SB 269-1_ Filed 02/14/2008, 07:03 Thompson

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    PREVAILED      Roll Call No. _______
    FAILED        Ayes _______
    WITHDRAWN        Noes _______





    I move that Engrossed Senate Bill 269 be amended to read as follows:

    Delete the title and insert the following:
    A BILL FOR AN ACT to amend the Indiana Code concerning health and insurance.

SOURCE: Page 2, line 32; (08)MO026902.2. -->     Page 2, between lines 32 and 33, begin a new paragraph and insert:
SOURCE: IC 16-18-2-84; (08)MO026902.2. -->     "SECTION 2. IC 16-18-2-84 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 84. "Council" refers to the following:
        (1) For purposes of IC 16-21, the hospital council.
        (2) For purposes of IC 16-25 and IC 16-27, the home health care services and hospice services council.
         (3) For purposes of IC 16-25.5, the dialysis facility council.
        (3) (4) For purposes of IC 16-28 and IC 16-29, the Indiana health facilities council.
        (4) (5) For purposes of IC 16-46-6, the interagency state council on black and minority health.
SOURCE: IC 16-18-2-94.5; (08)MO026902.3. -->     SECTION 3. IC 16-18-2-94.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2008]: Sec. 94.5. "Dialysis facility", for purposes of IC 16-25.5, means an entity that provides therapeutic or rehabilitative dialysis services required for the care of individuals with renal disease.
    Chapter 1. Dialysis Facility Council
    Sec. 1. (a) The dialysis facility council is established. The state department shall staff the council.
    (b) The council consists of nine (9) members appointed by the governor as follows:
        (1) Two (2) physicians, each of whom is:
            (A) licensed under IC 25-22.5; and
            (B) either:
                (i) a qualified nephrologist; or
                (ii) experienced in the care of patients with renal disease.
        (2) One (1) registered nurse licensed under IC 25-23 and experienced in the care of patients with renal disease.
        (3) Two (2) individuals engaged in the administration of facilities that provide dialysis services.
        (4) One (1) individual engaged in hospital administration.
        (5) The state health commissioner or the commissioner's designee.
        (6) One (1) representative of a statewide organization or association that assists kidney patients.
        (7) One (1) individual who is not associated with a hospital or facility that provides dialysis, except as a consumer.
    Sec. 2. (a) An appointment to the council is for four (4) years, beginning July 1 of the year of appointment. However, in the case of a vacancy, the appointee shall serve the remainder of the unexpired term. A vacancy shall be filled from the group represented by the outgoing member.
    (b) The governor shall appoint a chairperson from the members of the council.
    Sec. 3. A member of the council who is not a state employee is entitled to the minimum salary per diem provided by IC 4-10-11-2.1(b). A member is entitled to reimbursement for traveling expenses provided under IC 4-13-1-4 and other expenses actually incurred in connection with the member's duties, as provided in the state policies and procedures established by the Indiana department of administration and approved by the budget agency.
    Sec. 4. (a) The first meeting of the council shall be called by the chairperson and held not later than thirty (30) days after the appointment of the members of the council. The council shall meet at least two (2) times each calendar year on dates fixed by the chairperson.
    (b) Special meetings of the council shall be called by the chairperson at the request of any three (3) members of the council.
    (c) Five (5) members constitute a quorum for the transaction of business.
    Sec. 5. In the first meeting of the council and in the first annual

