resist any and all efforts by several county executive bodies or others to change, revise, substitute, repeal, modify or eliminate the office itself, matters pertaining to the qualifications for, or the methods of appointment to, the office.

Health Professions Bureau / Licensing Issues

(RESOLUTION 05-04) RESOLVED, that the ISMA request the Indiana Health Professions Bureau to redesign its Web site from “the ground up,” making a simple, concise renewal process for both medical licenses and controlled substance licenses by enabling an easy “check-out” process that is similar to many other Web sites and by allowing both licenses to be renewed at the same time, as they are nearly always renewed in the same month.

(RESOLUTION 04-47) RESOLVED, that the ISMA advocate, encourage, support and urge our state legislature to follow the Patient Safety Subcommittee of the Commission on Excellence in Health Care’s recommendation that our state Medical Licensing Board statutes and rules be modernized by emulating the Model Medical Practice Act of the Federation of State Medical Boards; and be it further,

RESOLVED, that ISMA’s support of the Patient Safety Subcommittee of the Commission on Excellence in Health Care recommendations conform to existing ISMA policies.

(RESOLUTION 04-26) RESOLVED, that the ISMA seek legislation requiring licensure fees health providers pay to the state of Indiana go directly to the budget of the Medical Licensing Board rather than the general fund of the state budget.

(RESOLUTION 03-38A) RESOLVED, that the ISMA recognizes the benefit of placing a psychiatrist on the Medical Licensing Board; and be it further,

RESOLVED, that if a psychiatrist is placed on the Medical Licensing Board that it be done in collaboration with the president of the Indiana Psychiatric Association.

(RESOLUTION 01-20) RESOLVED, that the ISMA consult with the Attorney General’s Office to explore the possibility of providing volunteer physicians who can serve to render assistance to that Office.

(RESOLUTION 01-19) RESOLVED, that the ISMA work with the attorney general to mutually agree upon rules of conduct by that Office in the management of cases involving professionals who have received a consumer complaint. Specifically, this dialogue should accomplish the following:

Consumer complaints should remain confidential until charges have been filed except to acknowledge receipt.

No public announcements should be made regarding professionals (until full investigation has been completed).

No hearings will be scheduled until after discussion with a defendant to allow adequate time to prepare the defense.

Temporary suspensions cannot last indefinitely.

(RESOLUTION 00-48) RESOLVED, that the ISMA seek support from the governor and the legislature to adequately fund and improve the operation of the Health Professions Bureau.

(READOPTED 99, HOD; RESOLUTION 87-16) RESOLVED, that the ISMA consult with the health Professions Bureau to establish a better method whereby the Health Professions Bureau will immediately notify the appropriate entities of actions taken.

RESOLUTION 95-51) RESOLVED, that the medical license fees paid by all physicians be put in a dedicated fund for the exclusive use of the Medical Licensing Board so it will have adequate funds to perform its mission of protecting the public.

Health Services - Local

(RESOLUTION 99-6) RESOLVED, that the ISMA request the Indiana General Assembly, in concurrence with the governor, fund all mandates passed to local health departments in order to assure the public health workforce is adequate to protect the health of Indiana's citizens; and be it further,

RESOLVED, that the ISMA ask the Indiana General Assembly that adequate funds to carry out present state health mandates be provided by state budgetary appropriation for county health departments beginning July 1, 2001 and ending June 30, 2003.

Healthy Lifestyles

(RESOLUTION 05-43) RESOLVED, that the ISMA collaborate with the Indiana State Department of Health, Indiana county health departments, Indiana Hospital and Health Association and other appropriate public health and primary care physician associations with the intent to promote at least annual disease screening and educational programs in every Indiana county. The goals of this effort would include detecting chronic diseases, encouraging individuals to seek treatment and educating Hoosiers about healthy lifestyles.

(RESOLUTION 05-08) RESOLVED, that the ISMA develop further efforts to educate and encourage healthy lifestyles.

(RESOLUTION 05-06) RESOLVED, that the ISMA work with schools to encourage programs to educate and promote a more active and healthy lifestyle, with special attention given to children; and be it further,

RESOLVED, that the ISMA discourage active promotion of unhealthy food, drinks and lifestyles in schools.

Heimlich Maneuver

(4/9/80, EC) Supports the Heimlich Maneuver as an appropriate emergency procedure for choking victims.

Helmets – Bicycle/Motorcycle

(RESOLUTION 99-43) RESOLVED, that the ISMA support legislation requiring children under the age of 16 to wear a properly fitted safety helmet when operating a bicycle or riding as a passenger on a street, highway or public bicycle path.

(READOPTED 99, HOD; RESOLUTION 85-17) RESOLVED, that the ISMA support legislation to require protective headgear to be worn by all drivers and passengers of motorcycles.

(RESOLUTION 98-4) RESOLVED, that the ISMA support legislation calling for mandatory use of bicycle helmets for minors and consider it mandatory for adults.

HIV

See: Acquired Immune Deficiency Syndrome (AIDS).

HMOs

(RESOLUTION 98-37) RESOLVED, that the ISMA seek legislation to place liability for medical malpractice on an HMO that makes a determination of medical necessity contrary to a recommendation of a patient’s physician that falls within normal standards of medical practice and includes contractually covered medical services.

(RESOLUTION 98-34) RESOLVED, that medical directors of insurance entities be held accountable and liable for medical decisions regarding contractually covered medical services; and be it further,

RESOLVED, that the ISMA undertake whatever legislative and regulatory measures necessary to bring about this accountability; and be it further,

RESOLVED, that the ISMA direct the Indiana delegation to the AMA to convey this resolution to the AMA for implementation into AMA policy and federal legislative agenda at the 1998 interim meeting of the AMA; and be it further,

RESOLVED, that the ISMA ask that insurance entities be required to explain to the covered members what is and what is not a contractually covered medical service.

