Reprinted

March 1, 2006





ENGROSSED

SENATE BILL No. 266

_____


DIGEST OF SB 266 (Updated February 28, 2006 6:55 pm - DI 110)



Citations Affected: IC 2-5; IC 5-10; IC 12-15; IC 16-40; IC 27-8; IC 27-13; noncode.

Synopsis: Bariatric surgery. Specifies that a physician's duty to monitor a bariatric surgery patient for five years applies unless the physician is unable to locate the patient after a reasonable effort. Establishes certain topics that must be discussed with a patient before bariatric surgery. Provides that a report made by a physician to the state department of health of a death, serious side effect, or major complication of a patient who had surgical treatment for the treatment of morbid obesity is confidential. Specifies that statistical reports compiled by the state department from the reported information are subject to public inspection. Requires six months of supervised nonsurgical treatment before health insurance, a state health care plan, or a health maintenance organization must cover surgical treatment for morbid obesity. (Current law requires 18 months of supervised nonsurgical treatment.) Requires the office of Medicaid policy and planning (OMPP) to: (1) report changes to the Medicaid plan to the health finance commission and legislative council; and (2) submit certain information to the select joint commission on Medicaid oversight. Allows a managed care organization, upon approval by OMPP, to adopt a plan for the collection of a copayment for services that are provided to a Medicaid recipient in an emergency room.


Effective: July 1, 2006.





Miller, Sipes
(HOUSE SPONSORS _ BROWN T, BROWN C)




    January 9, 2006, read first time and referred to Committee on Health and Provider Services.
    January 26, 2006, amended, reported favorably _ Do Pass.
    January 30, 2006, read second time, ordered engrossed. Engrossed.
    February 1, 2006, read third time, passed. Yeas 49, nays 1.

HOUSE ACTION

    February 7, 2006, read first time and referred to Committee on Public Health.
    February 23, 2006, amended, reported _ Do Pass.
    February 28, 2006, read second time, amended, ordered engrossed.





Reprinted

March 1, 2006

Second Regular Session 114th General Assembly (2006)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2005 Regular Session of the General Assembly.


ENGROSSED

SENATE BILL No. 266



    A BILL FOR AN ACT to amend the Indiana Code concerning health and human services.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 2-5-23-21; (06)ES0266.2.1. -->     SECTION 1. IC 2-5-23-21 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 21. Not more than thirty (30) days after a change to the state Medicaid plan for the Medicaid program, the office of Medicaid policy and planning shall submit a report of the change to the commission and the legislative council in an electronic format under IC 5-14-6.
SOURCE: IC 5-10-8-7.7; (06)ES0266.2.2. -->     SECTION 2. IC 5-10-8-7.7, AS AMENDED BY P.L.196-2005, SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 7.7. (a) As used in this section, "covered individual" means an individual who is covered under a health care plan.
    (b) As used in this section, "health care plan" means:
        (1) a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) a contract entered into under section 7(c) of this chapter to provide health services through a prepaid health care delivery

plan.
    (c) As used in this section, "health care provider" means a:
        (1) physician licensed under IC 25-22.5; or
        (2) hospital licensed under IC 16-21;
that provides health care services for surgical treatment of morbid obesity.
    (d) As used in this section, "morbid obesity" means:
        (1) a body mass index of at least thirty-five (35) kilograms per meter squared, with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or
        (2) a body mass index of at least forty (40) kilograms per meter squared without comorbidity.
For purposes of this subsection, body mass index is equal to weight in kilograms divided by height in meters squared.
    (e) Except as provided in subsection (f), the state shall provide coverage for nonexperimental, surgical treatment by a health care provider of morbid obesity:
        (1) that has persisted for at least five (5) years; and
        (2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least eighteen (18) six (6) consecutive months.
    (f) The state may not provide coverage for surgical treatment of morbid obesity for a covered individual who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to:
        (1) save the life of the covered individual; or
        (2) restore the covered individual's ability to maintain a major life activity (as defined in IC 4-23-29-6);
and each physician documents in the covered individual's medical record the reason for the physician's determination.

SOURCE: IC 12-15-15-2.7; (06)ES0266.2.3. -->     SECTION 3. IC 12-15-15-2.7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 2.7. (a) If approved by the office, a managed care organization may adopt a plan for the collection of a copayment for services that are provided to a Medicaid recipient in an emergency room.
    (b) Each managed care organization must adopt a plan that includes the following components:
        (1) The education of Medicaid recipients concerning how a recipient may access health care services and modifications to the recipient's health plan.
        (2) Procedures to track visits to emergency rooms by Medicaid recipients.
        (3) Alternative sites for Medicaid recipients to receive health care services.
        (4) Methods to clearly identify a Medicaid recipient's current status to a provider who is not a member of the recipient's managed care organization.
        (5) Procedures to pay for professional services provided to screen a Medicaid recipient who seeks services in an emergency room.
        (6) Protocols for dispute resolution between the managed care organization and providers.