meeting during each subsequent year, the council shall elect from the members a secretary who shall keep a record of all meetings. The term of secretary is one (1) year.
    Sec. 6. At the request of the council, the state department may obtain the services of experts or other persons to assist the council in the formulation of policy or in conducting the council's business.
    Sec. 7. (a) Except as provided in subsection (b), the council shall propose and the executive board may adopt rules under IC 4-22-2 necessary to protect the health, safety, rights, and welfare of patients, including the following:
        (1) Rules pertaining to the licensure, operation, and management of a dialysis facility.
        (2) Rules establishing standards for equipment, facilities, and staffing required for efficient and quality care of patients of a dialysis facility.
    (b) The state department may request the council to propose a new rule or an amendment to an existing rule necessary to protect the health, safety, rights, and welfare of patients of a dialysis facility. If the council does not propose a rule within ninety (90) days of the state department's request, the state department may propose the department's own rule.
    (c) The state department shall consider the rules proposed by the council and may adopt, modify, remand, or reject specific rules or parts of rules proposed by the council.
    Sec. 8. (a) The executive board may, upon recommendation by the state health commissioner and for good cause, waive a rule adopted under this chapter.
    (b) Disapproval of a waiver request requires executive board action.
    (c) A waiver may not adversely affect the health, safety, rights, or welfare of the patients.
    Sec. 9. If a dialysis facility is part of a hospital, IC 16-21 applies.
    Sec. 10. (a) Licensure inspections of a dialysis facility shall be made regularly in accordance with rules adopted under this chapter. The state department shall make all health and sanitation inspections, including inspections in response to an alleged breach of this chapter or rules adopted under this chapter. The division of fire and building safety shall make all fire safety inspections. The council may provide for other inspections necessary to implement this chapter.
    (b) An employee of the state department who knowingly or intentionally informs a dialysis facility of the exact date of an unannounced inspection shall be suspended without pay for five (5) days for a first offense and shall be dismissed for a subsequent offense.
    (c) Reports of all inspections must be in writing and sent to the inspected dialysis facility.

    (d) The report of an inspection and records relating to the inspection may not be released to the public until the conditions set forth in IC 16-19-3-25 are satisfied.
    Sec. 11. (a) The state department shall prepare an annual report concerning dialysis facilities. The report must provide a consumer with information concerning dialysis facilities in Indiana and include the following:
        (1) The location of each licensed dialysis facility and the services provided at the facility.
        (2) The inspection results of each dialysis facility.
        (3) Any remedial or licensure action taken against a dialysis facility.
        (4) Any other information the state department believes would assist a consumer.
    (b) The state department shall post the report required in subsection (a) on the state department's Internet web site and provide a written copy of the report to an individual upon request.
    Chapter 2. Licensure of Dialysis Facilities
    Sec. 1. (a) The state department shall license and regulate dialysis facilities.
    (b) A dialysis facility must be licensed by the state department in order to operate in the state.
    Sec. 2. The council may determine if a dialysis facility is covered by this chapter. A decision of the council under this section is subject to review under IC 4-21.5.
    Sec. 3. The state department shall administer this chapter with the advice of the council.
    Sec. 4. (a) An applicant for a license under this chapter must submit an application for a license on a form prescribed by the state department showing that:
        (1) the applicant is of reputable and responsible character; and
        (2) the applicant is able to comply with the minimum standards for a dialysis facility and with rules adopted under this chapter.
    (b) The submitted application must contain the following information:

         (1) The name of the applicant.
        (2) The location of the dialysis facility.
        (3) The name of the person to be in charge of the dialysis facility.
        (4) Other information required by the state department.
    Sec. 5. An application for a license under this chapter must be accompanied by a licensing fee at a rate adopted by the council under IC 4-22-2.
    Sec. 6. The state health commissioner may:
        (1) issue a license upon receipt of the application without

further evidence; or
        (2) request additional information concerning the
application and conduct an investigation to determine whether a license should be granted.
     Sec. 7. A license issued under this chapter:
        (1) expires one (1) year after the date of issuance;
        (2) is not assignable or transferable;
        (3) is issued only for the premises named on the application;
        (4) must be posted in a conspicuous place in the dialysis facility for which the license was issued; and
        (5) may be renewed each year upon the payment of a renewal fee at the renewal rate adopted by the council under IC 4-22-2.
    Sec. 8. A dialysis facility that provides to a patient notice concerning a third party billing for a service provided to the patient shall ensure that the notice:
        (1) conspicuously states that the notice is not a bill;
        (2) does not include a tear-off portion; and