(7/15/79, BOT) the ISMA in its support of pluralistic health care delivery systems recognizes freestanding, prepaid capitation programs as one form of delivery of medical services. the presence of such programs in a community may provide a choice to the individual patient under certain circumstances. However, an objective evaluation of all forms of medical care delivery systems can only exist in an atmosphere free of artificial restraints on or advantages to any one delivery system. therefore, the ISMA strongly objects to federal subsidization, either fiscally or legislatively, of any one form of delivery system as being inconsistent with an objective analysis and supports the concept of neutral public policy and free market competition.

Home Deliveries

(READOPTED 99, HOD; RESOLUTION 86-36) Recommends enforcement of existing laws that prohibit midwifery by unlicensed individuals.

(READOPTED 99, HOD; RESOLUTION 81-27) Encourages the delivery of all pregnancies in a hospital or in those settings best suited to minimize the risk to the mother and infant.

Hospice

(RESOLUTION 05-03) RESOLVED, that the ISMA petition the Indiana State Department of Health to exempt any patient who is enrolled in a licensed hospice organization from mandated psychiatric consultation in order to prescribe a Schedule II (mind-altering) drug before or during the admission of said patient to a health care institution.

Hospitals

(RESOLUTION 00-15) RESOLVED, that the ISMA will immediately petition the next session of the Indiana General Assembly to amend the Indiana Health Law Title 16, Article 22, Chapter 2, Section 2 to mandate or require active medical staff physician representation on the respective county hospital governing board; and be it further,

RESOLVED, that any and all active medical staff physician members of county hospital governing boards not be contracted employees of their respective county hospitals, its governing board, or any of its public or privately developed corporations.

(READOPTED 99, HOD; RESOLUTION 86-19) Approves the "model" Hospital Medical Staff Bylaws as an official ISMA document to be available to hospital medical staffs, and that the model bylaws be subject to annual review by the Hospital Medical Staff Section.

(READOPTED 99, HOD; RESOLUTION 84-24) Opposes efforts by any hospital which serves to limit physicians' free choice and competitive alternatives through the closing of medical staffs, sections of medical staffs, or which limit physician access to services based on arbitrary objectives which do not clearly enhance patient care.

(2/15/95, EC) Approved the following policy relating to anti-trust laws covering hospitals:

The state of Indiana should only grant 2 waivers (exempting certain hospitals from anti-trust laws).
The state cannot provide an exemption unless they get a resolution from the medical staffs stating support for the merger.
The EC would support future ISMA efforts to get state action exempted if such is deemed necessary by the ISMA. This support should be written to the ISMA Board of Trustees.

Immunizations

(RESOLUTION 06-01) RESOLVED, that the ISMA support public education regarding potential benefits of the HPV vaccine; and it further,

RESOLVED that the ISMA study the feasibility of a voluntary statewide HPV vaccination program.

(RESOLUTION 05-42) RESOLVED, that the ISMA work with the Indiana State Department of Health to increase awareness and encourage involvement of private medical Offices in the existing Children and Hoosiers Immunization Registry Program (CHIRP), and be it further,

RESOLVED, that the ISMA work with the Indiana State Department of Health to simplify the CHIRP process.

(RESOLUTION 05-23) RESOLVED, that ISMA staff work with the appropriate Indiana State Department of Health staff and the suppliers of vaccines to develop a plan for the distribution of vaccines in case another disaster occurs regarding availability, so that physicians will be involved in the provision of care to their patients.

(RESOLUTION 02-19) RESOLVED, that the ISMA request the Indiana State Department of Health to establish rules and policies relating to CHIRP that promote physician protection from liability and assist patients, parents or guardians with a practical, simple method of consent for participation in CHIRP; and be it further,

RESOLVED, that the ISMA support changes in legislation that may be required for physician protection from liability for participation in CHIRP, and for the use of an appropriate uniform method of patient or parental consent. (Passed 2003, SB 457).

(RESOLUTION 01-32) RESOLVED, that the ISMA use every means at its disposal to assure that all third-party payers reimburse for vaccinations recommended by the CDC; and be it further,

RESOLVED, that the ISMA identify third-party payers that fail to fully reimburse the cost of vaccinating patients; and be it further,

RESOLVED, that the ISMA use every means at its disposal to assure that physicians are properly reimbursed for the cost of procuring and the cost of administering vaccinations; and be it further,

RESOLVED, that the ISMA use every means at its disposal to assure additional reimbursement for evaluations or treatments given on the same day as the vaccinations are administered.

(RESOLUTION 00-33) RESOLVED, that the ISMA work with the Indiana State Department of Health to study the feasibility of implementing an immunization registry in Indiana; and be it further,

RESOLVED, that the ISMA educate its members on the importance of immunization registries.

(RESOLUTION 00-24) RESOLVED, that the ISMA support efforts, legislative, administrative and educational, that seek to ensure that Indiana children receive all CDC-recommended vaccinations.

(RESOLUTION 98-9) RESOLVED, that the ISMA either initiate legislation that prevents payers from denying reimbursement for immunizations that are a benefit/covered service through a health plan because administration did not occur during a preventive medicine evaluation, or if more appropriate, provide advocacy to change this problem through dialogue with the appropriate agency or the Insurance Commissioner.