SOURCE: IC 16-40-3-2; (06)ES0266.2.4. -->     SECTION 4. IC 16-40-3-2, AS ADDED BY P.L.196-2005, SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 2. (a) As used in this section, "major complication" means a complication from surgical treatment for morbid obesity that:
        (1) requires an extended hospitalization, additional surgical treatment, or invasive drug therapy within thirty (30) days of the original surgical treatment; or
        (2) results in a permanent disability.
    (b) As used in this section, "serious side effect" means a nutritional deficiency that requires hospitalization or invasive therapy.
    (c)
A physician who is licensed under IC 25-22.5 and who performs a surgical treatment for the treatment of morbid obesity shall do the following:
        (1) Before performing surgery, discuss the following with the patient:
            (A) The requirements to qualify for the surgery.
            (B) The details of the surgery.

             (C) The possible complications from the surgery.
            (D) The side effects from the surgery, including lifestyle changes and dietary protocols.

        (1) (2) Monitor the patient for five (5) years following the patient's surgery, unless the physician is unable to locate the patient after making reasonable efforts. and
        (2) (3) Report:
            (A) to; and
            (B) in a manner prescribed by;
        the state department any death, or serious side effect, or major complication of the patient.
    (b) (d) The report required in subsection (a) by subsection (b)(2) must include the following information:
        (1) The gender of the patient.
        (2) The name of the physician who performed the surgery.
        (3) The location where the surgery was performed.
        (4) Information concerning the death, serious side effect, or major complication and the circumstances in which the death, serious side effect, or major complication occurred.
         (5) The comorbidities, body mass index, and waist circumference of the patient:
            (A) at the time of the surgical treatment; and
            (B) thirty (30) days, ninety (90) days, and one (1) year after surgical treatment.
        (6) Whether the patient has had previous abdominal surgery.

SOURCE: IC 16-40-3-3; (06)ES0266.2.5. -->     SECTION 5. IC 16-40-3-3, AS ADDED BY P.L.196-2005, SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 3. (a) The state department shall collect and maintain the information reported to the state department under section 2 of this chapter.
    (b) The reports made under section 2(a)(2) section 2(c)(3) of this chapter are public records and are confidential. However, the state department may compile statistical reports from information contained in reports made under section 2(c)(3) of this chapter. Any statistical report is subject to public inspection. However, the state department may not release any information contained in the reports that the state department determines may reveal the patient's identity.
SOURCE: IC 27-8-14.1-4; (06)ES0266.2.6. -->     SECTION 6. IC 27-8-14.1-4, AS AMENDED BY P.L.196-2005, SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 4. (a) Except as provided in subsection (b), an insurer that issues an accident and sickness insurance policy shall offer coverage for nonexperimental, surgical treatment by a health care provider of morbid obesity:
        (1) that has persisted for at least five (5) years; and
        (2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least eighteen (18) six (6) consecutive months.
    (b) An insurer that issues an accident and sickness insurance policy may not provide coverage for a surgical treatment of morbid obesity for an insured who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to:
        (1) save the life of the insured; or
        (2) restore the insured's ability to maintain a major life activity (as defined in IC 4-23-29-6);
and each physician documents in the insured's medical record the reason for the physician's determination.
SOURCE: IC 27-13-7-14.5; (06)ES0266.2.7. -->     SECTION 7. IC 27-13-7-14.5, AS AMENDED BY P.L.196-2005, SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 14.5. (a) As used in this section, "health care provider" means a:
        (1) physician licensed under IC 25-22.5; or
        (2) hospital licensed under IC 16-21;
that provides health care services for surgical treatment of morbid obesity.
    (b) As used in this section, "morbid obesity" means:
        (1) a body mass index of at least thirty-five (35) kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or
        (2) a body mass index of at least forty (40) kilograms per meter squared without comorbidity.
For purposes of this subsection, body mass index equals weight in kilograms divided by height in meters squared.
    (c) Except as provided in subsection (d), a health maintenance organization that provides coverage for basic health care services under a group contract shall offer coverage for nonexperimental, surgical treatment by a health care provider of morbid obesity:
        (1) that has persisted for at least five (5) years; and
        (2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least eighteen (18) six (6) consecutive months.
    (d) A health maintenance organization that provides coverage for basic health care services may not provide coverage for surgical treatment of morbid obesity for an enrollee who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to:
        (1) save the life of the enrollee; or
        (2) restore the enrollee's ability to maintain a major life activity (as defined in IC 4-23-29-6);
and each physician documents in the enrollee's medical record the reason for the physician's determination.
SOURCE: ; (06)ES0266.2.8. -->     SECTION 8. [EFFECTIVE JULY 1, 2006] (a) The office of Medicaid policy and planning shall do the following:
        (1) Study possible changes to the state Medicaid program or other new programs that would limit or restrict a future increase in the number of Medicaid recipients in health facilities licensed under IC 16-28.
        (2) Prepare a comprehensive cost comparison of Medicaid and Medicaid waiver services and other expenditures in the following settings:
            (A) Home care.
            (B) Community care.
            (C) Health facilities.
        The cost comparison must include a comparison of similar services that are provided in the different settings.
    (b) Before October 1, 2006, the office of Medicaid policy and planning shall report its findings under subsection (a) to the select joint commission on Medicaid oversight established by IC 2-5-26-3.
    (c) This SECTION expires January 1, 2007.


ES 266_LS 6263/DI 104

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