HB 1130-1_ Filed 03/03/2000, 12:33
Adopted 3/3/2000
CONFERENCE COMMITTEE REPORT
DIGEST FOR EHB 1130
Citations Affected: IC 12-15; IC 12-26; noncode.
Synopsis: Medicaid and other health payments. Limits payments that a court may order to be
made from a county general fund to facilities that care for certain mentally ill individuals.
Requires the office of Medicaid policy and planning (OMPP) to adjust payments to providers
based on Medicare rates using certain conversion factors. Requires OMPP to make additional
payments to providers during fiscal year 2001 that increase state expenditures by $2,000,000.
Requires that payment for emergency services provided in a hospital's emergency department
to certain individuals must be equal to the current Medicaid fee for service reimbursement rates
for those services. Reestablishes the select joint committee on Medicaid oversight. (As affected
by this conference committee report, the bill would differ from the form in which it passed the
House in the following ways: (1) Adds a provision limiting payments that a court may order to
be made from a county general fund to facilities that provide care to certain mentally ill
individuals. (2) Removes a provision adjusting payments to providers under certain Medicaid
programs. (3) Requires OMPP to adjust payments for services provided in emergency
departments to certain individuals in order to conform with federal law. (4) Requires the select
joint committee on Medicaid oversight to review proposals regarding certain Medicaid waivers.)
Effective: January 1, 2000 (retroactive); Upon passage; July 1, 2000; July 1, 2001.
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Adopted Rejected
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CONFERENCE COMMITTEE REPORT
MR. SPEAKER:
Your Conference Committee appointed to confer with a like committee from the Senate
upon Engrossed Senate Amendments to Engrossed House Bill No. 1130 respectfully reports
that said two committees have conferred and agreed as follows to wit:
that the House recede from its dissent from all Senate amendments and that
the House now concur in all Senate amendments to the bill and that the bill
be further amended as follows:
Delete the title and insert the following:
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
SOURCE: Page 1, line 1; (00)CC113003.1. -->
Page 1, between the enacting clause and line 1, begin a new
paragraph and insert:
SOURCE: IC 12-15-12-13; (00)CC113003.1. -->
"SECTION 1.
IC 12-15-12-13
IS ADDED TO THE INDIANA
CODE AS A
NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2000]:
Sec. 13. (a) Except as provided in
subsection (b), this section applies to emergency services provided
to an individual enrolled in the Medicaid Risk-Based Managed
Care program.
(b) This section does not apply to the following:
(1) Services provided to an individual enrolled in the
Medicaid Risk-Based Managed Care program by a provider
who has contracted with a Medicaid Risk-Based Managed
Care organization to provide emergency services to the
individual.
(2) Services provided to an individual after the individual is
stabilized.
(c) Payment for emergency services (as defined in 42 U.S.C.
1396u-2(b)(2)(B)) provided for the evaluation or stabilization of an
emergency medical condition (as defined in 42 U.S.C.
1396u-2(b)(2)(C)) in the emergency department of a hospital
licensed under IC 16-21 must be in an amount equal to one
hundred percent (100%) of the current Medicaid fee for service
reimbursement rates for emergency services.
(d) Payment under subsection (c) is the responsibility of the
applicable Medicaid Risk-Based Managed Care organization under
42 U.S.C. 1396u-2(b)(2)(A)(i). This subsection does not prohibit the
organization described in this subsection from entering into a
subcontract with another Medicaid Risk-Based Managed Care
organization providing for the latter organization to assume
financial responsibility for making the payments due under
subsection (c).
(e) This section does not prohibit a managed care organization's
ability to:
(1) review; and
(2) make a determination of;
the medical appropriateness of the services provided in a hospital's
emergency department.
SOURCE: IC 12-15-13-2; (00)CC113003.2. -->
SECTION 2.
IC 12-15-13-2
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 2. (a) Except as
provided in
IC 12-15-14
and
IC 12-15-15
, payments to Medicaid
providers must be:
(1) consistent with efficiency, economy, and quality of care; and
(2) sufficient to enlist enough providers so that care and services
are available under Medicaid, at least to the extent that such care
and services are available to the general population in the
geographic area.