Insurance - Coding

(RESOLUTION 04-22) RESOLVED, that the ISMA seek legislation and urge the AMA to seek and support national legislation requiring the mandatory use of National Correct Coding Initiative (CCI) edits by self-insurance administrators and that all analyzing software be scrutinized for the appropriate use of CCI edits.

(RESOLUTION 02-24) RESOLVED, that the ISMA continue to confront unilateral code-collapsing and recoding practices by insurers; and be it further,

RESOLVED, that the ISMA request that Anthem no longer require physicians to sign a contract that permits Anthem to reassign and rebundle CPT codes.

(RESOLUTION 01-28A) RESOLVED, that the ISMA and the AMA be encouraged to continue to explore means to improve the CPT coding system and/or develop alternative systems.

(RESOLUTION 01-17) RESOLVED, that the ISMA use all means possible, including legislation, to encourage and require all third-party payers to use the Current ProceduralTerminology 4 th Edition (CPT), including modifiers, or the most current edition; and be it further,

RESOLVED, that third-party payers provide guidelines to patients and providers in writing if they deviate from the current CPT guidelines including the use of modifiers. Such information should be presented in such a manner that patients and providers may evaluate it prior to signing a contract with the third-party payer; and be it further,

RESOLVED, that the ISMA use all means possible, including legislation, to encourage and require all third-party payers to provide detailed explanation of any basis of limiting or restricting care (i.e., limitations and restrictions caused by the use of Milliman & Robertson/Milliman USA criteria). Such information should be presented in such a manner that patients and providers may evaluate it prior to signing a contract with the third-party payer.

(RESOLUTION 00-60) RESOLVED, that the ISMA support legislation that requires all payers and insurance companies to have all new CPT and ICD9 information loaded to their systems as of January 1 of each year.

(RESOLUTION 00-59) RESOLVED, that the ISMA support legislation that prohibits a payer or PPO from adjusting coding that results in unfair compensation for physicians’ services.

(READOPTED 99, HOD; RESOLUTION 89-4) RESOLVED, that the ISMA and the AMA combat severe sanctions and harsh and unreasonable penalties that are leveled because of errors in the coding process.

(RESOLUTION 99-55) RESOLVED, that the ISMA take appropriate action including legislation and through the press to prevent the practice of insurance companies from down-coding level 4 and 5 claims (inpatient and outpatient) for the insurance companies’ financial advantage and to the detriment of physician Offices.

Insurance – Contracts

(RESOLUTION 04-28) RESOLVED, that the ISMA support legislation that would permit language be added to managed care health plan contracts allowing providers to apply billed charges, without discount, to those patients who do not pay the required balances within 60 days of claim adjudication.

(RESOLUTION 03-30) RESOLVED, that the ISMA request the Indiana General Assembly to introduce and enact legislation to eliminate the use of “most favored nation” clauses in health care contracts in the state of Indiana.

(RESOLUTION 99-55) RESOLVED, that the ISMA strongly oppose insurance contractual language that requires physicians to accept all insurance plans provided by one insurance company, when these plans are not specified and/or are not yet created. Although this opposition will be supported by the membership of the ISMA, it will not in any way deny its membership the opportunity to make independent and individual choices in regard to their contractual relationship with any insurance company; and be it further,

RESOLVED, that the ISMA encourage the Indiana insurance commissioner to investigate the panels for Aetna Insurance in this state including but not limited to the availability of specialists within a reasonable travel distance to patients and availability of an adequate number of primary care physicians to provide of the insurance company’s patient population; and be it further,

RESOLVED, that the ISMA encourage the Indiana insurance commissioner to enact legislation/laws similar to that already passed in Nevada and being considered in Texas, Illinois and Rhode Island that would bar the “all or none” clause from insurance contracts in the state of Indiana.

Insurance - Coverage

(RESOLUTION 06-30) RESOLVED, that the ISMA initiate and support legislation to repeal the Uniform Accident and Sickness Policy Provision Law in Indiana; and it be further,

RESOLVED, that ISMA delegation introduce and vigorously support a resolution at the next annual AMA meeting that would make national repeal of this law a high priority AMA policy.

(RESOLUTION 05-29) RESOLVED, that the ISMA support legislation to stop excluding contraceptive drugs, devices and permanent birth control (tubal ligation and vasectomy) in health plans and to cease other discriminatory practices related to contraception.

(RESOLUTION 04-03) RESOLVED, that the ISMA support legislation that would require insurers, including Medicare and Medicaid, to cover weight-loss interventions that have been shown to be effective.

(RESOLUTION 02-36a) RESOLVED, the ISMA actively support a legal or legislative remedy to eliminate gaps in coverage that may occur upon insurance plan insolvency including but not limited to those situations that occur during the 60-day period after the plan enters receivership.

(RESOLUTION 02-31) RESOLVED, that the ISMA use whatever means possible to encourage and/or require third-party payers to notify physicians and insurees of services or diagnoses that will not be covered by their plans prior to membership or participation in said plans; and be it further,

RESOLVED, that third-party payers be required to make available to physicians and insurees a list of all services that will not be covered by their plans. This list should be available prior to membership or participation in said plans. Physicians and insurees should be notified immediately of any changes; and be it further,

RESOLVED, that physicians shall not be prohibited from collecting from patients for non-covered services.

(RESOLUTION 02-12) RESOLVED, the ISMA work with insurance companies to recognize Alopecia as a valid medical diagnosis for laboratory studies or physician visits.

(RESOLUTION 00-22) RESOLVED, that the ISMA support efforts by the Indiana Legislative Commission on Autism, the Indiana Resource Center for Autism and other appropriate agencies in their efforts to legislate health care insurance for autistic children.

