You must read the next slide regarding CME conflict of interest before continuing with the presentation. financialrelationship this will needtoresolvedprior to be the activity. financialIn addition,interest.relationships relevant withany commercial should itthata be conflict determinedof intere whoiseveryone in where positiona processhasimplementedaISMA The to control contenttheof an activityeducation hasdi OF GRIDDISCLOSURE CONFLICT INTEREST FINANCIAL providing this seminar,will beattestationandof name hours. CME certificate The educationalbetheto mademust theprior audienceactivity to the thatmight d be servicesrigor. Financial of or relationshipsproductcommercialor manufacturerdisclosurecommercial witha Support,forStandards Commercial educationalindependence, sponsoredprogramsobjectiv mustbalance,by the demonstrate ISMA and Speaker continuing foreducation medical activity. maximum CME CREDIT issues affecting the of practice patientmedicine, and/orcare publichealth and whatthe applicabledeadlines and requiremen deadlines, dates and/or newof requirements this legislationto their of practice patient care and/or public OBJECTIVES

PLANNING CMTE. SPEAKER Mike Mike Sandy Miller Jill Name Mike Brady Name Accreditation Bruce of Brady Rinebold

Committee FinancialCommittee 0.5 0.5 INFORMATION At

AMA PRA Category 1 Credits1 PRA CategoryAMA the endof

I do do I have not any relevant financial relationships with any commercial interests. do I have not any relevant financial relationships with any commercial interests. do I have not any relevant financial relationships with any commercial interests. do I have not any relevant financial relationships with any commercial interests. Commercial Interest do I have not any relevant financial relationships with any commercial interests. Commercial Interest Information: health; (2) live live

Credit activity, participantsshouldactivity, ablebe physicians. RelationshipGrid forDisclosure this program(see

The ISMA is accredited by AccreditationtheCouncilis ISMA accredited The for Continuing EducationMedical(ACCME) to provide Describe the affect each billhavewill on the practice of medicine, patient and/orcare public DesignationInformation:

Disclosure ™. Physiciansshould™. only ofwiththe claimtheir extent participationcommensuratethe creditin the Information:

The State Medical Association (ISMA) designates this live seminar fordesignates AssociationthisIndiana(ISMA)Medical live The seminar State activity. activity. to:

To includingTo complyisISMA the withACCME requirements, accreditationthe

(1) (1) List the 2014 legislationIndianain that affects the of practice medicine, To To medicine; medicine; Prepare (4) receive CMEcredit receive e - following mailed.

pages for grid).pageswith theACCME In accordance , you themust, evaluationclosecompletetheat

N/A N/A N/A N/A What receivedI N/A What receivedI a resolution to the of ISMAHouse Delegates on

N/A N/A N/A N/A My Role N/A My Role st

exists as a resultof aaas exists ts ts isc

are for are for doing so. ussed or referred to in or referredussed scl health; Apply(3) None None None None Conflict/Resolved None Conflict/Resolved osed to usosed all ity

and scientific a

of

2014 Legislative Wrap-up

Mike Brady Legislative Coordinator Indiana State Medical Association 2014

• “[Governor] Pence summed up the session this way: ‘Because of the leadership in the House and Senate and, frankly, because of a strong bipartisan effort of members of both chambers, I believe we've made measurable progress on jobs and schools and infrastructure.’” (Indianapolis Star)

• “[House Minority] Leader from Michigan City issued the following statement on the 2014 session of the Indiana General Assembly: ‘To adequately describe the worthlessness of the latest legislative session, one must look at what was said by Ed Ziegner of the Indianapolis News after the first legislative short session back in 1972: It has been a bad session in about every way a session can be bad, which is a good many.’” (Howey Politics Indiana) 2014 INDIANA GENERAL ASSEMBLY

Senate: 37 Republicans (Super Majority) 13 Democrats House: 69 Republicans (Super Majority) 31 Democrats 2014 INDIANA GENERAL ASSEMBLY

New Members: House: – Rep. Greg Beumer, R-Farmland Dist. 33 • (Rep. Bill Davis) – Rep. Casey Cox, R-Fort Wayne Dist. 85 • (Rep. Phyllis Pond) – Rep. , R-Evansville Dist. 76 • (Rep. )

