Recap: 2019 Legislative Session in Indiana

by | Aug 7, 2019 | Other, Topics of Interest

What happened in health workforce policy and what’s on the docket?

The dust has settled from Indiana’s 2019 Legislative Session and we want to provide you with a recap of major changes in the health workforce policy realm. With 2019 being a “long session” (AKA a budget year), it was jam-packed with initiatives and much was accomplished. We hope you were able to follow along during the session using the Bowen Biweekly Bill Brief, or B4, Tracker. The B4 highlighted health workforce-specific bills and served to inform and update stakeholders on relevant initiatives. The latest version of the B4 is linked at the bottom of the post. (This was our first year implementing the B4 and we’d love to get your feedback on it. What worked? What didn’t? How can we make it better? Email us at bowenctr@iu.edu with your thoughts.)

Now, let’s jump into a summary of enacted health workforce related legislation from the 2019 General Session:

 Licensing/Regulation Changes

  • Nurse Licensure Portability: The Nurse Licensure Compact was signed into law and is set to go into effect in 2020. This will allow participating nurses to practice in any compact state under a single compact license. (HEA 1344 [1])
  • Behavioral Health Workforce License Requirements: Regulatory changes were made to select behavioral health professions. These changes impact education or experience requirements for licensure. (SEA 527 [2], HEA 1199 [3])
  • Regulation of Physical Therapists: Physical therapy now has its own licensing board (it was previously a committee under the medical licensing board). (SEA 586 [4])
  • Office-based Opioid Treatment Providers (OBOTs): Medication-Assisted Treatment, or MAT, is generally delivered in two types of settings:
    1) Opioid Treatment Programs, which are organizations regulated at both the federal and state levels, and 2) OBOTs, which are community-based providers with a federal waiver to prescribe associated medications (DATA 2000 [5]). Before 2019, there was minimal state regulation for OBOTs. Rules will now be created by the Medical Licensing Board (in consultation with Indiana State Department of Health, Family and Social Services Administration) for office-based opioid treatment (SEA 141) [6]. Federal code for OTPs outline staffing requirements.[7] It is unclear whether Indiana seeks to adopt staffing requirements for OBOTs.

Delivery/Practice Changes

  • Mobile Integration Programs: Emergency medical personnel are now permitted to provide (and be reimbursed through Medicaid for) expanded services including: transportation, acute care, chronic condition, or disease management services. This is consistent with national trends to allow and reimburse for community paramedicine services.[8] (SEA 498 [9])
  • Addressing Infant Mortality through Perinatal Care: HEA 1007[10] requires health care providers to screen and treat pregnant women for/with substance use disorder and SEA 416[11] requires Medicaid reimbursement for doula providers.
  • Telehealth: Psychologists may now deliver tele-psychology services to patients in Indiana (HEA 1200 [12]).

 Summer Session Legislative Initiatives

Indiana’s 2019 policy work does not stop at the spring general session. There were a number of health workforce initiatives that spilled into summer session agendas. The 2019 Interim Study Committee topics were announced at the end of May and can be found at: https://iga.in.gov/documents/4500c157.

  • Health Care Costs: There were a number of bills calling for a study of the contributing factors of health care costs. This topic made it onto the agenda of multiple interim study committees (Financial Institutions & Insurance; Fiscal Opportunities; Public Health, Behavioral Health, and Human Services)
    • What does this have to do with the health workforce?
      • Access to care in rural areas was one of the identified sub-topics. As Indiana seeks to address shortages of health care providers, wise allocation of workforce development funding will be critical.
      • As Indiana seeks to reduce health care costs, it is likely that alternative payment and/or delivery models may be explored. Many new mechanisms for care delivery require that a workforce is trained and ready to deliver care in an innovative way. This could be applied to technology innovations (such as telehealth) or emerging care team models/members (such as community health workers, paramedics in community settings, doulas, etc.).
    • Advanced Practice Registered Nurses (APRN) Operating without a Practice Agreement: Two bills this session sought to remove requirements for a practice agreement for APRNs delivering care (SB 394 [13], SB 343 [14]). There was a lot of discussion on both sides and from public testimony; ultimately, neither bill made it across the finish line. This topic will be studied by the Public Health, Behavioral Health, and Human Services Interim Committee.
      • What does this have to do with the health workforce?
        • This topic addresses the practice and supervisory provisions for advanced practice registered nurses in Indiana.
        • For information on the Advanced Practice Registered Nurse workforce in Indiana, check out the Data Report and Brief linked at the bottom of the post.