(11/19/78, BOT) Reaffirmed the necessity of working for the development of a catastrophic insurance program in the private sector that would be available to all citizens of the State of Indiana and to take the lead in publicizing this program and assuring coverage.

Insurance - Credentialing

(RESOLUTION 04-46) RESOLVED, that the ISMA persuade insurance companies and health care entities to utilize the Uniform Credentialing Form; and be it further,

RESOLVED, that the ISMA persuade insurance companies and health care entities to allow updates to information without having to complete the entire form.

(RESOLUTION 03-29) RESOLVED, that the ISMA pursue legislation to have mandatory centralized and standardized credentialing for physicians in the state of Indiana.

Insurance – Disability

(RESOLUTION 02-17) RESOLVED, that the ISMA communicate with other professional organizations (dental, podiatric, osteopathic, etc) to encourage disability insurance companies to recognize the employment problems of infectious diseases on these professions and to offer income-gap clauses for professionals with infectious diseases that prevent their usual roles of employment.

Insurance – Grace Periods

(RESOLUTION 00-44) RESOLVED, that the ISMA seek legislation that requires all insurance programs doing business in this state are not allowed to reject claims purely upon the time of submission for a minimum period of one year from the last date of service.

Insurance - Patient/Physician Protections

(RESOLUTION 05-18) RESOLVED, that the ISMA support efforts which seek appropriate restrictions on insurance companies from using a history of abuse or the seeking of protection or shelter from abuse to (1) refuse to issue or renew insurance coverage, (2) restrict or terminate coverage, (3) add a surcharge or rating factor to insurance policy premiums, or (4) to exclude or limit losses for claims related to abuse.

(RESOLUTION 04-20) RESOLVED, that the ISMA House of Delegates condemn the excessive bonuses awarded by all health insurance companies to their top executives in 2004 and their impact on patients’ insurance premiums and access to affordable health care.

(RESOLUTION 04-08) RESOLVED, that the ISMA promote the public release and discussion of for-profit health insurance companies’ business practices with emphasis on their impact on patients’ access to and costs for health care.

(RESOLUTION 02-37) RESOLVED, that the ISMA seek and support legislation that would amend I.C. 24-5-21; 27-8-5.8 and 12-13-9.5 to require discount card vendors to obtain the expressed written consent of each individual physician before listing the physician as a discount card participating provider. (Passed 2006, HB 1097).

(RESOLUTION 02-39) RESOLVED, that the ISMA pursue all avenues to achieve Anthem’s fair play in the marketplace, which may include, at the appropriate time, a lawsuit against Anthem on behalf of our patients and the 8,000 ISMA member physicians in the state of Indiana.

(RESOLUTION 02-16) RESOLVED, that the ISMA work with the Indiana Hospital and Health Association, the Indiana Department of Insurance and, if necessary, the legislature to review current laws regarding the requirements to sell health insurance in this state and urge creation of adequate prohibitions to prevent further nonviable health insurance companies from entering the Indiana health insurance market.

(RESOLUTION 01-21) RESOLVED the ISMA advocate to the legislature and insurance companies that the patient has the right to an advanced and binding determination of medical necessity and payment approval for elective procedures (such as reduction mammoplasty) with properly submitted medical evidence prior to the procedure and, if denied, have the reason for denial and the right to arbitration.

(RESOLUTION 00-52) RESOLVED, that the ISMA seek legislative action mandating that network providers for laboratory testing, pathology services and radiology testing be specifically designated on the insurance card of the enrollee.

(RESOLUTION 00-35) RESOLVED, that the ISMA seek legislation requiring insurance companies to notify each participating physician of any major plan changes (i.e., fee schedules, rules) at least 90 days prior to enactment by the company and allow that physicians de-select their participation without penalty if the terms are not agreeable to them.

(READOPTED 99, HOD; RESOLUTION 88-28) RESOLVED, that it is the duty of any provider of medical insurance in the State of Indiana to fully inform in clear language prospective purchasers of insurance limitations which may affect the quality or quantity of medical services provided under the plan. Examples of such features are:

Contracts or agreements between the insurer and physicians, hospitals, pharmacies or other providers of services which limit or affect care provided to the patient either directly or indirectly by limiting reimbursement in any fashion;
Financial incentives, withholds, "gatekeeper" arrangements or other arrangements which may affect the medical decision-making process;
Agreements which limit free referral of patients by the patient's physician to any other physician or hospital.

(RESOLUTION 97-16A) RESOLVED, that the ISMA petition the Indiana Legislature to enact legislation which would require insurance companies and managed care plans offering medical coverage in Indiana to provide consumers with an easy-to-read summary of the policy in a standardized format which includes the percentage of premiums spent on patient care versus administrative expenses.

(RESOLUTION 97-15) RESOLVED, that the ISMA petition the Indiana Legislature to enact legislation which would require any health care insurer doing business in Indiana to document in writing any denial of physician-recommended care, or payment for physician-recommended care that has been recommended by the treating physician for any of its members; and be it further,

RESOLVED, that the health care insurer’s medical director, who is a licensed physician, must sign the denial of care document and forward a copy of the document to the patient and the treating physician within 60 days of the denial of care.

Insurance – Reimbursement

(RESOLUTION 06-39) RESOLVED, that the ISMA oppose efforts by insurance companies/networks/government to impose "cost-of-care" based payment systems, credentialing or other schemes to reduce physician and/or patient payments based solely on cost criteria.

