Bill Text: IN HB1280 | 2011 | Regular Session | Introduced
Bill Title: Health disparities in Medicaid.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2011-01-12 - First reading: referred to Committee on Public Health [HB1280 Detail]
Download: Indiana-2011-HB1280-Introduced.html
Citations Affected: IC 2-5-26-16; IC 5-22-9-2.5; IC 12-7-2-126.9;
IC 12-15; IC 12-21-6.5-8.5.
Synopsis: Health disparities in Medicaid. Requires a managed care
organization (MCO) that contracts with the office of Medicaid policy
and planning (OMPP) to do the following: (1) Report to the select joint
commission on Medicaid oversight (commission) concerning the
MCO's culturally and linguistically appropriate services (CLAS)
standards plan and the progress in implementing these standards. (2)
Implement standards concerning CLAS and encourage practices that
are more culturally and linguistically accessible. (3) Develop and
administer a community based health disparities advisory council.
Requires that a request for proposals must include criteria evaluating
the MCO's cultural competency in working with minority populations,
and requires preferences to be awarded in the bidding process to an
MCO that shows evidence of cultural competency. Requires OMPP to:
(1) annually report specified information to the legislative council, the
commission, and the commission on mental health; (2) beginning
January 1, 2012, withhold a percentage of reimbursement from a
managed care organization under specified circumstances; and (3)
establish standards and guidelines and ensure continuity of care for
Medicaid recipients who transfer from an MCO. Requires Medicaid
contractors to establish certain quality initiatives. Requires the Indiana
board of pharmacy to report to the commission during the 2011 interim
concerning the feasibility and cost of requiring pharmacies to print
prescription labels in foreign languages and the number of foreign
languages the board would recommend.
Effective: Upon passage; July 1, 2011.
January 12, 2011, read first time and referred to Committee on Public Health.
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A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
(b) Before October 1 of each year, a managed care organization that has contracted with the office of Medicaid policy and planning to provide Medicaid services under the risk based managed care program shall report to the commission concerning the following:
(1) The managed care organization's culturally and linguistically appropriate services (CLAS) standards plan, including the managed care organization's progress in implementing the standards.
(2) The progress of a contractor of the managed care organization in implementing a culturally and linguistically appropriate services standards plan.
(c) Before September 1 of each year, the office of Medicaid policy and planning shall report to the commission orally and in
writing the following:
(1) The following information concerning Medicaid recipients
by race, age, and gender:
(A) Percentage spent on mental health services.
(B) The number of hospitalizations for mental health
related services.
(C) The number and percentage of recipients receiving
behavioral health screenings.
(D) Average length of time between referral and access to
mental health services.
(E) The following behavioral health outcomes:
(i) Long term hospitalization.
(ii) Institutionalization, including group home
placements.
(iii) Lengths of stays in items (i) and (ii).
(iv) Number of readmissions.
(2) Barriers to providing mental health services for racial
ethnic minorities in the Medicaid program.
(3) Any quality improvement plans to increase identification,
stabilization, and utilization of mental health services by
Medicaid recipients.
(d) The reports required in this section shall be submitted to the
commission in an electronic format under IC 5-14-6.
(1) include as criteria that will be used in evaluating the proposals information concerning the managed care organization's cultural competency in working with minority populations in Indiana; and
(2) award preferences to a managed care organization that provides evidence of cultural competency in working with minority populations.
(1) A health maintenance organization established under
IC 27-13-2 with which the office of Medicaid policy and
planning has entered into a contract to provide services under
the risk based managed care program.
(2) A person that contracts with the office or a person
described in subdivision (1) to provide the administration or
coordination of managed services, including the following:
(A) A pharmacy benefit manager.
(B) A case management coordinator.
(C) A behavioral health services coordinator.
(1) The number and demographic characteristics of the individuals receiving Medicaid during the preceding fiscal year.
(2) The number of births during the preceding fiscal year.
(3) The number of infant deaths during the preceding fiscal year.
(4) The improvement in the number of low birth weight babies for the preceding fiscal year.
(5) The total cost of providing Medicaid during the preceding fiscal year.
(6) The total cost savings during the preceding fiscal year that are realized in other state funded programs because of providing Medicaid.
(7) The number of Medicaid recipients who transfer from a managed care organization to a different managed care organization under the Medicaid program, including the following:
(A) The number of Medicaid recipients transferring out of each managed care organization.
(B) The number of Medicaid recipients transferring into each managed care organization.
(C) The following information regarding the transferring recipient:
(i) Race.
(ii) Reason for transfer.
(iii) The health outcomes for each recipient during the six (6) months after the recipient transfers.
(8) The information required to be reported in IC 12-15-12-23.
The report must be in an electronic format under IC 5-14-6.
(b) The office shall report the information required in
subsection (a) in the aggregate and in a manner that protects
individual identifiable health information.
(1) Collect data on race and primary languages as a part of the application and enrollment process.
(2) Provide the data collected under subdivision (1) to the office or managed care organization providing the care to the recipient.
(1) Measure health disparities using Healthcare Effectiveness Data and Information Set (HEDIS) standards.
