Senate Bill 3 returned to the Indiana State Senate with amendments March 31 after passing its third reading in the House. The bill covers a variety of issues related to telehealth, including quality of care, usage and Medicaid reimbursement.
The bill was written by Senators Ed Charbonneau (R), Blake Doriot (R) and Michael Crider (R). According to a document from the Indiana State House Tour Office, once a bill advances through the house where it originated it is referred to the second house. If the bill receives amendments while in the second house, it is referred back to the original house where the changes are voted on.
Ross Silverman, professor of health policy and management and of law, said the bill has bipartisan support and he believes it is very likely to pass.
Telehealth is a specific way of delivering services, including medical exams and consultation, that allow a provider to service patients at a distance. Daniel Orenstein, visiting assistant professor of law at the McKinney School of Law, said most of what Senate Bill 3 does is bring some of the previous emergency provisions and waivers from the pandemic into the permanent legal framework.
The bill, Orenstein said, would make temporary emergency measures that had been taken during the pandemic part of permanent policy.
Silverman said he believes this bill will be helpful in expanding patient access to health care, especially in rural and underserved areas.
“Where you live should not have a negative effect on your ability to access high-quality care,” Silverman said. “This kind of bill that allows for flexible use of telehealth makes that closer to reality,”
According to the bill, providers and their employees are required to maintain the same standard of care as in-person medical practice when using telehealth and must create and maintain records under the same in-person standards.
Orenstein said he believes that while these provisions may not be necessary to include in the bill, the state wanted to ensure that practitioners are not excused from their job requirements when using telehealth.
“If you were a doctor or a nurse or a psychiatrist or a veterinarian or any of the other licensed professions, you already have a lot of rules that apply to you and the standard of care that you have to meet legally,” Orenstein said. “And the fact that you're providing that care, via Skype or Zoom or on a telephone doesn't change that standard.”
According to the bill, employers cannot require practitioners to provide a health service if they believe the patient's health quality would be negatively impacted or if they would be unable to provide the same standard of care as an in-person setting. The bill states that any contract to provide telehealth must include a clause allowing the practitioner to refuse service for the reasons above.
“There's some things that isn't gonna make much sense for telehealth to step in,” said D. Eric Schansberg, professor of economics at IU Southeast. “There’s a range of services that just aren't going to be provided by telehealth but there are some.”
Silverman said Senate Bill 3 expands the types of providers who can use telehealth.
Silverman said this could be particularly helpful in rural communities, where patients that were previously unable to access specific providers locally would be able to access them online.
“Expanding the kinds of providers who are able to use telehealth and get reimbursed for providing those services is a big deal,” Silverman said.
According to the bill, a patient waives their rights to the confidentiality of any medical information that is discussed during the telehealth visit that is overhead by people in the area where the patient is during the visit. The bill also prohibits Medicaid from specifying originating sites for reimbursement services and changes requirements for prescribing medication via telehealth, among other provisions.
Schansberg said moving forward, this bill gives the public more flexibility and options.
“Hopefully there'll be a general deregulation away from what interest groups have lobbied for in the past,” Schansberg said.