Bill Text: IN HB1591 | 2013 | Regular Session | Amended
Bill Title: Medicaid matters.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Introduced - Dead) 2013-02-18 - Amendment 2 (DeLaney), failed; Roll Call 133: yeas 30, nays 68 [HB1591 Detail]
Download: Indiana-2013-HB1591-Amended.html
Citations Affected: IC 2-5; IC 12-15; noncode.
Synopsis: Medicaid matters. Establishes the Indiana affordable care
committee. Amends application of certain Medicaid resource
requirements. Specifies policies that must be included in a contract
between the office of Medicaid policy and planning (office) and a
managed care organization. Requires the office to apply to the United
States Department of Health and Human Services to: (1) require risk
based managed care for certain Medicaid recipients; (2) authorize
implementation of a Medicaid program for individuals with an income
less than 133% of the federal income poverty level; and (3) require
certain Medicaid recipients to contribute to premiums and cost sharing.
Requires the office to report to the health finance commission
concerning Medicaid risk-based managed care. Establishes the Indiana
health benefit exchange advisory committee.
Effective: Upon passage; July 1, 2013.
January 23, 2013, read first time and referred to Committee on Rules and Legislative
Procedures.
January 31, 2013, reassigned to Committee on Public Health.
February 14, 2013, amended, reported _ Do Pass.
February 18, 2013, read second time, amended, ordered engrossed.
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
Chapter 36. Indiana Affordable Care Study Committee
Sec. 1. As used in this chapter, "Affordable Care Act" refers to the federal Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (P.L. 111-152).
Sec. 2. As used in this chapter, "committee" refers to the Indiana affordable care study committee established by section 4 of this chapter.
Sec. 3. As used in this chapter, "exchange" refers to an American health benefit exchange established for Indiana under the Affordable Care Act.
Sec. 4. (a) There is established the Indiana affordable care study committee.
(b) The committee shall study and make recommendations
concerning the following:
(1) The implementation of an exchange established for
Indiana.
(2) The definition of "essential health benefits" for use in
Indiana under the Affordable Care Act, including ensuring
that the definition results in adequate benefits.
(c) The committee shall receive and consider annual reports
from the office of the secretary of family and social services
concerning the status and operation of the exchange established for
Indiana.
(d) The committee shall, not later than November 1 of each
year, report the committee's findings and recommendations
concerning the committee's study under subsection (b) to the
legislative council in an electronic format under IC 5-14-6.
Sec. 5. The committee shall operate under the policies governing
study committees adopted by the legislative council.
Sec. 6. (a) The committee consists of the following voting
members:
(1) Four (4) members of the senate, not more than two (2) of
whom may be members of the same political party, appointed
by the president pro tempore.
(2) Four (4) members of the house of representatives, not
more than two (2) of whom may be members of the same
political party, appointed by the speaker.
(3) The secretary of family and social services or the
secretary's designee.
(4) The commissioner of the state department of health or the
commissioner's designee.
(5) The commissioner of insurance or the commissioner's
designee.
(6) One (1) member representing the insurance industry.
(7) One (1) member representing hospitals.
(8) One (1) member representing physicians.
(9) One (1) member representing senior citizens.
(10) One (1) member representing children.
(11) One (1) member representing providers of mental health
services.
The president pro tempore of the senate shall appoint the members
described in subdivisions (6) through (8). The speaker of the house
of representatives shall appoint the members described in
subdivisions (9) through (11).
(b) The president pro tempore shall appoint a chairperson of the
committee during each even-numbered year. The speaker shall
appoint a chairperson of the committee during each odd-numbered
year.
Sec. 7. The affirmative votes of a majority of the voting
members appointed to the committee are required for the
committee to take action on any measure, including final reports.
Sec. 8. This chapter expires July 1, 2016.
(1) who is:
(A) at least sixty-five (65) years of age; or
(B) disabled, as determined by the Supplemental Security Income program; and
(2) whose income and resources do not exceed those levels established by the Supplemental Security Income program;
is eligible to receive Medicaid assistance if the individual's family income does not exceed one hundred percent (100%) of the federal income poverty level for the same size family.
(1) An individual whose eligibility for Medicaid does not require a determination of income by the office, including an individual receiving Supplemental Security Income.
(2) An individual who is at least sixty-five (65) years of age if age is a condition of eligibility.
(3) An individual whose eligibility is being determined on the basis of being blind or disabled, or on the basis of being treated as blind or disabled.
(4) An individual who requests coverage for long term care services and supports for the purpose of being evaluated for an eligibility group under which long term care services or supports are covered, including the following:
(A) Nursing facility services.
(B) Nursing facility level of care services provided in an institution.
