Bill Text: IN SB0460 | 2011 | Regular Session | Introduced
Bill Title: Long term care issues.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Enrolled - Dead) 2011-04-21 - Returned to the Senate with amendments [SB0460 Detail]
Download: Indiana-2011-SB0460-Introduced.html
Citations Affected: IC 12-7-2; IC 12-15; IC 16-18-2; IC 16-28.
Synopsis: Quality assessment and moratorium. Requires and sets forth
the procedure for an institutional provider and a noninstitutional
provider to reimburse the office of the secretary of family and social
services for certain Medicaid overpayments made to the provider.
Extends: (1) the collection of a nursing facility quality assessment fee
with changes to the amount collected and the amount and to whom the
dollars are dispersed; and (2) a moratorium on the certification of new
or converted comprehensive care beds for participation in the state
Medicaid program; until June 30, 2014. Creates a moratorium on the
construction and certification of health facilities until June 30, 2014.
Effective: July 1, 2011.
January 12, 2011, read first time and referred to Committee on Health and Provider
Services.
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
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A BILL FOR AN ACT to amend the Indiana Code concerning
health.
(1) A health facility licensed under IC 16-28.
(2) An ICF/MR (as defined in IC 16-29-42).
(b) If the office of the secretary believes that an overpayment to a
noninstitutional provider has occurred, the office of the secretary may
do the following:
(1) Notify the noninstitutional provider in writing that the office
of the secretary believes that an overpayment has occurred.
(2) Request Demand in the notice that the noninstitutional
provider repay the amount of the alleged overpayment, including
interest:
(A) due from the noninstitutional provider; and
(B) accruing from the date of overpayment.
(b) (c) A noninstitutional provider who receives a notice and
request demand for repayment under subsection (a) (b) may elect to do
one (1) of the following:
(1) Repay the amount of the overpayment not later than sixty (60)
days after receiving notice from the office of the secretary,
including interest:
(A) due from the noninstitutional provider; and
(B) accruing from the date of overpayment.
(2) Request a hearing and repay the amount of the alleged
overpayment not later than sixty (60) days after receiving notice
from the office of the secretary.
(3) Request a hearing not later than sixty (60) days after receiving
notice from the office of the secretary and not repay the alleged
overpayment, except as provided in subsection (d).
(c) (d) If:
(1) a noninstitutional provider elects to proceed under subsection
(b)(2); (c)(2); and
(2) the office of the secretary determines after the hearing and any
subsequent appeal that the noninstitutional provider does not
owe the money that the office of the secretary believed the
noninstitutional provider owed;
the office of the secretary shall return the amount of the alleged
overpayment, and any interest paid by the noninstitutional provider,
and pay the noninstitutional provider interest on the money from the
date of the noninstitutional provider's repayment.
(d) If:
(1) a provider elects to proceed under subsection (b)(3); and
(2) the office of the secretary determines after the hearing and any
subsequent appeal that the provider owes the money;
the provider shall pay the amount of the overpayment, including
interest due from the provider and accruing from the date of the
overpayment.
(e) Interest that is due under this section shall be paid at a rate that
is determined by the commissioner of the department of state revenue
under IC 6-8.1-10-1(c) as follows:
(1) Interest due from a noninstitutional provider to the state shall
be paid at the rate set by the commissioner for interest payments
from the department of state revenue to a taxpayer.
(2) Interest due from the state to a noninstitutional provider shall
be paid at the rate set by the commissioner for interest payments
from the department of state revenue to a taxpayer.
(f) Interest on an overpayment to a noninstitutional provider is not
due from the noninstitutional provider if the overpayment is the result
of an error of:
(1) the office; or
(2) a contractor of the office;
as determined by the office of the secretary.
(g) If interest on an overpayment to a noninstitutional provider is
due from the noninstitutional provider, the secretary may, in the
course of negotiations with the noninstitutional provider regarding an
appeal filed under subsection (b), reduce the amount of interest due
from the noninstitutional provider.