(2) Implement standards concerning culturally and linguistically appropriate services (CLAS) issued by the federal Office of Minority Health within the United States Department of Health and Human Services to encourage practices that are more culturally and linguistically accessible, including:
(A) establishing and administering a written plan; and
(B) reporting annually on the progress of the plan.
(3) Develop and administer a community based health disparities advisory council as described in subsection (c). A managed care organization may partner with other managed care organizations in the establishment of the council required under this subdivision.
(4) Complete two (2) health risk assessments for each
recipient who has transferred from another managed care
organization to assist in measuring health outcomes of the
recipient as required by IC 12-15-1-14(a)(7)(C)(iii). The
health risk assessments must be completed as follows:
(A) The first health risk assessment must be completed not
later than fifteen (15) days after the transfer date.
(B) The second health risk assessment must be completed
not later than six (6) months after the transfer date.
(b) The managed care organization shall:
(1) provide the culturally and linguistically appropriate
services (CLAS) standards report required by subsection (a)
to the interagency state council on black and minority health
established by IC 16-46-6-3; and
(2) make the report available to the public upon request.
(c) The community based health disparities advisory council
developed by managed care organizations as required in subsection
(a)(3) must include the following:
(1) At least two (2) members who are minority (as defined in
IC 16-46-6-2) Medicaid recipients.
(2) Seventy-five percent (75%) of the members must be
individuals who are not employed by the managed care
organization, representing the following:
(A) Health care professionals.
(B) Advocates in the health and human services area.
(C) Individuals who provide direct services to risk based
managed care recipients.
(3) At least one (1) member representing each of the
following:
(A) The Indiana Minority Health Coalition.
(B) The commission on Hispanic/Latino affairs established
by IC 4-23-28-2.
(C) American Indian Center of Indiana.
(D) Asian Help Services.
(E) The Arc of Indiana.
(F) The Central Indiana Council on Aging.
(G) An entity that provides direct services to risk based
managed care recipients.
The council membership must reflect the population served.
(d) A community based health disparities advisory council shall
do the following:
(1) Provide input and assist the managed care organization in
the development and implementation of the culturally and
linguistically appropriate services (CLAS) standards.
(2) Review the annual assessment and evaluate whether the
plan is improving minority health outcomes.
(3) Review the annual report required by subsection (b)(1).
(4) Approve stipend reimbursement for travel expenses,
including mileage for council members who reside in a
location other than where the council meeting is being held to
travel to attend a council meeting.
(e) A managed care organization shall pay for the costs of the
managed care organization's community based health disparities
advisory council.
(f) Beginning January 1, 2012, the office shall withhold a
percentage of reimbursement from a managed care organization
based on a lack of progress by the managed care organization in
improving health disparity outcomes.
(1) Prepare requirements, including qualifications, for bidders offering to contract with the state to perform the functions under section 3 of this chapter.
(2) Assist the Indiana department of administration in preparing bid specifications in conformity with requirements.
(b) The office shall comply with IC 5-22-9-2.5 in preparing a bid for managed care organization services under the risk based managed care program.
(1) contracts with the office to provide direct services, including pharmacy vendors; and
(2) receives reimbursement under Medicaid;
shall implement at least two (2) quality improvement initiatives to reduce health disparities, at least one (1) of which addresses race, ethnic, or other geographic disparities.
(b) The initiatives required in subsection (a) must do the following:
(1) Include baseline data on individuals who receive services from the contractor.
(2) Include measurable goals and outcomes.
(3) Use a third party source to evaluate the contractor's initiatives.
(4) Be in one (1) of the following categories:
(A) Obstetrics.
(B) Asthma.
(C) Diabetes.
(D) Immunizations.
(E) Healthcare effectiveness data and information set.
(1) The following information concerning Medicaid recipients by race, age, and gender:
(A) Percentage spent on mental health services.
(B) The number of hospitalizations for mental health related services.
(C) The number and percentage of recipients receiving behavioral health screenings.
(D) Average length of time between referral and access to mental health services.
(E) The following behavioral health outcomes:
(i) Long term hospitalization.
(ii) Institutionalization, including group home placements.
(iii) Lengths of stays in items (i) and (ii).
(iv) Number of readmissions.
(2) Barriers to providing mental health services for racial ethnic minorities in the Medicaid program.
(3) Any quality improvement plans to increase identification, stabilization, and utilization of mental health services by Medicaid recipients.
(b) The report required in this section shall be submitted to the commission in an electronic format under IC 5-14-6.
(b) If the office of Medicaid policy and planning has a request for proposal or a request for services that:
(1) is in progress upon the passage of this act; and
(2) is affected by the requirements of IC 5-22-9-2.5, as added by this act;
the office shall communicate the requirements of IC 5-22-9-2.5, as
added by this act, and the culturally and linguistically appropriate
services (CLAS) standards to a person that has submitted a
proposal for the request.
(c) This SECTION expires December 31, 2011.
(b) The Indiana board of pharmacy shall report to the commission during the 2011 legislative interim concerning the feasibility and cost of requiring pharmacies to print prescription labels in foreign languages. The pharmacy board shall also report the number of foreign languages, if any, that the board would recommend to be required to be printed on a prescription drug label.
(c) This SECTION expires December 31, 2011.
