An elderly man meets with his doctor. The female doctor is using a stethoscope to listen to the man’s heart. The doctor has come to visit the man in his home.

A new state law will strengthen senior living providers’ ability to hire more caregivers and provide high-quality care, industry advocates say.

Last week, Indiana Gov. Eric Holcomb (R) signed House Enrolled Act 1461 into law. The law addresses workforce challenges and regulatory issues that have been daunting the state’s long-term care sector.

Backers say that HEA 1461 reduces administrator licensure requirements in assisted living communities and nursing homes, prohibits predatory business practices by temporary healthcare staffing agencies, allows Medicaid beneficiaries to more easily receive care near where they live and requires the state to improve Medicaid eligibility determinations and develop a plan to improve rural access to care.

“This is an incredibly important piece of legislation that will strengthen healthcare providers’ ability to hire more practitioners and continue to provide the highest level of care to residents,” Paul Peaper, president of the Indiana Health Care Association / Indiana Center for Assisted Living, said in a statement. “The long-term care sector has disproportionately lost more workers than any other healthcare sector during the pandemic, or approximately 10,000 practitioners in our state.”

Peaper said the new law gives the sector more tools to rebuild the healthcare workforce and provide high-quality care to elderly Hoosiers. 

Indiana, he added, has the most “onerous” licensing requirements in the country for assisted living administrators. With passage of HEA 1461, future applicants’ relevant work experience and / or education will count toward overall trying hours, greatly reducing the potential time from application to licensure.

The new law also created reciprocity for those holding a license from the National Association of Long Term Care Adminstrator Boards.

State Rep. Brad Barrett (R-Richmond), who authored the bill, said that long-term care facilities continue to be affected by staffing shortages. The legislation, he added, will help alleviate some of those workforce challenges by easing and streamlining licensing requirements for administrators and practitioners.

“We also took steps to improve the assisted living reimbursement formula, provide protections to residents of assisted living facilities, support efforts to get elderly Hoosiers into care quicker and bolster the services provided in home-based care,” Barrett said in a statement.

Staffing agencies targeted under bill

With passage of the bill, Indiana also joined several other states that have enacted laws addressing price gouging and predatory practices by temporary staffing agencies. The new law gives oversight to the state Department of Health and the attorney general’s office to take administrative action and levy fines against healthcare staffing agencies that engage in predatory practices.

Medicaid-reimbursed temporary agency costs in long-term care hit an all-time high of $108 million in the state last year, a 121% increase from 2019, according to IHCA. Federal and state appropriations through Medicare and Medicaid programs account for 85% of reimbursable costs in long-term care.

The new law also requires agencies to comply with state and federal regulations applicable to employees at healthcare facilities, including background checks, testing requirements and proper credentialing. Agencies also are prohibited from contract buyout provisions and noncompete clauses, liquidated damages, employment fees or other compensation if a direct care worker is hired as a permanent employee of an assisted living community, nursing home or other healthcare facility.

State government agencies also are now required to publish a plan for improving Medicaid eligibility determinations for home- and community-based services, with the goal of those determinations being made within 72 hours. The state also must develop a plan to improve access to assisted living communities in rural Indiana.

The law goes into effect on July 1.