(h) Proceedings under this section are subject to IC 4-21.5.
(1) A health facility that is licensed under IC 16-28.
(2) An ICF/MR (as defined in IC 16-29-4-2).
(b) If the office of the secretary believes that an overpayment to an institutional provider has occurred, the office of the secretary may do the following:
(1) Submit to the institutional provider a draft of the audit findings and accept comments from the institutional provider for consideration by the office of the secretary before the audit findings are finalized.
(2) Following consideration of an institutional provider's comments, notify the institutional provider in writing that the office of the secretary:
(A) believes that an overpayment has occurred; and
(B) is issuing a recalculated Medicaid rate.
(3) Upon the next payment cycle, retroactively implement the recalculated Medicaid rate.
(c) An institutional provider that receives a notice of overpayment and recalculated Medicaid rate under subsection (b)
may request administrative review of the recalculated Medicaid
rate not later than forty-five (45) days after the issuance of the
recalculated rate.
(d) If the institutional provider is dissatisfied with the office of
the secretary's reconsideration response, the institutional provider
may request a hearing.
(e) If an institutional provider requests a hearing under
subsection (d) and the office determines after the hearing and any
subsequent appeal that the institutional provider does not owe the
money that the office of the secretary believed the institutional
provider owed, the office of the secretary shall repay the following
to the institutional provider not later than thirty (30) days after the
completion of the hearing:
(1) The amount of the alleged overpayment.
(2) Any interest paid by the institutional provider.
(3) Interest on the money described in subdivisions (1) and (2)
from the date of the institutional provider's repayment.
(f) Interest due under this section by either the institutional
provider or the office of the secretary shall be paid at a rate that is
determined by the commissioner of the department of state
revenue under IC 6-8.1-10-1(c) at the rate set by the commissioner
for interest payments from the department of state revenue to a
taxpayer.
(g) Interest on an overpayment to an institutional provider is
not due from the institutional provider if the office of the secretary
determines that the overpayment is the result of an error by the
following:
(1) The office of the secretary.
(2) A contractor of the office of the secretary.
(h) If interest on an overpayment to an institutional provider is
due from the institutional provider, the office of the secretary may,
in the course of negotiations with the institutional provider
concerning an appeal filed under subsection (c), reduce the amount
of interest due from the institutional provider.
(b) If the office of the secretary of family and social services or
the administrator of the office and the provider cannot come to an
agreement within sixty (60) days after it is determined that a
provider has received payments that the provider is not entitled to,
the administrator may recoup the amount of overpayment to the
provider claimed by the state from subsequent payments to the
provider.
(b) "Comprehensive care bed", for purposes of IC 16-29-2, has the meaning set forth in IC 16-29-2-1.
(1) except for purposes of IC 16-28-15, means a building, a structure, an institution, or other place for the reception, accommodation, board, care, or treatment extending beyond a continuous twenty-four (24) hour period in a week of more than four (4) individuals who need or desire such services because of physical or mental illness, infirmity, or impairment; and
(2) for purposes of IC 16-28-15, has the meaning set forth in IC 16-28-15-3.
(b) The term does not include the premises used for the reception, accommodation, board, care, or treatment in a household or family, for compensation, of a person related by blood to the head of the household or family (or to the spouse of the head of the household or family) within the degree of consanguinity of first cousins.
(c) The term does not include any of the following:
(1) Hotels, motels, or mobile homes when used as such.
(2) Hospitals or mental hospitals, except for that part of a hospital that provides long term care services and functions as a health facility, in which case that part of the hospital is licensed under IC 16-21-2, but in all other respects is subject to IC 16-28.
(3) Hospices that furnish inpatient care and are licensed under IC 16-25-3.
(4) Institutions operated by the federal government.
(5) Foster family homes or day care centers.
(6) Schools for individuals who are deaf or blind.