2014 INDIANA GENERAL ASSEMBLY

1st Chamber 2nd Chamber Bill # Bill Title 9 10 1 2 3 4 5 6 7 8 ISMA SUPPORTED BILLS AUTHOR VOTE SPONSOR VOTE HB 1051 HEPATITIS C TESTING & STUDY OF NEEDLE EXCHANGES ERRINGTON 80 - 10 Patricia Miller HB 1097 IMMUNITY FOR PROVIDING HEALTH CARE FRIZZELL 86 - 4 Patricia Miller 48 - 0 HB 1139 SELLING HEARING AIDS BAUER 87 - 8 Patricia Miller 43 - 5 HB 1218 DRUG TREATING AND REPORTING (INSULIN SALES) DAVISSON 95 - 0 GROOMS 48 - 0 HB 1258 DISTANCE TREATMENT BY PHYSICIANS SHACKLEFORD 95 - 1 Patricia Miller 47 - 0 HB 1360 ADDICTION TREATMENT AND SERVICES C. BROWN 93 - 0 Patricia Miller 48 - 0 SB 50 MINORS AND TANNING DEVICES Patricia Miller 30 - 17 ZENT 69 - 23 SB 222 STUDENT ATHLETE CONCUSSIONS HOLDMAN 45 - 1 ARNOLD 95 - 3 SB 233 PHARMACY TRCHNICIANS AND AA LICENSURE GROOMS 47 - 1 DAVISSON 93 - 0 SB 245 SCHOOLS AND AUTO-INJECTABLE EPINEPHRINE Patricia Miller 49 -0 ZENT 74 - 0 SB 262 BIOSIMILAR DRUGS HERSHMAN 38 - 11 CLERE 92 - 5 SB 285 TRAMADOL GROOMS 49 - 0 DAVISSON

1st Chamber 2nd Chamber Bill # Bill Title 9 10 1 2 3 4 5 6 7 8 ISMA OPPOSED BILLS AUTHOR VOTE SPONSOR VOTE HB 1060 CERTIFIED REGISTERED NURSE ANESTHETIST FRIZZELL HB 1106 EPHEDRINE AND PSEUDOEPHEDRINE KUBACKI HB 1114 LEGEND DRUG PRESCRIPTIONS BY OPTOMETRISTS DAVISSON 85 - 8 GROOMS HB 1248 METHAMPHETAMINE SMALTZ SB 145 PHYSICAL EXAMINATION BY NURSE PRACTITIONERS CRIDER SB 219 PHYSICIAN ORDER FOR SCOPE OF TREATMENT HOLDMAN SB 290 MEDICAL DEBT COLLECTION PROCEDURES TALLIAN 47 - 1 DELANEY SB 294 WORKER'S COMPENSATION BOOTS 48 - 0 OBER 95 - 1 SB 346 MEDICATION THERAPY MANAGEMENT AND MEDICAD GROOMS

KEY LEGISLATIVE PROCESS COLOR INDICATOR

First Reading-First 1 6 Committee Passed Chamber

2 Committee 7 Second Reading Died

AMENDED- 3 Second Reading 8 Third Reading LANGUAGE MOVED Conference 4 Third Reading 9 Committee First Reading-Second 5 10 Governors Office Chamber 118th Indiana General Assembly-Second Session SCOPE OF PRACTICE

2014 INDIANA GENERAL ASSEMBLY • Scope of Practice – Enacted • SB 233 – Pharmacy Technicians and Anesthesiologist Assistants – Dead • HB 1060 – Certified Registered Nurse Anesthetists • HB 1114 – Legend Drug Prescriptions by Optometrists • SB 145 – Physical Examinations by Nurse Practitioners

2014 INDIANA GENERAL ASSEMBLY

• SB 233 – Pharmacy Technicians and Anesthesiologist Assistants – Author: Sen. Ron Grooms, R-Jeffersonville – Sponsor: Rep. Steve Davisson, R-Salem – ISMA Supported • Originally just dealt with changes to Pharmacy Technicians • Amended to provide for the licensure of Anesthesiologist Assistants (AA) – Class B misdemeanor for professing to be an AA without a license

