By Grant Achenbach, JD
Director of Government Relations
Due to the COVID-19 pandemic, the 2021 session of the Indiana General Assembly was unique in that many new laws were set to become effective either immediately upon passage or in 2022, to allow more time for Hoosiers to adjust. However, there are still several changes physicians should be aware of that will take effect next month, on July 1.
Good faith estimates (House Enrolled Act (HEA) 1447)
HEA 1447 includes several technical follow-up clarifications to the good faith estimate law passed in 2020. One change impacts the good faith estimate notices that must be made available to a patient. Under the current version of the law, at least one printed notice must be posted in the waiting room of a practitioner’s office that states, “a patient may ask for an estimate of the amount the patient will be charged for a nonemergency medical service provided in this practitioner office. The law requires that an estimate be provided within 5 business days."
The new requirement, which goes into effect July 1, is more flexible and instead requires “[e]ach provider [to] make diligent attempts to ensure that the patient is aware of the patient's right to request a good faith estimate….The communication by each provider of information to the patient concerning the right to a good faith estimate must be conspicuous and must be provided by at least three (3) of the following means:
(1) Notice on the provider's Internet web site.
(2) On hold messaging.
(3) Waiting room notification.
(4) Pre-appointment reminders, including through electronic mail (email) or text messaging.
(5) During appointment or services check in.
(6) During appointment or services check out.
(7) During patient financial services or billing department inquiries.
(8) Through an electronic medical and patient communication portal.”
The communication must also include the following statement (or words to the same effect): "A patient may ask for an estimate of the amount the patient will be charged for a nonemergency medical service provided in our office. The law requires that an estimate be provided within 5 business days of scheduling the nonemergency health care service unless the nonemergency health care service is scheduled to be performed by the practitioner within 5 business days of the date of the patient's request."
HEA 1447 also aligns the state mandatory
good faith estimate requirements – which were originally set to go into effect on July 1, 2021 – with a new federal law called the No Surprises Act. These requirements are now effective Jan. 1, 2022.
For more information on the changes discussed above and the upcoming federal health care pricing transparency laws, see ISMA’s updated information on Practitioner Good Faith Estimates
On a related note, HEA 1421
ensures that patients are not barred from receiving any requested good faith estimates due to language included in contracts with health plans. More specifically, HEA 1421 states that a health provider contract entered into, amended, or renewed after June 30, 2021 may not contain a provision that “[l]imits the ability of either the health carrier or the health provider facility to disclose the allowed amount and fees of services to any insured enrollee” or “limits the ability of either the health carrier or the health provider facility to disclose out-of-pocket costs to an insured or an enrollee….”
INSPECT reporting (HEA 1109)
Prescribers who dispense controlled substances from their offices are currently required to report dispensations to INSPECT within 24 hours. However, once a prescriber dispenses a controlled substance from their office once, they are then required to report dispensations to INSPECT daily, regardless of whether a dispensation was made on a particular day. Thus, dispensing prescribers are currently required to issue “zero” reports to INSPECT on days they do not dispense.
Thanks to HEA 1109, which becomes effective on July 1, dispensing prescribers are only required to report actual dispensations to INSPECT within 24 hours and are no longer required to issue “zero” reports.
Opioid maintenance treatment (HEA 1225)
HEA 1225 expands access to opioid maintenance treatment medications by doubling the number of days’ supply a patient can receive through an opioid treatment program without obtaining prior authorization. Under the new law, effective July 1, patients may receive 14 days of opioid maintenance treatment medications at one time instead of a 7 day supply.
Reminder: E-prescribing mandate delayed until Jan. 1, 2022 (HEA 1468)
As reported at the conclusion of the 2021 legislative session, Indiana’s electronic prescribing of controlled substances mandate was retroactively delayed until Jan. 1, 2022, to align with a similar federal requirement for Medicare Part D prescriptions. More information on the state and federal e-prescribing requirements can be found here
This article is for general informational purposes only and does not constitute legal advice. Members should consult with their attorneys regarding any specific legal questions and to ensure their practices are in compliance with applicable law.