(7) Day schools for individuals with mental retardation.
(8) Day care centers.
(9) Children's homes and child placement agencies.
(10) Offices of practitioners of the healing arts.
(11) Any institution in which health care services and private duty nursing services are provided that is listed and certified by the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc.
(12) Industrial clinics providing only emergency medical services or first aid for employees.
(13) A residential facility (as defined in IC 12-7-2-165).
(14) Maternity homes.
(15) Offices of Christian Science practitioners.
(b) The term does not include the premises used for the reception, accommodation, board, care, or treatment in a household or family, for compensation, of a person related by blood to the head of the household or family (or to the spouse of the head of the household or family) within the degree of consanguinity of first cousins.
(c) The term does not include any of the following:
(1) Hotels, motels, or mobile homes when used as such.
(2) Hospitals or mental hospitals, except for that part of a hospital that provides long term care services and functions as a health facility, in which case that part of the hospital is licensed under IC 16-21-2, but in all other respects is subject to IC 16-28.
(3) Hospices that furnish inpatient care and are licensed under IC 16-25-3.
(4) Institutions operated by the federal government.
(5) Foster family homes or day care centers.
(6) Schools for individuals who are deaf or blind.
(7) Day schools for individuals with mental retardation.
(8) Day care centers.
(9) Children's homes and child placement agencies.
(10) Offices of practitioners of the healing arts.
(11) Any institution in which health care services and private duty nursing services are provided that is listed and certified by the Commission for Accreditation of Christian Science Nursing Organizations/Facilities, Inc.
(12) Industrial clinics providing only emergency medical services or first aid for employees.
(13) A residential facility (as defined in IC 12-7-2-165).
(14) Maternity homes.
(15) Offices of Christian Science practitioners.
(d) "Health facility", for purposes of IC 16-28-15, has the meaning set forth in IC 16-28-15-3.
(b) "Office", for purposes of IC 16-19-14, refers to the office of minority health established by IC 16-19-14-4.
(c) "Office", for purposes of IC 16-28-15, has the meaning set forth in IC 16-28-15-5.
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2011]:
Chapter 15. Health Facility Quality Assessment Fee
Sec. 1. The imposition of a quality assessment fee under this
chapter occurs after July 31, 2011.
Sec. 2. As used in this chapter, "continuing care retirement
community" means a health care facility that:
(1) provides independent living services and health facility
services in a campus setting with common areas;
(2) holds continuing care agreements with at least twenty-five
percent (25%) of its residents (as defined in IC 23-2-4-1);
(3) uses the money from the agreements described in
subdivision (2) to provide services to the resident before the
resident may be eligible for Medicaid under IC 12-15; and
(4) meets the requirements of IC 23-2-4.
Sec. 3. As used in this chapter, "health facility" refers to a
health facility that is licensed under this article as a comprehensive
care facility.
Sec. 4. As used in this chapter, "nursing facility" means a health
facility that is certified for participation in the federal Medicaid
program under Title XIX of the federal Social Security Act (42
U.S.C. 1396 et seq.).
Sec. 5. As used in this chapter, "office" refers to the office of
Medicaid policy and planning established by IC 12-8-6-1.
Sec. 6. (a) Effective August 1, 2011, the office shall collect a
quality assessment fee from each health facility.
(b) The quality assessment fee must apply to all non-Medicare
patient days of the health facility. The office shall determine the
quality assessment rate per non-Medicare patient day in a manner
that collects the maximum amount permitted by federal law as of
July 1, 2011, based on the latest nursing facility financial reports
and nursing facility quality assessment data collection forms as of
July 28, 2010.
(c) The office shall offset the collection of the assessment fee for
a health facility:
(1) against a Medicaid payment to the health facility;
(2) against a Medicaid payment to another health facility that
is related to the health facility through common ownership or
control; or
(3) in another manner determined by the office.