(C) Intermediate care facility services for the mentally retarded.
(D) Home and community based services.
(E) Home health services.
(F) Personal care services.
(5) An individual applying for Medicare cost sharing assistance.
(1) establishes one (1) irrevocable trust that has a value of not more than ten thousand dollars ($10,000), exclusive of interest, and is established for the sole purpose of providing money for the burial of the applicant or recipient;
(2) enters into an irrevocable prepaid funeral agreement having a value of not more than ten thousand dollars ($10,000); or
(3) owns a life insurance policy with a face value of not more than ten thousand dollars ($10,000) and with respect to which provision is made to pay not more than ten thousand dollars ($10,000) toward the applicant's or recipient's funeral expenses;
the value of the trust, prepaid funeral agreement, or life insurance policy may not be considered as a resource in determining the applicant's or recipient's eligibility for Medicaid.
(1) growth in principal;
(2) accumulation and reinvestment of dividends;
(3) accumulation and reinvestment of interest; and
(4) accumulation and reinvestment of distributions;
on the applicant's or recipient's trust, escrow, life insurance policy, or prepaid funeral agreement over and above the seller's current retail price of all services, merchandise, and cash advance items set forth in the applicant's or recipient's contract.
(1) the applicant or recipient is more than one thousand five hundred dollars ($1,500) for assistance to the aged, blind, or disabled; or
(2) the applicant or recipient and the applicant's or recipient's spouse is more than two thousand two hundred fifty dollars ($2,250) for medical assistance to the aged, blind, or disabled.
(b) In the case of an applicant who is an eligible individual, a Holocaust victim's settlement payment received by the applicant or the applicant's spouse may not be considered when calculating the total cash value of money, stock, bonds, and life insurance owned by the applicant or the applicant's spouse.
(c) In the case of an individual who:
(1) resides in a nursing facility or another medical institution; and
(2) has a spouse who does not reside in a nursing facility or another medical institution;
the total cash value of money, stock, bonds, and life insurance that may be owned by the couple to be eligible for the program is determined under IC 12-15-2-24.
(d) This section expires December 31, 2013.
(b) If an individual:
(1) resides in a nursing facility or another medical institution; and
(2) has a spouse who does not reside in a nursing facility or
another medical institution;
the total cash value of money, stock, bonds, and life insurance that
may be owned by the couple to be eligible for Medicaid is
determined under IC 12-15-2-24.
(b) However, a Holocaust victim's settlement payment received by the parent of an applicant for or a recipient of assistance may not be added to the total cash value of money, stock, bonds, and life insurance owned by the applicant or recipient to determine the recipient's eligibility for Medicaid under section 1 of this chapter.
(c) This section expires December 31, 2013.
(b) This section expires December 31, 2013.
(1) Increase positive health outcomes.
(2) Promote personal responsibility and informed decision making by a Medicaid recipient concerning the Medicaid recipient's health.
(3) Promote the greatest degree of independence and use of
community based supports, including home and community
based services, for long term care.
(4) Prevent fraud, waste, and abuse by both Medicaid
providers and Medicaid recipients participating in the
program.
(b) The office may apply to the United States Department of Health and Human Services for authorization to require other Medicaid population groups to enroll in risk-based managed care.
(c) The office may not implement the state plan amendment or Medicaid waiver described in this section until the office files an affidavit with the governor attesting that the state plan amendment or Medicaid waiver applied for under this section has been approved by the United States Department of Health and Human Services. The office shall file the affidavit under this subsection not later than five (5) days after the office is notified that the state plan amendment or Medicaid waiver described in this section has been approved.
(d) The office shall, not later than October 1, 2013, implement the state plan amendment or Medicaid waiver described in subsection (a) if the state plan amendment or Medicaid waiver is approved by the United States Department of Health and Human Services and the governor has received the affidavit required under subsection (c).
(e) The office may adopt rules under IC 4-22-2 necessary to implement this section.
(b) The request for a program in the state plan amendment or waiver described in subsection (a) must include the following components:
(1) Require a recipient to make out-of-pocket payments related to coverage for health care expenses provided under the program.
(2) Require a health care account to be used to pay the recipient's out-of-pocket health care expenses associated with health care coverage provided as part of the recipient's participation in the program described in this section.
(3) Include health care initiatives designed to promote the general health and well being of recipients and encourage an understanding of the cost and quality of care.
(4) Include coverage for preventative care services provided at no cost to the recipient.
(5) Use of a managed care organization model for providing services to program recipients.
(6) Provision of the following services:
(A) Outpatient services.
(B) Inpatient services.
(C) Pharmaceutical services.
(D) Behavioral health.