         (3) is not accompanied by a return mailing envelope.
    Chapter 3. Remedies for Violations
    Sec. 1. The state health commissioner may take any of the following actions on any of the grounds listed in section 2 of this chapter:
        (1) Issue a letter of correction.
        (2) Issue a probationary license.
        (3) Conduct a resurvey.
        (4) Deny renewal of a license.
        (5) Revoke a license.
        (6) Impose a civil penalty in an amount not to exceed ten thousand dollars ($10,000).
    Sec. 2. The state health commissioner may take action under section 1 of this chapter on any of the following grounds:
        (1) Violation of any of the provisions of this article or the rules adopted under this article.
        (2) Permitting, aiding, or abetting the commission of an illegal act in a dialysis facility.
        (3) Knowingly collecting or attempting to collect from a subscriber (as defined in IC 27-13-1-32) or an enrollee (as defined in IC 27-13-1-12) of a health maintenance organization (as defined in IC 27-13-1-19) any amounts that are owed by the health maintenance organization.
        (4) Conduct or practice found by the council to be detrimental to the health, safety, rights, and welfare of the patients of a dialysis facility.

     Sec. 3. (a) IC 4-21.5 applies to an action under this chapter.
    (b) A licensee or an applicant for a license aggrieved by an action under this article may request review under IC 4-21.5.

    Sec. 4. The state department shall investigate a report of an unlicensed dialysis facility and report the findings to the attorney general. The attorney general may seek any of the following:
        (1) An injunction in a court with jurisdiction in the county in which the unlicensed dialysis facility is located or in the circuit or superior court of Marion County.
        (2) Relief under IC 4-21.5, including a civil penalty not to exceed an amount of twenty-five thousand dollars ($25,000) for each day of unlicensed operation.
        (3) Criminal penalties as provided in section 5 of this chapter.
    Sec. 5. A person who knowingly or intentionally:
        (1) operates a dialysis facility that is required to be licensed under this article that is not licensed under this article; or
        (2) advertises the operation of a dialysis facility that is required to be licensed under this article and that is not licensed under this article;
commits a Class A misdemeanor.
SOURCE: Page 5, line 8; (08)MO026902.5. -->     Page 5, between lines 8 and 9, begin a new paragraph and insert:
SOURCE: ; (08)MO026902.7. -->     "SECTION 7. [EFFECTIVE UPON PASSAGE] (a) As used in this SECTION, "council" refers to the dialysis facility council established by IC 16-25.5-1-1(a), as added by this act.
    (b) The governor shall make the initial appointments to the council not later than July 1, 2008. In making the initial appointment, the governor shall indicate the length of the term for which the individual is appointed.
    (c) Notwithstanding IC 16-25.5-1-2, as added by this act, the initial terms of the members of the council, except for the state health commissioner appointed under IC 16-25.5-1-1(b)(5), shall be staggered as follows:
        (1) Two (2) members of the council appointed for a term of two (2) years.
        (2) Three (3) members of the council appointed for a term of three (3) years.
        (3) Three (3) members of the council appointed for a term of four (4) years.
    (d) The initial term for council members begins July 1, 2008.
    (e) This SECTION expires December 31, 2012.

SOURCE: ; (08)MO026902.8. -->     SECTION 8. [EFFECTIVE UPON PASSAGE] (a) If the state department of health grants an exemption to a person that is required to be licensed, or that meets the definition of a person licensed under:
        (1) IC 16-21-2-2(4); or
        (2) IC 16-25.5, as added by this act;
from a physical plant standard requirement under the person's licensure, the state department may not grant the exemption for a period ending later than December 31, 2011, and the person must meet the physical plant standards required for the person's

licensure not later than January 1, 2012.
    (b) This SECTION expires December 31, 2012.

SOURCE: Page 5, line 18; (08)MO026902.5. -->     Page 5, after line 18, begin a new paragraph and insert:
SOURCE: ; (08)MO026902.10. -->     "SECTION 10. An emergency is declared for this act.".
    Renumber all SECTIONS consecutively.
    (Reference is to ESB 269 as printed February 12, 2008.)


Representative Thompson

MO026902/DI 104     2008