(RESOLUTION 06-35) RESOLVED, that the ISMA seek cooperation and/or sponsorship from other interested groups (e.g., pharmacists, unions, AARP) to educate patients about how the health insurance companies’ internal grievance and appeal processes work; and be it further,

RESOLVED, that the ISMA support legislation to prohibit health insurance companies from contractually requiring patients to exhaust the insurance companies’ internal grievance and appeal procedures before accessing the courts for claims of less than $2,000.

(RESOLUTION 06-28) RESOLVED, that the ISMA introduce legislation that includes the following seven principles for regulation of the secondary discount market:

Physicians must have the right to affirmatively opt in and/or out of any agreements of all network entities and associated discounts that the rental (silent) network has accessed.
A network PPO (or similar entity) that rents/leases its network must supply providers and the Indiana Department of Insurance complete and detailed identification of all entities accessing its network and associated discounts.
The terms of the underlying contract between the PPO (or similar entity) who is renting/leasing its network and the physician govern any agreements between the rental (silent) network PPO or similar entity and those entities accessing its network and associated discounts.
A rental (silent) network PPO (or similar entity) cannot rent or sell its network more than once. Any entity accessing the rental network PPO physician discounts cannot then sublease the network and associated discounts.
If a physician terminates the underlying contract with a PPO (or similar entity) who is renting/leasing its network, the rental network PPO and all entities accessing its network and associated discounts must cease to apply the discounted rate agreed to in the underlying contract.
A rental (silent) network PPO cannot rent or sell its network to non-payers (e.g. re-pricers, aggregators, etc).
Administrative fines, penalties and state law causes of action must apply; and be it further,

RESOLVED, that the Indiana AMA Delegation formulate an AMA resolution that the AMA support legal action against these “repricers” and investigate why these inappropriate endeavors do not violate the HIPAA Act and the basics of contract law.

(RESOLUTION 06-21) RESOLVED, that the ISMA support legislation in the Indiana General Assembly to establish a uniform timely filing limit of two years from the date of service, thereby creating parity with the insurer’s ability to demand repayment of money it overpaid for health care services, eliminating disparate arbitrary deadlines designed to limit payment for services rendered, giving medical providers sufficient time to discover and resolve billing errors, and providing insurers the necessary cut-off for reconciling their financial obligations; and be it further,

RESOLVED, that the ISMA support legislation in the Indiana General Assembly that will establish a timely filing limit of six months from notice or two years from the date of service, whichever is later, to file with the insurer responsible for the claim, when the original claim has been filed within the two-year limit to a payer who is later determined not to be responsible for the claim.

(RESOLUTION 06-20) RESOLVED, that the ISMA support legislation in the Indiana General Assembly that requires all payers to have the same contracted time frames for the submission of health care claims, and that this time frame be at least within two years from the date of service.

(RESOLUTION 06-11) RESOLVED, that the ISMA work to encourage a more rapid, user friendly and streamlined process for prior authorization of medications.

(RESOLUTION 06-10) RESOLVED, that the ISMA work to secure physician reimbursement for performing the clinical service of required authorizations and pre-authorizations.

(RESOLUTION 06-07) RESOLVED, that the ISMA encourage the consideration of patient complexity when developing pay-for-performance evaluation criteria.

(RESOLUTION 05-56) RESOLVED, that the ISMA work with the Indiana Academy of Family Physicians to enact state legislation making complete payer fee schedules and reimbursement practices readily available.

(RESOLUTION 05-55) RESOLVED, that the ISMA work with the IAFP to enact legislation that would require insurers to perform an onsite, open-chart coding audit with opportunity for physician rebuttal prior to disciplinary action.

(RESOLUTION 05-21) RESOLVED, that the ISMA propose legislation to the Indiana General Assembly to correct inequitable time constraints on physicians to submit claims while payers have no such restraints and require that the time period payers can go back on providers for refunds be limited to no more than two years. (Passed 2006, SB 147).

(RESOLUTION 05-05) RESOLVED, that the ISMA House of Delegates encourage the Indiana General Assembly to assist the physicians of Indiana by enacting assignment of benefits legislation.

(RESOLUTION 05-12) RESOLVED, that the ISMA encourage insurance companies to adopt automatic crossover electronic billing. (If patient refuses this, the patient will be responsible for that portion of the bill and for sending the claim to the secondary provider.)

(RESOLUTION 05-13) RESOLVED, that the ISMA encourage all third-party payers to extend the same coverage to patients with other diseases requiring life-long anti-coagulation; and be it further,

RESOLVED, that Indiana’s AMA delegation encourage the AMA to adopt a similar position.

(RESOLUTION 05-14) RESOLVED, that the ISMA encourage any third party payer to incorporate at least some physician chart review for all pay-for-performance programs.

(RESOLUTION 04-01) RESOLVED, that the ISMA ask the Indiana General Assembly to prohibit insurance companies and third-party payers from offsetting payments from one patient’s account to another, and from offsetting payments from a gross amount to recoup payments made to patients; and be it further,

RESOLVED, that the ISMA ask the Indiana General Assembly to prohibit insurance companies and third-party payers from adjusting claims that are older than the allowed limit for filing claims. (To wit: If physicians have a 90-day limit to file claims, insurance companies have a 90-day limit to make adjustments.)

(RESOLUTION 02-44) RESOLVED, that the ISMA seek every avenue available to cause AdminaStar Federal to promptly and correctly pay processed claims; and be it further,

RESOLVED, that the ISMA seek every avenue available to cause AdminaStar Federal to correct its systems problems that result in denial of correct claims prompt payment and need for resubmission, which results in delayed payments.