LEGAL

2014 INDIANA GENERAL ASSEMBLY • Legal – Enacted • HB 1139 – Selling Hearing Aids* • HB 1258 – Distance Treatment by Physicians • HB 1323 – Epinephrine in Institutions of Higher Education • SB 50 – Minors and Tanning Devices* • SB 56 – Medical Malpractice Patient’s Compensation Fund • SB 139 – Health Matters

*Designates an ISMA Resolution

2014 INDIANA GENERAL ASSEMBLY

• Legal (Continued) • SB 222 – High School Student Athlete Concussions • SB 245 – Schools and Auto-Injectable Epinephrine* • SB 294 – Worker’s Compensation – Dead • HB 1097 – Immunity for Providing Volunteer Health Care Services • SB 244 – Health Care Professional Registry • SB 290 – Medical Debt Collection Procedures • SB 346 – Medication Therapy Management and Medicaid

*Designates an ISMA Resolution

2014 INDIANA GENERAL ASSEMBLY • HB 1139 – Selling Hearing Aids* – Author: Rep. Patrick Bauer, D-South Bend – Sponsor: Sen. Patricia Miller, R-Indianapolis – ISMA Initiative, Supported – Provides that a person may not sell, lease or rent a hearing aid in Indiana unless the hearing aid has been fitted by a hearing aid dealer or an audiologist – Also calls for a study by the ISDH to: » Determine the number of Indiana residents who are less than 19 and are hearing impaired » Calls for a study to determine cost of a state program and health insurance requirement » Deadline of September 1, 2014

*Designates an ISMA Resolution

2014 INDIANA GENERAL ASSEMBLY

• HB 1258 – Distance Treatment by Physicians – Author: Rep. , D-Indianapolis – Sponsor: Sen. Patricia Miller, R-Indianapolis – ISMA Supported • Requires the Medical Licensing Board to establish: – A pilot program to allow treatment, including issuing a prescription, without the establishment of an in-person patient/physician relationship – Standards and procedures for the physician in the pilot program

2014 INDIANA GENERAL ASSEMBLY • SB 245 – Schools and Auto-Injectable Epinephrine* – Author: Sen. Pat Miller, R-Indianapolis – Sponsor: Rep. , R-Angola – ISMA Initiative, Supported • Allows a health care provider with prescriptive authority to prescribe auto-injectable epinephrine to a school or school district • Sets requirements for certain individuals employed by a school or school district to fill, store and administer auto- injectable epinephrine

*Designates an ISMA Resolution 2014 INDIANA GENERAL ASSEMBLY

• SB 245 (Continued) – Provides civil immunity for: • Certain school employees in the administration of auto-injectable epinephrine • Health care providers in the prescribing of epinephrine and the training of school personnel in the administration of auto- injectable epinephrine

2014 INDIANA GENERAL ASSEMBLY • HB 1323 – Epinephrine in Institutions of Higher Education – Author: Rep. , R-Albion – Sponsor: Sen. Patricia Miller, R-Indianapolis – ISMA Supported • Allows a postsecondary educational institution to develop a policy for the emergency administration of an auto-injectable epinephrine to a student, faculty member, or staff member under certain circumstances • Sets forth requirements for the policy and for those employees who act as trained designees and administer the epinephrine. – Requires the state department of health to set forth guidelines for the policies

2014 INDIANA GENERAL ASSEMBLY

• HB 1323 (Continued) • Allows a health care provider to write a prescription for epinephrine for a postsecondary educational institution and allows a pharmacist to dispense the prescription • Requires storage of the epinephrine in a safe location – Provides for civil immunity for licensed campus medical professionals, trained designees, and certain healthcare providers in the administration of epinephrine in compliance with the policy and guidelines

2014 INDIANA GENERAL ASSEMBLY

• SB 50 – Minors and Tanning Devices* – Author: Sen. Pat Miller, R-Indianapolis – Sponsor: Rep. Dennis Zent, R-Angola – ISMA Initiative, Supported • Prohibits a person younger than 16 years of age from using a tanning device in a facility • Repeals a provision requiring a person less than 16 years of age to be accompanied by a parent or guardian when using a tanning device in a facility – Requires the ISDH to adopt standards concerning the use of tanning devices

