SB 266-1_ Filed 03/09/2006, 09:34
Adopted 3/13/2006
CONFERENCE COMMITTEE REPORT
DIGEST FOR ESB 266
Citations Affected: IC 5-10-8-7.7; IC 16-40-3-2; IC 16-40-3-3; IC 27-8-14.1-4;
IC 27-13-7-14.5.
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 shall occur two times per year and 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.) (This conference
committee report: (1) removes language that: (A) requires the office of Medicaid policy and
planning (OMPP) to report changes to the Medicaid plan to the health finance commission
and legislative council and submit certain information to the select joint commission on
Medicaid oversight; and (B) 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; and (2) specifies that the physician's report
to the state department of health shall occur before June 30 and before December 31 of
each year.)
Effective: July 1, 2006.
CONFERENCE COMMITTEE REPORT
MADAM PRESIDENT:
Your Conference Committee appointed to confer with a like committee from the House
upon Engrossed House Amendments to Engrossed Senate Bill No. 266 respectfully reports
that said two committees have conferred and agreed as follows to wit:
that the Senate recede from its dissent from all House amendments and that
the Senate now concur in all House amendments to the bill and that the bill
be further amended as follows:
Delete the title and insert the following:
A BILL FOR AN ACT to amend the Indiana Code concerning health.
Delete everything after the enacting clause and insert the following:
SOURCE: IC 5-10-8-7.7; (06)CC026602.1.1. -->
SECTION 1. 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 16-40-3-2; (06)CC026602.1.2. -->
SECTION 2. 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 before June 30 and before December 31 of each
year:
(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 A report required in subsection (a) by subsection (c)(3)
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)CC026602.1.3. -->
SECTION 3. 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)CC026602.1.4. -->
SECTION 4. 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)CC026602.1.5. -->
SECTION 5. 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
(Reference is to ESB 266 as reprinted March 1, 2006.)
Conference Committee Report
on
Engrossed Senate Bill 266
Text Box
S
igned by:
____________________________ ____________________________
Senator MillerRepresentative Lehe
Chairperson
____________________________ ____________________________
Senator SipesRepresentative Brown C
Senate Conferees House Conferees