By Grant Achenbach, JD
Director of Government Relations

The recently concluded 2019 session of the Indiana General Assembly saw the passage of several bills that will affect the practice of medicine in Indiana. Most of these new laws have an effective date of July 1.

With that in mind, below are summaries of the key changes and their effective dates. At the end of this article, you will also find a list of topics assigned to the Public Health interim study committee.

July 1: Validated Verbal Screening Tool (HEA 1007). House Enrolled Act (HEA) 1007 was heavily supported by Indiana’s State Health Commissioner Kristina Box, MD. Originating with a recommendation from the Indiana Perinatal Quality Improvement Collaborative (IPQIC), the bill is intended to ensure early detection of substance use disorder in pregnant women by requiring all health care providers who see pregnant women to use a validated, evidence-based verbal screening tool. If the screening tool indicates that a pregnant woman has a substance use disorder, the provider is to provide treatment to the patient or refer her to treatment.

The use of such a tool is already recommended by the American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine. To learn about available validated verbal screening tools, visit www.ismanet.org/ACOGopinion.

July 1: INSPECT (SEA 221-2018). Starting July 1, all Indiana prescribers providing services to patients in an emergency department or pain management clinic must query the INSPECT prescription drug monitoring program before prescribing an opioid or benzodiazepine.

This is the second stage of a process begun last year by SEA 221, which phases the query requirement. The queries can be completed seamlessly during the course of a patient visit, thanks to INSPECT’s ability to integrate data into providers’ electronic health records (EHRs). As a result, the mandate first went into effect July 1, 2018, but only for those providers who have INSPECT information integrated into their EHRs.

You may recall that the 2018 legislation also required all physicians with a Controlled Substance Registration (CSR) to register with INSPECT by Jan. 1 of this year. If you haven’t yet done so, you can complete that process at www.in.gov/pla/inspect.

Please note that there are no longer any criminal penalties tied to the requirements listed above, thanks to legislation that ISMA supported during the 2019 session. Any noncompliance will now be referred to the Indiana Medical Licensing Board (MLB).

July 1: Office Based Opioid Treatment (SEA 141). SEA 141 was a priority bill on Gov. Holcomb’s legislative agenda. Starting July 1, it institutes minimum regulations that physicians authorized by SAMHSA and the DEA must follow in providing office-based treatment to opioid-addicted patients. Specifically, SEA 141 sets requirements for physicians to meet before prescribing office-based opioid treatment and for treatment agreements with patients receiving these services. The full bill can be viewed at http://iga.in.gov/legislative/2019/ bills/senate/141.

Jan. 1, 2020: Injectable Epinephrine and Glucagon (HEA 1246). Starting Jan. 1, 2020, a pharmacy may not dispense injectable epinephrine or glucagon to a person unless the product has an expiration date of at least 12 months from the date of dispensing, or the person consents to the product having an expiration date of less than 12 months from the date of dispensing.

Jan. 1, 2021: E-Prescribing (SEA 176). Multiple e-prescribing mandate bills were introduced during the 2019 session. Fortunately, the introduced versions of these bills did not NEW LAWS - CONTINUED FROM PAGE 1 pass, as they would have been particularly burdensome for physicians. SEA 176 simply mirrors a federal e-prescribing mandate signed into law by President Donald Trump in October that requires prescribers to e-prescribe controlled substances for Medicare patients starting Jan. 1, 2021. SEA 176 extended this requirement to controlled substance prescriptions for all patients in Indiana starting Jan. 1, 2021. Multiple exceptions to this rule are included in SEA 176, including one for technical difficulties. In addition, a prescriber may obtain a waiver from the Indiana Board of Pharmacy and the MLB. The bill also charges the MLB and the Board of Pharmacy with creating other exceptions, to account for situations in which an e-prescription is impractical or could adversely affect a patient’s health. An interim committee of the legislature is set to further study exceptions that may be needed to ensure that this requirement is not burdensome to physicians, and we anticipate that additional exceptions may be added before the law becomes effective in 2021.

Summer study
The following issues were referred for summer study:

• Medical reimbursement under worker’s compensation for ambulatory surgical centers.
• Taxation of CBD oil and vaping products.
• The various drivers of health care cost increases, including:
  • Current trends in health care delivery and new approaches, such as value-based medicine.
  • Prescription drug pricing and access.
  • Regulation and practices of pharmacy benefit managers.
• Current trends in health care delivery and new approaches, such as value-based medicine.
• Prescription drug pricing and access.
• Regulation and practices of pharmacy benefit managers.
• Authorization of an advanced practice registered nurse to operate without a practice agreement with a physician or certain other practitioners.
• Hospital licensure issues.

Any exceptions that would be needed to a requirement for health care providers to issue prescriptions in an electronic format and by electronic transmission (as mentioned above). To read more about these bills, please visit www.ismanet.org/2019bills.