(RESOLUTION 02-38) RESOLVED, that the ISMA research the effects of unrealistic claim filing deadlines imposed upon physicians by health insurance companies, health maintenance organizations and third-party administrators, through contracting or otherwise, that result in denial of payment for services that are otherwise covered services eligible for reimbursement under the patient’s benefit plan, and explore potential solutions that are fair and equitable to all parties, and take appropriate action.

(RESOLUTION 02-35) RESOLVED, that the ISMA seek and support legislation that would prevent health insurance companies, health maintenance organizations and third-party administrators (payers) from refusing to contract with and include physician in the payer’s participating provider network on the basis that physician refuses to agree to a compensation model that reimburses for only one of multiple procedures performed in a single operative episode; and be it further,

RESOLVED, that the ISMA seek and support legislation that would require payers to recognize and compensate physicians for distinct, separately identifiable services or procedures performed on the same date of service utilizing AMA CPT coding and Medicare guidelines.

(RESOLUTION 02-34) RESOLVED, that the ISMA seek and support legislation that would specify that when health insurance companies and health maintenance organizations (payer) fail to adhere to the requirements of the Indiana Code governing the appeal rights of patients and/or physicians, such failure would constitute automatic approval by payer of the patient and/or physician request stated in such appeal.

(RESOLUTION 02-33) RESOLVED, that the ISMA seek and support legislation that would prevent health insurance companies, health maintenance organizations and third-party administrators (payers) from denying reimbursement for services that are covered services eligible for reimbursement under the patient’s health benefit plan solely on the basis that administrative rules of the payer were not followed.

(RESOLUTION 02-26) RESOLVED, that the ISMA actions to make it mandatory for all insurance companies to send payments to the physician once the patient assigns benefits, whether or not the doctor is a preferred provider in the insurance plan.

(RESOLUTION 02-25) RESOLVED, that the ISMA support efforts to require insurance companies and health maintenance organizations to provide for payment for intraoperative services provided by assistant surgeons.

(RESOLUTION 00-46) RESOLVED, that the ISMA work with the legislature to support laws for payment of services rendered with penalties to insurance companies for improper denials including but not restricted to denials based on multiple physician visits on the same day.

(READOPTED 99, HOD; RESOLUTION 89-52) RESOLVED, that the ISMA take all remedies to ensure that providers are not penalized for listing second and third procedure charges at the correct, reduced amounts and to ensure correction of physician profiles that have been reduced because of incorrect processing by third party insurers for second and third procedures.

(READOPTED 99, HOD; RESOLUTION 87-20) RESOLVED to seek imposition of federal and/or state sanctions on the insurance carriers that do not reimburse patients promptly or correctly.

(READOPTED 99, HOD; RESOLUTION 82-6) Rescinded RESOLUTION 62-26 (adopted at a special meeting of the ISMA House of Delegates); and be it further,

RESOLVED, that the ISMA continue to oppose any third party payment program that delineates physicians by lists or assignment or payments or treats policyholders without uniformity.

(RESOLUTION 98-21) RESOLVED, that the ISMA introduce legislation in the Indiana General Assembly to require the payment of interest to physicians who are not paid in a reasonable period of time for the care that was provided and billed appropriately.

Insurance - Terminology

(READOPTED 99, HOD; RESOLUTION 89-53) RESOLVED, that all remedies be taken by the ISMA to force the Health Care Financing Administration (HCFA) and others to use « unreasonable and unnecessary » only for services and treatments that are considered unreasonable and unnecessary by the medical community; and be it further,

RESOLVED, that all remedies be taken by the ISMA to force HCFA and others to not use « unreasonable and unnecessary » for services that they have simply decided not to accept as covered services.

(READOPTED 99, HOD; RESOLUTION 88-6A) RESOLVED, that the ISMA object to statements by insurers of appropriateness of care; that the ISMA urge all such statements by insurers and their designees be clearly limited to statements pertaining to whether the care or service is covered or not covered; and be it further,

RESOLVED, that the ISMA investigate whether attempts to determine appropriateness by third parties constitutes the practice of medicine without a license; and be it further,

RESOLVED, that the ISMA Board of Trustees refer this resolution to the Indiana State Insurance Commission, to the appropriate insurers, to the public, and direct a similar resolution to the AMA Delegation.

Internet Medicine

(RESOLUTION 00-16) RESOLVED, that the ISMA adopt and place into policy the “Guidelines for Medical and Health Information Sites on the Internet” adopted by the Executive Committee of the AMA Board of Trustees in February 2000.

Jury Duty

(RESOLUTION 03-31A) RESOLVED, that jury duty is a civic responsibility and no profession should be excluded; and be it further,

RESOLVED, that the court should recognize special patient scheduling considerations. (1st Resolved passed 2006, SB 232).

Laboratory Tests

(READOPTED 99, HOD; RESOLUTION 81-24) RESOLVED, that the pathologists, laboratories, and practicing physicians in this state endeavor, wherever at all possible, to refer laboratory testing to qualified local, regional and state laboratories so that the functional integrity of these necessary facilities may be maintained; and be it further,

RESOLVED, that the medical laboratories and pathologists in Indiana identify the needs of the physician and patients in Indiana and endeavor to fulfill these needs.

Laser Surgery

(RESOLUTION 00-2) RESOLVED, that the ISMA adopt the policy that laser surgery should be performed only by individuals currently licensed by statute (MD or DO) and properly trained to practice medicine and perform surgical services.

(READOPTED 06, HOD; RESOLUTION 96-15) RESOLVED, that the ISMA oppose any legislation that would expand the scope of practice of any non-physician group to include the performance of surgery (including laser surgery).

