Introduced Version, Senate Bill 0458

January 10, 2000, read first time and referred to Committee on Rules and Legislative Procedure.

Introduced

Second Regular Session 111th General Assembly (2000)

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 ~~this~~ ~~style~~ ~~type.~~
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SENATE BILL No. 458

A BILL FOR AN ACT to amend the Indiana Code concerning human services.

Be it enacted by the General Assembly of the State of Indiana:

    SECTION 1. IC 4-33-13-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 1. (a) A tax is imposed on the adjusted gross receipts received from gambling games authorized under this article at the rate of ~~twenty~~ thirty-three percent ~~(20%)~~ (33%) of the amount of the adjusted gross receipts.
    (b) The licensed owner shall remit the tax imposed by this chapter to the department before the close of the business day following the day the wagers are made.
    (c) The department may require payment under this section to be made by electronic funds transfer (as defined in IC 4-8.1-2-7 (e)).
    (d) If the department requires taxes to be remitted under this chapter through electronic funds transfer, the department may allow the licensed owner to file a monthly report to reconcile the amounts remitted to the department.
    (e) The department may allow taxes remitted under this section to be reported on the same form used for taxes paid under IC 4-33-12.
    SECTION 2. IC 4-33-13-5 , AS AMENDED BY P.L.273-1999,

SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 5. After funds are appropriated under section 4 of this chapter, each month the treasurer of state shall distribute the tax revenue deposited in the state gaming fund under this chapter to the following:
        (1) ~~Twenty-five~~ Fifteen and fifteen hundredths percent ~~(25%)~~ (15.15%) of the tax revenue remitted by each licensed owner shall be paid:
            (A) to the city that is designated as the home dock of the riverboat from which the tax revenue was collected, in the case of a city described in IC 4-33-12-6 (b)(1)(A);
            (B) in equal shares to the counties described in IC 4-33-1-1 (3), in the case of a riverboat whose home dock is on Patoka Lake; or
            (C) to the county that is designated as the home dock of the riverboat from which the tax revenue was collected, in the case of a riverboat whose home dock is not in a city described in clause (A) or a county described in clause (B); and
        (2) ~~Seventy-five~~ Forty-five and forty-five hundredths percent ~~(75%)~~ (45.45%) of the tax revenue remitted by each licensed owner shall be paid to the build Indiana fund lottery and gaming surplus account.
         (3) Thirty-nine and forty hundredths percent (39.40%) of the tax revenue remitted by each licensed owner shall be paid to the pharmaceutical assistance fund established by IC 12-9-7-7.
    SECTION 3. IC 12-7-2-63.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 63.5. "Diabetic testing materials", for purposes of IC 12-9-7 , has the meaning set forth in IC 12-9-7-1.
    SECTION 4. IC 12-7-2-65 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 65. "Disabled", for purposes of IC 12-9-7 and IC 12-10-10 , has the meaning set forth in IC 12-10-10-3.
    SECTION 5. IC 12-7-2-144.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 144.5. "Prescription drugs", for purposes of IC 12-9-7 , has the meaning set forth in IC 12-9-7-2.
    SECTION 6. IC 12-7-2-146 , AS AMENDED BY P.L.273-1999, SECTION 166, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 146. "Program" refers to the following:

