The Indiana State Medical Association had an incredibly successful 2023 legislative session, as several ISMA-supported bills were passed by the General Assembly and signed by Gov. Eric Holcomb. ISMA also successfully stopped multiple bills it opposed, including legislation on scope of practice issues. Below are some of the highlights from the session.

See how bills progressed with the 2023 ISMA Bill Tracker.

   SUPPORTING PUBLIC HEALTH  
 
Governor’s Public Health Commission
 > Establishes a regulatory framework and optional grant program to support local health departments in delivering core public health services to their communities. (SEA 4)
 > Appropriates a combined $225 million over the biennium -- $75 million in 2024 and $150 million in 2025 -- to fund the grants established by SEA 4. (HEA 1001)

Contraception and maternal health
 > Allows unopened, unused long-acting reversible contraceptives (LARCs) to be transferred between Medicaid recipients if certain conditions are met. (SEA 252)

Trauma system quality improvements
 > Establishes and funds the Indiana Trauma Care Commission to promote statewide cooperation and the development of a comprehensive state trauma plan. (SEA 4)

  
   ACCESS TO CARE; PHYSICIAN WORKFORCE  
   
HIP equalization
 > Requires all Indiana Medicaid programs to reimburse physician services at not less than 100% of the Medicare rate. (HEA 1001)

Graduate medical education (GME)
 > Appropriates $14 million over the biennium to the Graduate Medical Education Board and $4,764,394 to the Medical Education Board to support establishing and expanding
    physician residency programs across Indiana. (HEA 1001)

Physician noncompetes
 > Provides a primary care physician (family practice, pediatricians, and internal medicine) and an employer may not enter a noncompete agreement after July 1, 2023. (SEA 7)
 > Outlines a mediation process to settle a disagreement over a reasonable buy-out provision amount. (SEA 7)
 > Renders noncompetes unenforceable in the following circumstances: (1) the physician is terminated without cause; (2) the physician terminates a contract for cause;
    or (3) the contract term is expired and both parties have fulfilled the obligations of the contract. (SEA 7)

Physician tax credits
 > Establishes a $20,000 state income tax credit for physicians with an ownership interest in a new primary care physician practice
    (family medicine, pediatrics, and internal medicine). (HEA 1004)

   
   INSURANCE; REGULATORY ISSUES  
 
Prior authorization and payment reforms 
 > Establishes a provisional credential until a decision is made on a provider’s credentialing application and allows for retroactive reimbursement. (SEA 400)
 > Shortens the timeframe for an insurer to respond with a prior authorization determination for urgent cases from 72 to 48 hours
    and for nonurgent cases from seven to five business days. (SEA 400)
 > Prohibits prior authorization and retroactive denial for a specific set of commonly requested and granted CPT codes for services rendered 
    to patients covered by the state employee health plan. (SEA 400)

INSPECT
  > Creates an exception from the requirement to query INSPECT before prescribing a controlled substance for patients enrolled in hospice (HEA 1445)

  
  TRANSPARENCY; SCOPE OF PRACTICE    
 
Emergency department supervision
 > Requires that a hospital with an emergency department (ED) must have at least one physician on-site and on duty
    who is responsible for the ED at all times the ED is open. (SEA 400)

Advertising of physician information
 > Adds allergist, electrophysiologist, geriatrician, immunologist, medical geneticist, neonatologist, and pulmonologist
    to the list of medical specialty titles reserved for physicians. (SEA 275)

Defeated numerous attempts to inappropriately expand the scope of practice of nonphysician practitioners:
 > SB 49 – Removed the requirement that certified registered nurse anesthetists (CRNAs) must be in the immediate presence of a physician to administer anesthesia,
    and further permitted CRNAs the ability to administer anesthesia under the supervision of a dentist or podiatrist.
 > SB 190 – Eliminated the requirement that not more than four physician assistants (PAs) may collaborate with a physician concurrently.
 > SB 191 – Established the licensure of an associate physician for medical students that did not match into a residency program.
 > SB 213 – Removed the requirement that advanced practice registered nurses (APRNs) must enter into a collaborative agreement with a physician.
 > SB 371 – Removed the requirement that psychiatric mental health APRNs must enter into a collaborative agreement with a physician.
 > HB 1330 – Removed the requirement that advanced practice registered nurses (APRNs) must enter into a collaborative agreement with a physician.