 

Save the Dates

Dates and agendas for interim study committees can be found at each committee’s respective homepage. Dates for the Public Health, Behavioral Health, and Human Services Interim Study Committee may be found below:

  • Wednesday, September 4: 9:00am in Senate Chamber | Agenda | Link to Watch Live
  • Wednesday, September 18: 10:00am in Room 431
  • Wednesday, October 2: 10:00am in Room 431
  • Wednesday, October 16: 10:00am in Room 431
  • Wednesday, October 30: 10:00am in Room 431

Resources Referenced in the Post:

Latest Version of the B4:
https://scholarworks.iupui.edu/bitstream/handle/1805/20130/2019%20Bowen%20Biweekly%20Bill%20Brief_8-1-19.pdf?sequence=1&isAllowed=y

2017 Nurse Data Report: https://scholarworks.iupui.edu/bitstream/handle/1805/17195/2017-Nursing-Data-Report-Final-RS_Authored%20Version.2.28.19.pdf?sequence=10&isAllowed=y

2017 Nurse Brief:  https://scholarworks.iupui.edu/bitstream/handle/1805/18302/RN%20Fact%20Sheet-FINAL%28revised%29.pdf?sequence=6&isAllowed=y

References

[1] https://www.iga.in.gov/legislative/2019/bills/house/1344

[2] https://www.iga.in.gov/legislative/2019/bills/senate/527

[3] https://www.iga.in.gov/legislative/2019/bills/house/1199

[4] https://www.iga.in.gov/legislative/2019/bills/senate/586

[5] U.S. Department of Justice, Drug Enforcement Administration. DEA Requirements for DATA Waivered Physicians. Available at: https://www.deadiversion.usdoj.gov/pubs/docs/dwp_buprenorphine.htm

[6] https://www.iga.in.gov/legislative/2019/bills/senate/141

[7] Minimum Standards for the Provision of Services by

Opioid Treatment Facilities and Programs. 440 IAC 10-4-13. Available at: https://iac.iga.in.gov/iac/T04400/A00100.PDF?

[8] https://www.hhs.gov/about/news/2019/02/14/hhs-launches-innovative-payment-model-new-treatment-transport-options.html

[9] https://www.iga.in.gov/legislative/2019/bills/senate/498

[10] https://www.iga.in.gov/legislative/2019/bills/house/1007

[11] https://www.iga.in.gov/legislative/2019/bills/senate/416

[12] https://www.iga.in.gov/legislative/2019/bills/house/1200

[13] https://www.iga.in.gov/legislative/2019/bills/senate/394

[14] https://www.iga.in.gov/legislative/2019/bills/senate/343

Workforce Shortage: A wellness issue

by | Apr 22, 2019 | Other

At first blush you may wonder how workforce shortages and wellness could possibly be related. Workforce shortages contribute to the wellness of providers and the populations they serve. From the provider perspective, the symptoms of workforce shortages may sound like “I spend too many hours at work” or “I see too many patient appointments in a day.” Without sufficient support from peers and colleagues, providers are more likely to feel isolated, overwhelmed, and experience burnout. The bottom line: workforce shortages contribute to burnout and threaten provider wellness.

Now, you may be wondering how this impacts population wellness. Providers experiencing burnout are more likely to reduce the number of hours they work and/or leave practice all together. In underserved communities, provider burnout contributes to exacerbating existing workforce shortages and further threatens access to the health care services, including those critical to wellness (examples: vaccination, well-child visits, prenatal care.) It’s a vicious cycle.

How can we fix this problem? Policies to address workforce shortages are an important part of the solution. Loan Repayment Programs (LRP) support recruitment of providers in workforce shortage areas. These programs reduce provider debt burden and encourage practice in underserved communities. Over the last several legislative sessions in Indiana there have been more than 15 LRP bills proposed, and this year 4 bills are on the table. At the Bowen Center, we are keeping our finger on the pulse of these important initiatives and providing data and research to inform related conversations. Do you want more information? Contact us at Bowenctr@iu.edu.

Diversity in the Health Workforce

Diversity in the Health Workforce

by | Feb 26, 2019 | Topics of Interest

Why it matters

Improving diversity among health professionals has been an important initiative for decades. Increased diversity in the health care workforce has demonstrated benefits to improved health outcomes. Besides creating a workforce more representative of the communities it serves, there are three commonly identified values to having a diverse workforce.

 

Increased quality of care

A medical professional who understands the history, beliefs, behavior and attitudes of underserved or underrepresented minority patients (also known as ‘cultural competence’) will have the best ability to communicate and treat effectively. Moreover, giving patients the option to interact with a health care professional from a similar background may foster a stronger doctor-patient relationship. Not to mention, this could also reduce much of the anxiety associated with visiting the doctor and increase a patient’s satisfaction with the care they receive.

Zanimivo je tudi dejstvo, da vam bodo zdravila prodali, če ste stari vsaj 18 let lekarnaena.com. Seveda vam nihče ne bo pogledal v potni list, vendar je bolje, da otrok ne pošljete “bežati” po tablete – malo verjetno je, da bodo lahko sami kupili potrebna zdravila. Na to opozarja tudi napis v bližini blagajne.

 

Enhanced access to care

Many underserved communities, especially those in urban settings, have large minority populations with limited access to health care services. This can propagate health inequity when workforce capacity is disproportionately greater in suburban communities. Health care professionals from an underrepresented minority group are more likely to practice in an underserved area. Therefore, increased diversity in the health care workforce has the potential to expand workforce capacity and reduce the gap in health care access and treatment.

 

Advancements in research

As with the health workforce that provides patient care, there is a need for diversity among medical researchers. Many diseases have greater negative impacts on racial and ethnic minorities. However, these same groups are less likely to participate in research. Diversity in the investigative team may increase diversity in the study population as participants may wish to interact with investigators from similar backgrounds.

Though increased diversity is needed, there already exists a proven history of great medical discoveries from minority researchers. In celebration of Black History Month, below is a short list of medical research and inventions by previous and current African American physicians that have significantly impacted the advancement of health care and research.