Medicaid

(RESOLUTION 06-43) RESOLVED, that the ISMA express concern to Indiana Medicaid about the decrease in access to care that removing the three incumbent contractors will cause to the Medicaid population; and be it further,

RESOLVED, that the ISMA communicate this resolution to the governor, secretary of the Family and Social Services Administration, the Indiana General Assembly and CMS.

(RESOLUTION 06-06) RESOLVED, that the ISMA work with Office of Medicaid Policy and Planning to take any and all actions possible to assure adequate panels of primary care and specialty care physicians in all geographic areas of the state. This should include:

Appropriate fees for services rendered, at least covering the cost of care
Consideration of lower panel size requirements
Reduction of red tape and hassles as was promised in the past but not delivered
Creating uniform processes across multiple Medicaid managed care plans
Development of consistent formularies across all Medicaid managed care plans
Correction of the massively flawed auto-assignment processes:
and be it further,

RESOLVED, that ISMA work with appropriate legislative or other regulatory
bodies to:

Promote appropriate Medicaid payments for provision of necessary medical services provided
Exert pressure wherever appropriate to evolve the Medicaid program into an entity that meets the needs of the state, Indiana Medicaid recipients, the physicians and the hospitals of the state of Indiana.

(RESOLUTION 05-52) RESOLVED, that the ISMA work with the OMPP on the modification of the Medicaid Crossover Remittance Advice by moving the Medicaid service fee schedule amount to its own column so that it is not included in the Medicaid billed/paid column.

(RESOLUTION 05-51) RESOLVED, that the ISMA work with Office of Medicaid and Policy Planning (OMPP) and Indiana Health Care Programs/Electronic Data Systems (IHCP/EDS) to offer provider inquiry access to the appropriate Managed Care organization (MCO) in Web interChange to streamline the process of enrolling Primary Medical Provider (PMP)s under the MCO; and be it further,

RESOLVED, that ISMA encourage OMPP and IHCP/EDS to train the MCOs on the use of the provider update form so that the MCO can facilitate changes to the provider file.

(RESOLUTION 04-50) RESOLVED, that the ISMA seek legislation that would require the Medicaid program develop one PDL to be used by all Indiana Medicaid products/MCOs, and that the PDL should be monitored and regulated by the DUR Board and therapeutics Committee, in accordance with Senate Bill 228.

(RESOLUTION 04-48) RESOLVED, that the ISMA seek legislation that would require EDS to reimburse by line item rather than by total claim allowable amount; and be it further,

RESOLVED, that such legislation shall be retroacted to July 2002 with retroactive corrective reimbursements made to providers.

(RESOLUTION 04-45) RESOLVED, that the ISMA seek assistance for providers and facilities giving care to Medicaid patients who seek care in states where they do not reside; and be it further,

RESOLVED, that the ISMA encourage the AMA to look at such assistance; and be it further,

RESOLVED, that the ISMA seek and support legislation, as needed, to promote payment for rendering services to out-of-state Medicaid patients for urgent care issues, tertiary care issues, or as authorized by their primary care physician.

(RESOLUTION 02-42) RESOLVED, that the ISMA seek through any means available to have OMPP rescind the revised crossover claims methodology to more appropriately reimburse physicians for services provided.

(RESOLUTION 01-38) RESOLVED the Indiana State Medical Association recognize and acknowledge that the Medicaid program faces serious funding problems in light of recent economic projections regarding the state budget; and be it further,

RESOLVED, that state legislation be initiated to assure state pharmaceutical rebate monies be returned to the Medicaid program and not the state’s general fund; and be it further,

RESOLVED the Indiana State Medical Association, through its Board of Trustees and Commission on Legislation, immediately study efforts by other states in solving this problem in the Medicaid program and move forward in the next state legislative session with any means feasible in Indiana; and be it further,

RESOLVED, that if cost containment for medications in Medicaid requires the use of a Medicaid formulary, the Indiana State Medical Association actively seek participation in the construction of the formulary.

(RESOLUTION 01-36) RESOLVED, that the Indiana State Medical Association pursue changes in the recently passed legislation in order to allow continuation of PCCM Medicaid in the entire state of Indiana.

(RESOLUTION 00-7) RESOLVED, that the ISMA reaffirm its policy and continue to support legislation that increases Medicaid provider reimbursement, preferably to a level comparable to Medicare.

(READOPTED 99, HOD; RESOLUTION 89-25) RESOLVED, that the ISMA encourage the adjustment of Medicaid eligibility criteria to include economically compromised citizens whose incomes fall below 175% of poverty level.

(READOPTED 99, HOD; RESOLUTION 88-21) RESOLVED, that the ISMA:

Expend legislative and public relations efforts to support expanding the Medicaid program to cover all pregnant women and their infants who have family incomes at or below 150% of the federal poverty level; and
Support expanding the Medicaid program to cover children ages 1 through 8 who have family incomes at or below 100% of the poverty level; and
Encourage outreach programs to identify persons eligible to participate, direct those persons to the prenatal care programs, and ensure their participation in the programs.

(READOPTED 99, HOD; RESOLUTION 88-8) RESOLVED, that the ISMA initiate and support a federal legislative proposal allowing states to monitor and to prescribe (within federal guidelines) responsive administrative practices for Medicare/Medicaid carriers serving patients and practitioners within the state.

(RESOLUTION 99-56) RESOLVED, that the ISMA advocate for an adjustment of all Medicaid reimbursement rates in Indiana in order to bring Indiana’s rates in line with the rates of neighboring states, the national average, and Medicare rates in order to improve access to care for the growing number of Medicaid patients in our state.