Sec. 7. The office shall implement the waiver approved by the
United States Centers for Medicare and Medicaid Services under
42 CFR 433.68(e)(2), that provides for the following:
(1) Non-uniform quality assessment fee rates.
(2) An exemption from collection of a quality assessment fee
from the following:
(A) A continuing care retirement community as follows:
(i) A continuing care retirement community that was
registered with the securities commissioner as a
continuing care retirement community on January 1,
2007, is not required to meet the definition of a
continuing care retirement community in section 2 of
this chapter.
(ii) A continuing care retirement community that, for the
period January 1, 2007, through June 30, 2009, operated
independent living units, at least twenty-five percent
(25%) of which are provided under contracts that
require the payment of a minimum entrance fee of at
least twenty-five thousand dollars ($25,000).
(iii) An organization registered under IC 23-2-4 before
July 1, 2009, that provides housing in an independent
living unit for a religious order.
(iv) A continuing care retirement community that meets
the definition set forth in section 2 of this chapter.
(B) A hospital based health facility.
(C) The Indiana Veterans' Home.
Any revision to the state plan amendment or waiver request under
this section is subject to and must comply with the provisions of
this chapter.
Sec. 8. (a) The money collected from the quality assessment fee
during the first year following the enactment may be used only as
follows:
(1) Sixty-eight percent (68%) to pay the state's share of costs
for Medicaid nursing facility services provided under Title
XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(2) One and four-tenths percent (1.4%) to pay the state's
share of costs for Medicaid aged and disabled waiver services
provided under Title XIX of the federal Social Security Act
(42 U.S.C. 1396 et seq.).
(3) Seventeen and six-tenths percent (17.6%) to pay the state's
share of costs for other Medicaid services provided under
Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.).
(4) Four percent (4%) to be deposited in the office's Medicaid
administration fund to pay the state's share of costs associated
with the federal Patient Protection and Affordable Health
Care Act.
(5) Nine percent (9%) as determined by the office.
(b) The money collected from the quality assessment fee during
the second year following enactment may be used only as follows:
(1) Sixty-eight percent (68%) to pay the state's share of costs
for Medicaid nursing facility services provided under Title
XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(2) One and four-tenths percent (1.4%) to pay the state's
share of costs for Medicaid aged and disabled waiver services
provided under Title XIX of the federal Social Security Act
(42 U.S.C. 1396 et seq.).
(3) Twenty percent (20%) to pay the state's share of costs for
other Medicaid services provided under Title XIX of the
federal Social Security Act (42 U.S.C. 1396 et seq.).
(4) Six and four-tenths percent (6.4%) to be deposited in the
office's Medicaid administration fund to pay the state's share
of costs associated with the federal Patient Protection and
Affordable Health Care Act.
(5) Four and two-tenths percent (4.2%) as determined by the
office.
(c) The money collected from the quality assessment fee after
the second year following enactment may be used only as follows:
(1) Seventy-two and two-tenths percent (72.2%) to pay the
state's share of the costs for Medicaid nursing facility services
provided under Title XIX of the federal Social Security Act
(42 U.S.C. 1396 et seq.).
(2) One and four-tenths percent (1.4%) to pay the state's
share of costs for Medicaid aged and disabled waiver services
provided under Title XIX of the federal Social Security Act
(42 U.S.C. 1396 et seq.).
(3) Twenty percent (20%) to pay the state's share of costs for
other Medicaid services provided under Title XIX of the
federal Social Security Act (42 U.S.C. 1396 et seq.).
(4) Six and four-tenths percent (6.4%) to be deposited in the
office's Medicaid administration fund to pay the state's share
of costs associated with the federal Patient Protection and
Affordable Health Care Act.
(d) Any increase in reimbursement for Medicaid nursing facility
services resulting from maximizing the quality assessment under
section 6(b) of this chapter shall be directed exclusively to
initiatives determined by the office to promote and enhance
improvements in quality of care to nursing facility residents.