        (1) For purposes of IC 12-9-7 , the meaning set forth in IC 12-9-7-3.
         (2) For purposes of IC 12-10-7 , the adult guardianship services program established by IC 12-10-7-5.
        ~~(2)~~ (3) For purposes of IC 12-10-10 , the meaning set forth in IC 12-10-10-5.
        ~~(3)~~ (4) For purposes of IC 12-17.6, the meaning set forth in IC 12-17.6-1-5.
    SECTION 7. IC 12-7-2-156.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 156.5. "Reasonable cost", for purposes of IC 12-9-7 , has the meaning set forth in IC 12-9-7-4.
    SECTION 8. IC 12-7-2-164 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 164. "Resident" has the following meaning:
        (1) For purposes of IC 12-9-7 , the meaning set forth in IC 12-9-7-5.
         (2) For purposes of IC 12-10-15 , the meaning set forth in IC 12-10-15-5.
        ~~(2)~~ (3) For purposes of IC 12-16, except IC 12-16-1 , an individual who has actually resided in Indiana for at least ninety (90) days.
        ~~(3)~~ (4) For purposes of IC 12-20-8 , the meaning set forth in IC 12-20-8-1.
        ~~(4)~~ (5) For purposes of IC 12-24-5 , the meaning set forth in IC 12-24-5-1.
    SECTION 9. IC 12-9-7 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]:
     Chapter 7. Pharmaceutical Assistance for the Aged and Disabled
    Sec. 1. As used in this chapter, "diabetic testing materials" includes the following:
        (1) Blood glucose reagent strips that can be visually read.
        (2) Urine monitoring strips.
        (3) Tapes.
        (4) Tablets.
        (5) Bloodletting devices.
        (6) Lancets.
The term does not include electronically monitored devices.
    Sec. 2. As used in this chapter, "prescription drugs" means all legend drugs (as defined in IC 16-18-2-199 ), including the following:
        (1) Any interchangeable drug products, including generic drug products, approved by the drug utilization review board established under IC 12-15-35-19.
        (2) Diabetic testing materials.
        (3) Insulin, insulin syringes, and insulin needles.
    Sec. 3. As used in this chapter, "program" refers to the pharmaceutical assistance for the aged and disabled program established by section 6 of this chapter.
    Sec. 4. As used in this chapter, "reasonable cost" means the maximum allowable cost of prescription drugs and dispensing fee, as determined by the division. However, in the case of diabetic testing materials, the maximum allowable cost of prescription drugs and dispensing fee equals the lesser of:
        (1) the manufacturer's suggested retail price; or
        (2) the pharmacy's usual over the counter price charged to other persons in the community.
    Sec. 5. As used in this chapter, "resident" means an individual legally domiciled within Indiana for a period of thirty (30) days immediately preceding the date of application for inclusion in the program. The term does not include the following:
        (1) An individual who maintains only seasonal or temporary residence within Indiana.
        (2) An individual who is absent from Indiana for at least twelve (12) continuous months.
    Sec. 6. The pharmaceutical assistance for the aged and disabled program is established. The division shall administer the program.
    Sec. 7. (a) The pharmaceutical assistance fund is established for the purpose of making payments or reimbursements under section 10 of this chapter. The fund shall be administered by the division.
    (b) The expenses of administering the fund shall be paid from money in the fund.
    (c) The treasurer of state shall invest the money in the fund not currently needed to meet the obligations of the fund in the same manner as other public money may be invested. Interest that accrues from these investments shall be deposited in the fund.
    (d) Money in the fund at the end of a state fiscal year does not revert to the state general fund.
    Sec. 8. (a) To be eligible for assistance under the program, a resident:
        (1) must have:
            (A) an annual income of not more than fifteen thousand five hundred dollars ($15,500), if single; or
            (B) a combined annual income of not more than nineteen

thousand five hundred dollars ($19,500), if married;
        (2) must not be:
            (A) covered by Medicaid under IC 12-15; or
            (B) wholly covered for prescription drug costs by another plan of assistance or insurance; and
        (3) must be:
            (A) a recipient of disability insurance benefits under Title II of the federal Social Security Act (42 U.S.C. 401 et seq.); or
            (B) at least sixty-five (65) years of age.
    (b) For purposes of this section, annual income does not include gain from the sale of a principal residence that is excluded from gross income under 26 U.S.C. 121.
    (c) Beginning January 1, 2000, and annually thereafter, the income eligibility limits provided in subsection (a) must increase by the amount of the maximum Social Security benefit cost of living increase for that year for single and married persons respectively.
    Sec. 9. Funds received from the following sources may not be counted as income for the purpose of determining eligibility for the program:
        (1) Funds received from the federal government under 50 App. U.S.C. 1989b-4 and 50 App. U.S.C. 1989b-5.
        (2) Funds received in a Holocaust victim's settlement payment (as defined in IC 6-3-1-30 ).
    Sec. 10. (a) The program consists of payments to pharmacies for the reasonable cost of prescription drugs that are provided to eligible persons, to the extent that the reasonable cost for each prescription exceeds a five dollar ($5) copayment.
    (b) A copayment must be paid in full by each eligible person to the pharmacist at the time of each purchase of prescription drugs. The copayment may not be waived, discounted, or rebated in whole or in part.
    (c) The division may restrict the supply of initial prescriptions under the program to less than a thirty (30) day supply to reduce waste and inappropriate drug utilization. The division may limit refills of prescription drugs used in the treatment of acute care medical conditions to an amount that does not exceed a thirty (30) day supply. The division may not allow the greater of a sixty (60) day supply or one hundred (100) unit doses of prescription drugs used in the treatment of a chronic maintenance condition.
    (d) Whenever an interchangeable drug product, including a generic drug product, approved by the drug utilization review board established under IC 12-15-35-19 is available for a written