*Designates an ISMA Resolution

2014 INDIANA GENERAL ASSEMBLY

• SB 56 – Medical Malpractice Patient’s Compensation Fund – Author: Sen. Allen Paul, R-Richmond – Sponsor: Rep. Richard Hamm, R-Richmond – ISMA Supported • Requires claims for payment from the Patient’s Compensation Fund to be computed and paid every three months instead of every six months

2014 INDIANA GENERAL ASSEMBLY

• SB 139 – Health Matters – Author: Sen. , R-Evansville – Sponsor: Rep. Ed Clere, R-New Albany – ISMA Supported • Amends the definition of “attendant care services” to include providing assistance for taking of medications, including controlled substances and prescription drugs • Removes the July 1, 2014, expiration date of the Anatomical Gift Promotion Fund

2014 INDIANA GENERAL ASSEMBLY • SB 222 – High School Student Athlete Concussions – Author: Sen. , R-Indianapolis – Sponsor: Rep. Lloyd Arnold, R-Leavenworth – ISMA Supported • Provides that a high school student athlete who has been removed from play because of a suspected concussion or head injury may not return to play until at least 24 hours have passed since the incident • Training: Beginning July 1, 2014, the bill requires football coaches and assistant football coaches who are coaching individuals less than 20 years of age to complete a course concerning player safety and concussions at least once during a two-year period. – Provides immunity for coaches under certain circumstances

2014 INDIANA GENERAL ASSEMBLY • SB 294 – Worker’s Compensation – Author: Sen. , R-Crawfordsville – Sponsor: Rep. David Ober, R-Albion – ISMA Opposed • Changes the worker’s compensation law by providing that: – A medical service provider may not be reimbursed for more than one office visit for each repackaged legend drug prescribed – The maximum period during which a medical service provider, may receive reimbursement for a repackaged legend drug begins on the date of the injury or disablement and ends at the beginning of the eighth day after the date of the injury or disablement – A medical service provider is distinguished from a medical service facility on the basis of the provider’s billing form for Medicare reimbursement

PHARMACY 2014 INDIANA GENERAL ASSEMBLY

• Pharmacy – Enacted • HB 1218 – Drug Treatment and Reporting, Insulin Sales • HB 1360 – Addiction Treatment and Services • SB 262 – Biosimilar Drugs – Died • HB 1248 – Methamphetamine • SB 285 – Tramadol

2014 INDIANA GENERAL ASSEMBLY • HB 1218 – Drug Treatment and Reporting, Sales of Insulin* – Author: Rep. Steve Davisson, R-Salem – Sponsor: Sen. Patricia Miller, R-Indianapolis – ISMA Initiative, Supported • Expires standards for operation rules concerning prior authorization for a take home supply of opioid treatment medication – Current law requires rules to require prior authorization for more than 14 days of medication • Prohibits an opioid treatment program from prescribing, dispensing, or providing more than a seven day supply of opioid treatment medication to a patient to take out of the facility

*Designates an ISMA Resolution

2014 INDIANA GENERAL ASSEMBLY

• HB 1218 (Continued) • Requires an opioid treatment program to follow the standards and protocols adopted by the division of for each opioid treatment program patient • Requires the dispenser at an opioid treatment program to transmit certain information to the division within specified time frames • Provides that the information is subject to federal patient confidentiality regulations • Requires a provider to release certain information from a committed patient's mental health records upon request of a court

2014 INDIANA GENERAL ASSEMBLY • HB 1218 (Continued) • Requires the Indiana professional licensing agency to study the impact of including all prescription drugs in the INSPECT program and sets forth requirements of the study. • Requires the legislative council to assign a committee to study: – Security of the INSPECT program – If opioid treatment programs should be prohibited from allowing patients to take home opioid treatment medication • Prohibits the sale of insulin without a prescription from an authorized provider

2014 INDIANA GENERAL ASSEMBLY • HB 1360 – Addiction Treatment and Services – Author: Rep. C. Brown, D-Gary – Sponsor: Sen. Patricia Miller, R-Indianapolis – ISMA Supported • Adds psychiatrists pursuing fellowship training and certification in addiction psychiatry to persons eligible for the loan forgiveness program • Provides that a psychiatrist pursuing fellowship training and certification in addiction psychiatry may receive loan forgiveness grants for not more than five years • Requires the board to give consideration to annually funding two psychiatrists pursuing fellowship training and certification in addiction psychiatry