(E) Other services determined by the office.
(7) Provide incentives for health behavior and encourage an understanding of the cost and quality of health care.
(8) Require to the fullest extent possible the use of home and community based services for long term care.
(9) Opportunities for cost containment.
(c) The office may not implement the state plan amendment or waiver described in this section until the office files an affidavit with the governor attesting that the state plan amendment or Medicaid waiver applied for under this section is in effect. The office shall file the affidavit under this subsection not later than five (5) days after the office is notified by the United States Department of Health and Human Services that the state plan amendment or Medicaid waiver described in this section is approved.
(d) If the office receives approval for a state plan amendment or a Medicaid waiver under this section and the governor receives the affidavit described in subsection (c), the office shall implement the state plan amendment or Medicaid waiver.
(e) The office may adopt rules under IC 4-22-2 necessary to
implement this section.
(b) As used in this section, "exchange" refers to an American health benefit exchange established for Indiana under the Affordable Care Act.
(c) The Indiana health benefit exchange advisory committee is created for the purpose of advising the office with respect to policy and program administration related to:
(1) an exchange established for Indiana under the Affordable Care Act consistent with the requirements of federal law; and
(2) implementation of a program under section 4 of this chapter.
(d) The governor shall appoint nine (9) members of the advisory committee as follows:
(1) One (1) member who is a representative of health consumer advocates.
(2) One (1) member who is a representative of small business.
(3) One (1) member who is a self-employed individual.
(4) One (1) member who has expertise in small employer health insurance coverage.
(5) One (1) member who has expertise in individual health insurance coverage.
(6) One (1) member who has expertise in administration of a health benefit plan.
(7) One (1) member who has expertise in administration of a public or private health care delivery system.
(8) Two (2) members who are eligible for or enrolled in Medicaid risk-based managed care implemented under sections 4 and 5 of this chapter.
(e) Three (3) individuals shall serve as ex officio members of the advisory committee, as follows:
(1) The commissioner or the commissioner's designee, who shall serve as chairperson.
(2) The secretary of family and social services or the secretary's designee.
(3) The commissioner of the state department of health, or the
commissioner's designee.
(f) Members of the advisory committee:
(1) shall serve a three (3) year term;
(2) may be reappointed to successive terms; and
(3) serve at the pleasure of the governor.
(g) Members of the advisory committee shall serve without
compensation. However, if sufficient money is available from
federal grant funds or revenues generated by the exchange, each
member may receive the per diem allowance and travel expenses
provided for in rules that apply to executive committees adopted
by the Indiana department of administration.
(h) The advisory committee shall do the following:
(1) Review and comment on policy initiatives related to
quality improvement, health care benefits, and eligibility of
individuals for coverage through the exchange and
implementation of sections 4 and 5 of this chapter.
(2) Advise the department in setting budget priorities,
including consideration of scope of benefits, beneficiary
eligibility, health care professional reimbursement rates,
funding outlook, financing options, and possible budget
recommendations.
(3) Assess the effectiveness of implementation of sections 4
and 5 of this chapter.
(4) Not later than June 30 of each year, submit
recommendations to the governor and, in an electronic format
under IC 5-14-6, to the legislative council concerning the
implementation of the exchange and of sections 4 and 5 of this
chapter.
(5) Provide other advisory assistance as requested by the
department or other agencies of the state.
(1) Require a recipient who has an annual household income of at least one hundred fifty percent (150%) of the federal income poverty level to make premium payments in order to participate in the program.
(2) Require Medicaid recipients to participate in cost sharing, as allowable under federal law.
( b) The office may not implement the state plan amendment
described in this section until the office files an affidavit with the
governor attesting that the state plan amendment applied for
under this section has been approved by the United States
Department of Health and Human Services. The office shall file the
affidavit under this subsection not later than five (5) days after the
office is notified that the state plan amendment described in this
section has been approved.
(c) The office may adopt rules under IC 4-22-2 necessary to
implement this section.
(b) Before October 1, 2013, the office of Medicaid policy and planning shall present a plan to the commission concerning whether to increase Indiana's use of a risk-based managed care model to provide care to Medicaid populations currently being served under fee-for-service Medicaid. The plan must do the following:
(1) Provide an overview of the Medicaid populations in Indiana that are currently being served under fee-for-service Medicaid.
(2) Review the use of risk-based managed care for Medicaid populations in other states, including Texas and Florida.
(3) Explain any determination that a current fee-for-service Medicaid population should continue to be served under the fee-for-service model.
(4) Make recommendations concerning the use of risk-based managed care for Medicaid recipients receiving long term care services.
(c) This SECTION expires December 31, 2013.