(e) The office may establish a method to allow a health facility
to enter into an agreement to pay the quality assessment fee
collected under this chapter under an installment plan.
Sec. 9. If federal financial participation becomes unavailable to
match money collected from the quality assessment fees for the
purpose of enhancing reimbursement to nursing facilities for
Medicaid services provided under Title XIX of the federal Social
Security Act (42 U.S.C. 1396 et seq.), the office shall cease
collection of the quality assessment fee under this chapter.
Sec. 10. The office shall adopt rules under IC 4-22-2 necessary
to implement this chapter.
Sec. 11. (a) If a health facility fails to pay the quality assessment
under this chapter not later than ten (10) days after the date the
payment is due, the health facility shall pay interest on the quality
assessment at the same rate as determined under
IC 12-15-21-3(6)(A).
(b) The office shall report to the state department each nursing
facility and each health facility that fails to pay the quality
assessment fee under this chapter not later than one hundred
twenty (120) days after payment of the quality assessment fee is
due.
Sec. 12. (a) The state department shall do the following:
(1) Notify each nursing facility and each health facility
reported under section 11 of this chapter that the nursing
facility's license or health facility's license under IC 16-28 will
be revoked if the quality assessment fee is not paid.
(2) Revoke the nursing facility's license or health facility's
license under IC 16-28 if the nursing facility or the health
facility fails to pay the quality assessment fee.
(b) An action taken under subsection (a)(2) is governed by:
(1) IC 4-21.5-3-8; or
(2) IC 4-21.5-4.
Sec. 13. The select joint commission on Medicaid oversight
established by IC 2-5-26-3 shall review the implementation of this
chapter.
Sec. 14. This chapter expires June 30, 2014.
Chapter 16. Health Facility Moratorium
Sec. 1. This chapter does not apply to the following:
(1) For purposes of the construction of a health facility, an entity that:
(A) is licensed or to be licensed under this article;
(B) has complied with the moratorium in effect before July 1, 2011 in P.L.121-2008, SECTION 5;
(C) has physically begun significant construction of the health facility before May 15, 2011; and
( D) meets the licensure and survey requirements of this article.
(2) A new continuing care retirement community required to file a disclosure statement under IC 23-2-4 that has only Medicare certified beds or non-certified beds.
(3) A health facility that is licensed under IC 16-28-2 and does one (1) of the following:
(A) Transferring or relocating an existing health facility within the county of the existing health facility.
(B) Adding comprehensive care beds not certified under the Medicaid program to an existing campus under the same license.
(4) A small house health facility.
The state department may make the final determination on whether an entity has physically begun significant construction of a health facility for purposes of subdivision (1)(C).
Sec. 2. As used in this chapter, "small house health facility" means a freestanding, self-contained health facility that has the following characteristics:
(1) Has at least ten (10) and not more than twelve (12) private resident rooms in one (1) structure that has the appearance of a residential dwelling that is not more than eight thousand (8,000) square feet and includes the following:
(A) A fully accessible private bathroom for each resident room that includes a toilet, sink, and roll in shower with a seat.
(B) A common area living room seating area.
(C) An open full-sized kitchen where one hundred percent (100%) of the resident's meals are prepared.
(D) A dining room that has one (1) table large enough to seat each resident of the dwelling and at least two (2) staff members.
(E) Access to natural light in each habitable space.
(2) Does not include the following characteristics of an
institutional setting:
(A) A nurse's station.
(B) Room numbering or other signs that would not be
found in a residential setting.
(3) Provides self-directed care.
Sec. 3. The director may not approve a new health facility
license under IC 16-28-2 and an entity may not add or construct a
health facility licensed or to be licensed under this article.
Sec. 4. (a) A person planning to construct a small house health
facility shall apply to the Indiana health facility council for
approval.