(RESOLUTION 98-23) RESOLVED, that the ISMA support legislation to provide Medicaid coverage for a period of nine months for all uninsured and poor patients with active tuberculosis.

(1/17/93, BOT) Approved the following report, as amended, from the ISMA Medicaid Reform Task Force:

A case management system should be implemented, including co-payments and deductibility of co-payments from other state support payments to the patient if the patient fails to comply with co-payment requirements.

Optional benefits should be reduced and a basic benefits package should be provided.

The Health Professions Bureau should be responsible for investigating fraud and abuse in the Medicaid program, and funding should be provided to the Bureau to undertake these activities.

The proposals above should be financed with an income tax increase, a sin tax on alcohol and cigarettes, eliminating the scheduled physician payment increase, and implementation of an RBRVS reimbursement schedule for Medicaid.

Medical Education

(RESOLUTION 05-46) RESOLVED, that the ISMA develop programs of cultural outreach to minority individuals and communities with the goal of promoting a career in medicine as a realistic goal for any Hoosier.

(RESOLUTION 04-41) RESOLVED, that the ISMA advocate and champion efforts of all regional medical education centers to expand the number of faculty and increase their operating budgets; and be it further,

RESOLVED, that the ISMA encourage, support and urge the state legislature to provide increased funding in the amount of $1 million each for the Evansville and Fort Wayne Centers for Medical Education in order to enable their participation in the objective of the IU School of Medicine to be a top 10 medical school.

(RESOLUTION 01-35) RESOLVED, that the ISMA continue support for the regional medical campuses through continued personal participation, local legislative contact for adequate funding, and patient contact to improve community awareness of the need for adequate state funding to ensure high quality medical education and practitioners to care for Indiana citizens, now and into the future.

(3/5/00, BOT) the ISMA opposes the establishment in Indiana of any medical education facility that seeks to provide instruction leading to a medical doctor (M.D.) or doctor of osteopathy (D.O.) degree if the facility is not accredited by the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA).

(READOPTED 99, HOD; RESOLUTION 89-13) RESOLVED, that the ISMA support the concept and help seek additional funding for GME from the Indiana General Assembly.

(READOPTED 99, HOD; RESOLUTION 89-10) RESOLVED, that the ISMA, in cooperation with the Indiana University School of Medicine and other organizations, develop and encourage the establishment of Medical Career Development Programs in high schools and universities throughout the state.

(READOPTED 99, HOD; RESOLUTION 85-4) RESOLVED:

That the ISMA recommend reimbursement of direct costs be with increases in costs linked to an inflation indicator [e.g., medical component of the Consumer Price Index (CPI)]; and further that it should be provided for the entire duration of residency training; and be it further,
RESOLVED, that the ISMA recommend indirect pass-through payment should not be changed until the accurate data are available for computing disease severity indices which will allow the DRG rate system to be applied equitably in teaching and non-teaching hospitals; and be it further,
RESOLVED, that the ISMA recommend the use of patient care dollars for GME funding should continue until careful study has determined that an alternate and adequate stable source of funding is available; and be it further,
RESOLVED, that the ISMA recommend that all graduates of Liaison Committee on Medical Education (LCME) accredited medical schools should be assured an opportunity for positions in funded accredited GME programs while opportunities for alien and American-born foreign medical graduates may be provided (but not assured); and be it further,
RESOLVED, that the ISMA recommend that when the total number of physicians needed in the U.S. is reasonably determined, if changes in the number are required that said changes be placed upon entry to medical schools and not upon entry into GME; and be it further,
RESOLVED, that the ISMA recommend strategies for producing the "proper" specialty distribution of primary care physicians and other specialists be carefully developed and studied before specific manpower suggestions are proposed; and be it further,
RESOLVED, that the ISMA recommend that physicians should have the opportunity to seek residencies in the specialty of their choice; and be it further,
RESOLVED, that the ISMA recommend that GME should continue to be governed by the existing highly effective Accreditation Council for Graduate Medical Education (ACGME) which would assure the preservation of institutional authority and responsibility for GME; and be it further,
RESOLVED, that the ISMA recommend that institutions sponsoring GME should be encouraged to be affiliated with an LCME accredited medical school but with no implication of medical school administrative control; and be it further,
RESOLVED, that the ISMA recommend that before any "reform" in financing GME there must be careful study of the potential impact of changes in GME on both access and quality of health care for the uninsured, underinsured or indigent patients in Indiana and the U.S.; and that a copy of this RESOLUTION be distributed to all Indiana legislators.

(READOPTED 99, HOD; 1981, HOD) the ISMA encourages all providers of CME to meet AMA criteria for "Category 1 and Category 2 CME" so that credit can be given to physicians attending.

(7/10/85, EC) Approved the Commission on Medical Education's recommendation to delegate provider responsibility to the ISMA Section on Directors of Medical Education/Association of Indiana Directors of Medical Education (AIDME). (the ISMA is the accrediting body for all intrastate institutions and organizations.)

(11/23/80, BOT) the ISMA supports federal grants for IU Medical School and opposes any abrupt withdrawal of federal funds to medical schools.

(6/12/77, BOT) the ISMA will encourage CME on a voluntary basis and voice objection to CME being made a requirement for membership in the ISMA as well as CME being made mandatory for relicensure and re-registration.

Medical-Legal Compact of Conduct of the ISBA and ISMA

(READOPTED 99, HOD; RESOLUTION 86-6) Approved the "Medical-Legal Compact of Conduct of the Indiana State Bar Association and the Indiana State Medical Association."

Medical Liability Issues

(RESO