Indiana’s 2023 Legislative Session Wrap Up: Health Workforce Takeaways

Indiana’s 2023 Legislative Session Wrap Up: Health Workforce Takeaways

by | May 4, 2023 | Policy, Topics of Interest

What is the B4?  

The Bowen Center is committed to providing relevant and timely data to inform health workforce policy. A few years ago, we realized the best way to fulfill that commitment was to keep close tabs on the topics of interest by Indiana stakeholders. One way we monitor this is by tracking Indiana health workforce legislation through implementation of the Bowen Bi-Weekly Bill Brief or “B4.” When we first developed the B4, we kept it as an internal tracker to keep our team up-to-date on health workforce happenings. We quickly realized that this tracker could serve additional audiences and we could pivot its dissemination to a forward-facing tool. 

Now in its fifth iteration, the B4 experienced a re-design in 2022 to enhance accessibility of customized information for users through the use of an interactive table hosted on the Bowen Portal. Users can now search for keywords of interest and filter by topic area. Below are this year’s topical categories for health workforce-related legislation: (Note: in the instance a bill may fall under multiple categories, it was assigned to a primary topic. We are already making plans for 2024’s B4 to allow for tagging of multiple topical areas.) 

Topic Areas

 

  • Behavioral Health (substance use and mental health), 
  • Corrections 
  • Direct Care Workforce 
  • Maternal/Child Health 
  • Nursing Workforce 
  • Oral health 
  • Other 
  • Physician Workforce 
  • Prevention & awareness (public health, infrastructure, and healthy and active living) 
  • Regulatory (Agency, Boards, PLA) 
  • Safety net (Medicaid, SNAP, TANF, SNAP, etc.) 
  • School Health 
  • Workforce Pipeline (Education) 
  • Workforce Incentive Program 

What else did we do new in 2023? 

In addition to making the B4 more interactive, we expanded its reach. Before 2023, we focused almost exclusively on bills with a primary focus on the health workforce. Think health workforce incentive program development, new license types, educational policy changes, etc. While planning for 2023, we realized that there are many instances where the bills that impact health care professionals the most are broader bills that impact both the health workforce and other sectors. In 2023, we developed a new structure that monitors bills with a primary focus on the health workforce (of course), but we began including bills that also impact health or workforce/education. These major category areas can be found within the 2023 B4.  

 

Top Health Workforce Themes in the 2023 Legislative Session 

Let’s cut to the chase. What health workforce legislation passed in the 2023 session? There were a few major themes that arose. We have conceptualized these themes, and summarized the outcomes below.  

Long-term Supports and Services Workforce 

  • Outlines that a home health agency is not required to conduct a preemployment physical on prospective staff prior to patient contact; Allows home health aides to administer g- or j-tube feedings if certain criteria are met (Senate Enrolled Act 474) 
  • Outlines requirements for a direct support professional registry which direct support professionals must be on in order to provide direct support services, and describes requirements for the creation of a training curriculum and growth opportunities for direct support professionals (House Enrolled Act 1342) 
  • Provides that the Family and Social Services Agency Division of Aging may hire a dementia care coordinator to establish a “dementia care specialist” program to establish training requirements for dementia care specialists employed by area agencies (House Enrolled Act 1422) 
  • Sets the professional requirements for an individual to serve as a residential care facility administrator and creates notification requirements to the Indiana department of health when there is a vacancy or new hire of a residential care administrator. (House Enrolled Act 1461) 
Licensure Compacts  

  • Establishes Indiana’s participation in Occupational Therapy Licensure Compact to allow occupational therapists and occupational therapy assistants to practice in Indiana under an out-of-state license if certain criteria are met (Senate Enrolled Act 73) 
  • Professional Counselors Licensure Compact to allow professional counselors to practice in Indiana under an out-of-state license if certain criteria are met (Senate Enrolled Act 160) 
  • Recommendation for interim study committee to study whether Indiana should adopt an interstate mobility to allow individuals with licenses in another state to practice in Indiana (Senate Enrolled Act 400) 
Removal or Reduction of Noncompetitive Agreements:  

  • Beginning July 1, 2023, primary care physicians and employers may not enter into a noncompete agreement. This legislation also outlines procedures for eligible physicians to purchase a release from a noncompete agreement for agreements entered into after July 1, 2023. The legislation also establishes circumstances under which an agreement is not enforceable (Senate Enrolled Act 7)  
Regulatory Changes 

  • Modifies field experience requirements for marriage and family therapist or a therapist associate licenses (Senate Enrolled Act 11) 
  • The Office of Medicaid Policy and Planning may not require telehealth providers to have a physical address in Indiana in order to be enrolled in Medicaid. (House Enrolled Act 1352) 
  • Would allow nursing practice (RN and LPN) under a temporary permit while pending application review. Would allow information to be collected from IDOH consumer services occupations (home health aides, qualified medication aides, certified nurse aides) and state board of physical therapy. Transitions nearly all initial licenses and registrations from paper to electronic. Removes provisional license language and requires issuance of license by endorsement (if license held in other state or jurisdiction) in 30 days (House Enrolled Act 1460) 
  • Establishment of a “Temporary Health Care Services Agencies” registration (under Indiana Department of Health), including outlining which Indiana licensed health professions met its criteria, services provided, regulatory requirements, and prohibited services (ex. restricting employment opportunities) (House Enrolled Act 1461) 
  • Removal of requirement for dentist and dental hygiene licensees pay a $20 compliance fee (House Enrolled Act 1113) 
  • Pharmacists are able to prescribe and dispense certain hormonal contraceptives if certain criteria are met (House Enrolled Act 1568)  
There were many other health and workforce/education related bills that also made it into law. Check out the full B4 to learn more about those bills. 

What other resources do you have that might be of interest to me? 

The Bowen Bi-Weekly Bill Brief is just one way the Bowen Center seeks to provide stakeholders with high-quality, objective information about Indiana’s health workforce. Through the Bowen Library, you can stay in the know about Indiana’s health workforce professions through bi-annual health workforce data reports, policy briefs, and more. 

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