(b) An applicant under this section, including an entity related
to the applicant through common ownership or control, may apply
for not more than fifty (50) comprehensive care bed for small
house health facilities per year.
(c) The Indiana health facilities council may not recommend,
and the state department may not approve, certification of more
than one hundred (100) new comprehensive care beds designated
for small house health facilities per year.
(d) The state department shall approve an application for a
small house health facility:
(1) in the order of the completed application date; and
(2) if the applicant meets the definition of a small house health
facility and the requirements of this section; and
(3) after the Indiana health facilities council has
recommended the application for approval.
(e) The health facilities council may not recommend, and the
state department may not approve, an application for construction
and operation of a small house health facility if the person meets
any of the following:
(1) Has a record of operation of less than a full license.
(2) Has owned or operated a health facility that has had the
health facility's license revoked, suspended, or denied.
(3) Has received a survey finding of substandard quality of
care, immediate jeopardy, or actual harm.
(4) Has filed for bankruptcy, reorganization, or receivership.
(5) Was the subject of any of the following:
(A) License decertification.
(B) License termination.
(C) A finding of patient:
(i) abuse;
(ii) mistreatment; or
(iii) neglect.
(f) A person that fails to complete construction and begin
operation of a small house health facility within twelve (12) months
of the state department's approval of the application shall forfeit
the person's right to the comprehensive care beds approved by the
state department if:
(1) another person has applied to the Indiana health facilities
council for approval of at least (1) small house health facility;
and
(2) the person's application was denied for the sole reason that
the maximum number of comprehensive care beds specified
in subsection (c) had been certified for small house health
facilities.
Sec. 5. This chapter expires June 30, 2014.
Chapter 17. Moratorium on Medicaid Certification of Comprehensive Care Beds
Sec. 1. This chapter does not apply to the conversion of acute care beds to comprehensive care beds under IC 16-29-3.
Sec. 2. As used in this chapter, "comprehensive care bed" means a bed that:
(1) is licensed or is to be licensed under IC 16-28-2;
(2) functions as a bed licensed under IC 16-28-2; or
(3) is subject to this article.
The term does not include a comprehensive care bed that will be used solely to provide specialized services and that is subject to IC 16-29.
Sec. 3. As used in this chapter, "replacement bed" means a comprehensive care bed that is relocated to a health facility that is licensed or is to be licensed under this article. This term includes comprehensive care beds that are certified for participation in:
(1) the state Medicaid program; or
(2) both the state Medicaid program and federal Medicare program.
Sec. 4. (a) Except as provided in subsection (b), the Indiana health facilities council may not recommend and the state department of health may not approve the certification of new or converted comprehensive care beds for participation in the state Medicaid program unless the statewide comprehensive care bed occupancy rate is more than ninety-five percent (95%), as
calculated annually on January 1 by the state department of
health.
(b) This section does not apply to the following:
(1) A health facility that:
(A) seeks a replacement bed exception;
(B) applies to the state department of health to certify a
comprehensive care bed for participation in the Medicaid
program if the comprehensive care bed for which the
health facility is seeking certification is a replacement bed
for an existing comprehensive care bed in the same facility;
and
(C) applies to the division of aging in the manner:
(i) described in subsection (c); and
(ii) prescribed by the division; and
( iii) meets the licensure, survey, and certification
requirements of this article.
(2) A replacement facility if:
(A) the location of the replacement facility is within the
same county of where the original facility was located;
(B) the replacement facility maintains the same ownership
as the original facility; and
(C) the number of comprehensive care beds certified for
participation in the Medicaid program does not exceed the
number of comprehensive care beds certified for
participation in the original facility.
(c) An application made under subsection (b) for a replacement
bed exception must include the following:
(1) The total number and identification of the existing
comprehensive care beds that the applicant requests be
replaced by health facility location and by provider.
(2) Any other information requested by the division of aging
that is necessary to evaluate the transaction.
Sec. 5. This chapter expires June 30, 2014.