(b) If federal law or regulations specify reimbursement criteria,
payment shall be made in compliance with those criteria.
(c) In addition to the requirements under subsection (a), the
office shall establish payments to providers listed under 405
IAC 1-11.5-1 (except for oral surgeons and dentists) that are
reimbursed through the resource based relative value scale as
provided in 405 IAC 1-11.5 under a fee for service program or the
Medicaid primary care case management program as follows:
(1) Not less than the most current relative value unit, as
established by the federal Health Care Financing
Administration, factoring in:
(A) the existing geographic practice cost indices; and
(B) the conversion factor established by 405 IAC 1-11.5-2.
(2) If relative value units are not applicable, the office shall
review and adjust the payments as appropriate.
(3) For anesthesia services, the office shall use:
(A) the most current American Society of Anesthesiologists
relative value guide's base and modifier units; and
(B) the time unit and the conversion factor established by
405 IAC 1-11.5-2.
(d) The office shall update payment rates at least one (1) time
every two (2) years in compliance with this section.".
SOURCE: Page 1, line 2; (00)CC113003.1. -->
Page 1, line 2, after "If" insert " upon a showing by the facility
that".
Page 1, line 8, delete ", if the facility demonstrates that diligent
efforts to".
Page 1, delete line 9.
Page 1, line 10, delete "(3) have been unsuccessful,".
Page 1, between lines 16 and 17, begin a new paragraph and insert:
" (c) Subsection (b) is subject to the terms of any written
agreement between a county and a facility regarding the comfort
and care of an individual.
SOURCE: ; (00)CC113003.4. -->
SECTION 4. [EFFECTIVE JULY 1, 2000] (a) Notwithstanding
IC 12-15-13-2
, as amended by this act, the office of Medicaid policy
and planning shall adjust payments to providers listed under 405
IAC 1-11.5-1 (except for oral surgeons and dentists) that are
reimbursed through the resource based relative value scale as
provided in 405 IAC 1-11.5 under a fee for service program or the
Medicaid primary care case management program. The
adjustment described in this SECTION shall increase state general
fund expenditures by not less than two million dollars ($2,000,000)
annually.
(b) This SECTION expires June 30, 2001.".
SOURCE: Page 2, line 25; (00)CC113003.2. -->
Page 2, line 25, delete "study, investigate, and oversee" and insert
" do".
Page 2, line 27, delete "Whether" and insert " Determine whether".
Page 2, line 27, delete "of" and insert " for".
Page 2, line 32, delete "Legislative" and insert " Study and propose
legislative".
Page 2, line 32, delete "are needed" and insert " could help".
Page 2, line 33, delete "eliminate" and insert " reduce the amount
of time needed to process".
Page 2, line 33, after "claims" delete "," and insert " and eliminate".
Page 2, line 35, delete "The" and insert " Oversee the".
Page 2, line 38, delete "Any" and insert " Study and investigate
any".
Page 3, delete lines 2 through 9.
Page 3, line 10, delete "(l)" and insert " (j)".
Page 3, line 10, after "contractor" delete "of" and insert " for".
Page 3, line 10, delete "of Medicaid policy and planning".
Page 3, line 20, delete "(m)" and insert " (k)".
Page 3, line 24, delete "(n)" and insert " (l)".
Page 3, between lines 24 and 25, begin a new paragraph and insert:
SOURCE: ; (00)CC113003.6. -->
"SECTION 6. [EFFECTIVE UPON PASSAGE]
(a) The office of
the secretary of family and social services shall submit proposals
developed by the office:
(1) to fund adult foster care and assisted living services
through the Medicaid waiver program; and
(2) to expand adult day care services available through the
aged and disabled Medicaid waiver;
to the select joint committee on Medicaid oversight established by
this act for review by the committee before the submitting the
proposals to the federal Health Care Financing Administration.
(b) This SECTION expires December 31, 2001.".
Renumber all SECTIONS consecutively.
(Reference is to EHB 1130 as printed February 16, 2000.)
Conference Committee Report
on
Engrossed House
Bill 1130
Text Box
S
igned by:
____________________________ ____________________________
Representative Crawford Senator Miller
Chairperson
____________________________ ____________________________
Representative Becker Senator Server
House Conferees Senate Conferees