2014 INDIANA GENERAL ASSEMBLY • SB 262 – Biosimilar Drugs – Author: Sen. , R-Buck Creek – Sponsor: Rep. Ed Clere, R-New Albany – ISMA Supported • Allows a pharmacist to substitute an interchangeable biosimilar product for a prescribed biological product if certain conditions are met • It requires the Indiana Board of Pharmacy to maintain an Internet website listing the biosimilar biological products determined to be interchangeable • Allows the pharmacy to adopt rules and provides that a written or electronic prescription for a biological product must comply with existing prescription form requirements

PUBLIC HEALTH 2014 INDIANA GENERAL ASSEMBLY • Public Health – Enacted • SB 88 – Mental Health Witnesses in Criminal Cases • SB 408 – Neonatal Abstinence Syndrome – Died • HB 1051 – Hepatitis C Testing and Study of Needle Exchanges • HB 1309 – Medicaid Matters • SB 219 – Physician Order for Scope of Treatment

2014 INDIANA GENERAL ASSEMBLY

• SB 88 – Mental Health Witnesses in Criminal Cases – Author: Sen. , R-Lafayette – Sponsor: Rep. Ron Bacon, R-Chandler – ISMA Monitored • Specifies who may be appointed as a mental health expert in a criminal case

2014 INDIANA GENERAL ASSEMBLY • SB 408 – Neonatal Abstinence Syndrome – Author: Sen. Vaneta Becker, R-Evansville – Sponsor: Rep. , R-Syracuse – ISMA Supported • Defines "neonatal abstinence syndrome" (NAS) – The ISDH shall: (a) Meet with representatives of certain associations to study and make recommendations on issues concerning NAS. (b) Report, before November 1, 2014, on certain issues concerning NAS to the Legislative Council for distribution to the appropriate interim study committee • Allows the ISDH to establish, one or more pilot programs with hospitals that consent to participate in the programs to implement appropriate and effective models for NAS identification, data collection, and reporting.

LEGISLATIVE MORGUE 2014 INDIANA GENERAL ASSEMBLY

• Scope of Practice – HB 1060 – Certified Registered Nurse Anesthetists (Opposed) – HB 1114 – Legend Drug Prescriptions by Optometrists (Opposed) – SB 145 – Physical Examinations by Nurse Practitioners (Opposed)

2014 INDIANA GENERAL ASSEMBLY

• Legal – HB 1097 – Immunity for Providing Volunteer Health Care Services (Supported) – SB 244 – Health Care Professional Registry (Monitored) – SB 290 – Medical Debt Collection Procedures (Opposed) – SB 346 – Medication Therapy Management and Medicaid (Opposed)

2014 INDIANA GENERAL ASSEMBLY

• Pharmacy – HB 1248 – Methamphetamine (Opposed) – SB 285 – Tramadol (Supported)

2014 INDIANA GENERAL ASSEMBLY

• Public Health – HB 1051 – Hepatitis C Testing and Study of Needle Exchanges (Supported) – HB 1309 – Medicaid Matters (Monitored) – SB 219 – Physician Order for Scope of Treatment (Opposed)

Simple steps for writing a resolution

By following these five easy steps, you can write a resolution: • Determine a clear action or stand you would like the ISMA to take on an issue and the reasons why. • Write a short title. • Include your name or names of ISMA members introducing the resolution. • Develop one or more “Whereas” statements explaining the issue and why ISMA action is requested. • Conclude with one or more “Resolve” statements that must stand alone and say what you want the ISMA to do in a clear and concise action plan. For example: “RESOLVED, that the ISMA form an ad hoc commission to study the problem of drug-addicted neonates and propose a solution within one year. • Only ISMA members may submit resolutions.

Need help? • The ISMA staff is always willing to provide assistance in helping you with your resolution. Also, find a tutorial at www.ismanet.org/convention/howtores.htm. Only ISMA members may submit resolutions. THANK YOU Contact Info: Mike Brady Legislative Coordinator Indiana State Medical Association [email protected] 317.489.2209 cell 317.454.7727 office