By Richard Feldman
The 2018 Indiana legislative session was packed with significant health-related legislation. Here is my assessment of the bills that most caught my attention.
House Bill 1302 would have allowed advanced practice registered nurses (AKA nurse practitioners) to prescribe independently (and thus practice totally independently) without collaborating physician oversight. The medical community strongly opposed this measure because of insufficient clinical training of APRNs for this authority. No compromise for additional training requirements was reached and the bill did not receive a hearing. The legislation will undoubtedly be introduced again next year.
Senate Bill 221 requires physicians to enroll in and check INSPECT (the state’s electronic controlled substances prescription tracking system) before writing each prescription for opioid or benzodiazepine medications. The rationale is to decrease “doctor shopping” and the resultant illegal diversion of these medications.
The bill was amended to allow checking every 90 days only if the patient has a controlled substance contract with the provider. There’s no question that providers should utilize INSPECT when prescribing these medications. Don’t be surprised or offended if your health-care provider presents you with a contract in the future.
Senate Bill 398, strongly opposed by the medical community, would have created onerous regulations for office-based buprenorphine (Suboxone) prescribing for the treatment of opioid addictions, creating requirements close to the rigor of methadone clinics. Primary care physicians caring for small numbers of patients in the office setting are essential in fighting the opioid epidemic in order to extend community treatment capacity. This regulation-laden bill would have made office prescribing essentially impossible.
Despite progress with the attorney general’s and governor’s offices in amending the bill, the decision was made to send the bill to a summer study committee for review. A reasonable result for a bill that needs more work.
Senate Bill 1380 that would have raised the legal age for purchasing tobacco to 21 did not survive. Five states have now enacted the 21-year-old age requirement, and so should Indiana. There’s always next year.
Senate Bill 340 adds some regulations regarding performing abortions and abortion clinics. One element is the burdensome requirement for physicians to extensively report to the state on an astonishingly long list of abortion complications. Non-compliance is a criminal violation. This requirement is not just for the immediate time period after the abortion but potentially anytime thereafter for any physician who is treating the patient for a complication, potentially many years later.
Such physician inquiries may create barriers in the doctor-patient relationship. The medical and research value for this reporting is very questionable. A woman’s reproductive health should be purely between a doctor and patient without undue governmental interference.
House Bill 1143 provides for increased consistency, transparency and accountability for insurance companies in the prior authorization process for tests and other services. Insurers are required to give clear guidance on needed documentation and time frames for notification of approval or denial. Insurers must provide specific reasons for denial, and issuing a prior authorization will now guarantee payment for the authorized services. These are much needed reforms for both patients and physicians.
Senate Bill 52 represents a great progressive bipartisan effort that legalizes low THC cannabis CBD oil. The testimony from physicians and patients on various health benefits of CBD was powerful and compelling. As a harmless herbal supplement with no intoxicating effects, there is no reason for it to be illegal.
The session has been criticized on a number of counts, but in regard to health-related issues, legislators earnestly listened to differing opinions, carefully considered the issues and were willing to compromise.
All-in-all, a good result.
Richard Feldman, M.D., is an Indianapolis family physician and the former Indiana State Health commissioner. Send comments to [email protected].
