The following is the most recent legislative update from the IHA. Items that may be of interest to healthcare quality professionals are in red.
General Assembly Faces April 29 Deadline
With the final day for action in the General Assembly less than one week away, conference committees are busy working out compromises between House and Senate versions of legislation. There are plenty of meetings today and rumors that more will be scheduled for Saturday and even possibly Sunday. Needless to say, many members of the General Assembly will not be headed home for the weekend.
Many significant bills failed to clear both chambers, but legislation that previously passed either the House or Senate is usually eligible to be placed into another “live” bill. Check the latest Bill Track to see which bills are headed to conference committee, which ones could be brought back, and which ones likely remain off the table in 2009.
In addition to monitoring the final days of the legislative session, IHA will also participate in the American Hospital Association’s annual meeting in Washington, D.C. and engaging with members of Congress. Key topics that will be addressed are the needs of hospitals in the current economic and financial crisis, concerns over the Employee Free Choice Act, possible reductions in Medicare reimbursement, and national health reform.
HIP Changes in Limbo (SB 472)
IHA has closely followed SB 472, authored by Sen. Pat Miller (R-Indianapolis), even after the hospital assessment and the “HIP 2” proposal was removed earlier this session. As it passed the Senate, this legislation would have allowed certain Hoosiers to buy into the HIP program without state support by paying the full premium as well as making any POWER account contributions. It also would have specified that the minimum POWER account contribution required for HIP enrollees would be $60 (FSSA believes that this minimum payment is critical to maintaining the element of personal responsibility within the HIP program).
In addition to the eligibility changes, SB 472 would have also permitted non-for-profit foundations to contribute to a participant’s required POWER account payments. As passed in the Senate, the amount a not-for-profit could contribute would be 50 percent. Later amendment in the House increased the share to 75 percent.
Other amendments added in the House would have broadened HIP eligibility by reducing the time for which an individual must be without health insurance from six to three months. Another change would increase the share that participating employers can pay for employees’ POWER account payments from 50 percent to 75 percent.
The bill was withdrawn before a third reading vote in the House, and it did not pass before the deadline on April 16. Some raised concerns that certain elements of SB 472 could lead to Hoosiers dropping their private insurance to join HIP. It is important to note that while the cap of 34,000 has been reached for non-parental adults, sufficient funding remains available to enroll thousands more eligible parents or “caretaker adults” in HIP.
The language allowing foundations to contribute to POWER accounts was of particular interest to many hospitals, and it could be revived in a different bill before session’s end. Such language, however, has not yet been inserted into any other conference committee reports.
Indiana Innovation Alliance May Be Funded
There has been only one public conference committee meeting to date on HB 1001, but the prospects for Indiana Innovation Alliance funding improved when it was included in the Senate-passed budget. This proposal is a joint request by Indiana and Purdue Universities, and hospitals may be particularly interested in the component of the program to expand medical education to include two- to four-year programs in Bloomington, Evansville, Fort Wayne, Gary, Indianapolis, Muncie, New Albany, South Bend, Terre Haute, and West Lafayette.
The Senate Republicans’ budget assumed the latest revenue forecast would reflect a shortfall of $1 billion, but by fully-utilizing the significant dollars allocated to Indiana through the stimulus legislation they were able to accommodate this program in their plan.
The Senate provided approximately $26 million for state fiscal years 2010 and 2011 as follows:
- $5 million/year: Medical Education Center Expansion (to increase the medical school class size by 30 percent statewide)
- $3.8 million/year: Technical Assistance and Advanced Manufacturing (to expand post-graduate pharmacy residency training for post-graduate biomedical engineering specialization and for the Healthcare TAP program at Purdue)
- $11.3 million/year: Core Research
- $5.6 million/year: Matching Grants for Federal Research Projects
IU and Purdue were seeking a total of $35 million per year, and the House budget funded the whole program at this level in its one-year budget bill earlier in the session. You can read more about the Alliance at http://www.indianainnovationalliance.org/.
Smokefree Air Legislation Revived
As indicated in the most recent IHA Bill Track, a good deal of legislation that was previously approved by only one chamber remains in play—very little is ever entirely dead during conference committees. HB 1213, the smoke-free air bill, passed the Indiana House by a vote of 70-26, but did not receive a hearing in the Senate Commerce and Public Policy & Interstate Cooperation Committee. However, the author of the original bill, Rep. Charlie Brown, has attempted to insert a revised proposal into HB 1208.
In a conference committee meeting this week, the contents of HB 1208 (establishing a mental health corrections quality advisory committee and a related multi-agency task force) were moved into another bill and replaced with a smoke-free air proposal. The conference committee has not yet acted on HB 1208, but Rep. Brown has asked other legislators to assess what level of support exists for his proposal. To move HB 1208 forward for a full vote in the House and Senate, all four conferees would have to sign off on the report. Rep. Eric Turner, Sen. Connie Lawson, and Sen. Vi Simpson are the other conferees along with Rep. Brown.
The bill as originally introduced contained a comprehensive smoking ban in public places, including bars, casinos, and all other enclosed areas of employment. The bill was lauded by IHA and the Indiana Campaign for Smokefree Air (of which IHA is a member) as a major step forward in protecting the health of Hoosier workers. The bill met a set-back when the House Public Policy Committee passed a heavily amended bill that exempted casinos and most bars.
Rep. Brown has proposed to exempt only casinos in HB 1208. However, since the chair of the Senate Commerce Committee did not hear the original bill, we do not expect that the conferee representing the Senate majority caucus (Sen. Lawson) would sign any conference committee report on this topic.
Admitting Privileges Receive Scrutiny
As it passed the Indiana Senate earlier this session, SB 89 would have required physicians performing abortions in Indiana to have “admitting privileges” at a hospital in that county or an adjacent county. When the bill came to the House Public Policy Committee, IHA was asked to testify on SB 89 solely to provide answers regarding the nature of admitting privileges.
SB 89 was later expanded greatly on the House floor on April 13 and passed the House on April 15. The changes to the bill include requiring any “health care provider licensed by the state” performing a “surgical procedure” to have admitting privileges at a hospital in that county or an adjacent county. “Surgical procedure” was not further defined, which meant that thousands of medical professionals could be impacted.
Although this problematic language passed, other proposals that would have mandated how hospitals award admitting privileges were defeated. It is likely that admitting privileges will continue to receive scrutiny from now until the end of the session on April 29. On Tuesday, the Indianapolis Star published an article on SB 89 and cited information provided by IHA. Read the article here: http://www.indystar.com/article/20090421/NEWS05/904210376.
Sen. Patricia Miller has dissented with the changes made by the House and the matter will likely be taken up by a conference committee. The Senate has appointed conferees and advisers but the House had not yet named its appointments as of April 23. IHA anticipates that the language broadening the requirement to all surgical procedures will be removed. IHA will continue to monitor the bill and defend against any possible attempts to dictate how hospitals grant admitting privileges.
State Revenue Forecast Mixed; Documents Online
The new state forecast projects that Indiana will take in slightly more tax revenue over the biennium than some had feared, but this optimism has been openly questioned by legislators. The budget writers will have about $830 million less than was estimated based on the December 2008 forecast, but some expected the shortfall to exceed $1 billion.
Following the presentation to the State Budget Committee, the forecast documents were posted to the Budget Agency’s website. The “Economic Outlook” document from Nigel Gault, chief U.S. economist for HIS Global Insight, is particularly interesting: http://www.in.gov/sba/2489.htm.
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