prescription, an eligible person shall either:
        (1) purchase an interchangeable drug product, including a generic drug product, the cost of which is equal to or less than the maximum allowable cost, with a five dollar ($5) copayment; or
        (2) purchase the prescribed drug product that is higher in cost than the maximum allowable cost and pay the difference in cost between the two (2) drug products, in addition to the five dollar ($5) copayment, unless the health care provider prescribing the drug product specifically indicates that substitution is not permissible, in which case an eligible person may purchase the prescribed drug product with a five dollar ($5) copayment.
    Sec. 11. The program may not make payment to a pharmacy for a prescription drug purchase under section 10 of this chapter unless, at the time of the prescription drug purchase for which the pharmacy submits a claim, the pharmacy prominently displayed on the receipt provided with the prescription drug the usual price charged by the pharmacy to other persons in the community.
    Sec. 12. If an eligible person's prescription drug costs are covered in part by another plan of assistance or insurance, the assistance provided under the program to the person may be reduced.
    Sec. 13. (a) The division shall adopt rules under IC 4-22-2 to provide for a system of payments or reimbursements and a system for determining eligibility of persons for the program, including:
        (1) provisions for submission of proof of actual and anticipated annual income; and
        (2) evidence of complete or partial coverage of prescription drug costs by another plan of assistance or insurance plans.
    (b) The division's rules must provide for the payment or reimbursement of a claim within thirty (30) days of the division's receipt of the claim.
    Sec. 14. The cost of a prescription may not be reimbursed by the program unless the prescription contains the name and address or identification number of the eligible person.
    Sec. 15. The division shall include on identification cards used in the program a conspicuous notice of the penalties for violating this chapter.
    Sec. 16. (a) Upon the submission of an application and proof of expenditure as prescribed by the division, an eligible person shall be reimbursed for the cost, minus a five dollar ($5) copayment for each prescription, of all prescription drugs purchased by the

person under section 10(d)(2) of this chapter during the period:
        (1) beginning thirty (30) days after the person's properly completed application is received by the division; and
        (2) ending on the date when the person receives proof of eligibility from the division.
    (b) Reimbursement may not be made under this chapter for a prescription drug purchased before July 1, 2000.
    Sec. 17. The division shall provide a notice of the availability of reimbursement under the program and an application form to every eligible person.
    Sec. 18. (a) A person who knowingly or intentionally violates this chapter commits a Class A misdemeanor.
    (b) An eligible person who violates this chapter is subject to:
        (1) suspension of the person's eligibility for the program for one (1) year for the first offense; and
        (2) permanent revocation of the person's eligibility for a second offense.
    SECTION 10. IC 12-15-35-28 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 28. The board has the following duties:
        (1) The adoption of rules to carry out this chapter, in accordance with the provisions of IC 4-22-2 and subject to any office approval that is required by the federal Omnibus Budget Reconciliation Act of 1990 under Public Law 101-508 and its implementing regulations.
        (2) The implementation of a Medicaid retrospective and prospective DUR program as outlined in this chapter, including the approval of software programs to be used by the pharmacist for prospective DUR and recommendations concerning the provisions of the contractual agreement between the state and any other entity that will be processing and reviewing Medicaid drug claims and profiles for the DUR program under this chapter.
        (3) The development and application of the predetermined criteria and standards for appropriate prescribing to be used in retrospective and prospective DUR to ensure that such criteria and standards for appropriate prescribing are based on the compendia and developed with professional input with provisions for timely revisions and assessments as necessary.
        (4) The development, selection, application, and assessment of interventions for physicians, pharmacists, and patients that are educational and not punitive in nature.
        (5) The publication of an annual report that must be subject to

public comment before issuance to the federal Department of Health and Human Services and to the Indiana legislative council by December 1 of each year.
        (6) The development of a working agreement for the board to clarify the areas of responsibility with related boards or agencies, including the following:
            (A) The Indiana board of pharmacy.
            (B) The medical licensing board of Indiana.
            (C) The SURS staff.
        (7) The establishment of a grievance and appeals process for physicians or pharmacists under this chapter.
        (8) The publication and dissemination of educational information to physicians and pharmacists regarding the board and the DUR program, including information on the following:
            (A) Identifying and reducing the frequency of patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care among physicians, pharmacists, and recipients.
            (B) Potential or actual severe or adverse reactions to drugs.
            (C) Therapeutic appropriateness.
            (D) Overutilization or underutilization.
            (E) Appropriate use of generic drugs.
            (F) Therapeutic duplication.
            (G) Drug-disease contraindications.
            (H) Drug-drug interactions.
            (I) Incorrect drug dosage and duration of drug treatment.
            (J) Drug allergy interactions.
            (K) Clinical abuse and misuse.
        (9) The adoption and implementation of procedures designed to ensure the confidentiality of any information collected, stored, retrieved, assessed, or analyzed by the board, staff to the board, or contractors to the DUR program that identifies individual physicians, pharmacists, or recipients.
        (10) The implementation of additional drug utilization review with respect to drugs dispensed to residents of nursing facilities shall not be required if the nursing facility is in compliance with the drug regimen procedures under 410 IAC 16.2-3-8 and 42 CFR 483.60.
         (11) Advising the division of disability, aging, and rehabilitative services in the operation of the pharmaceutical assistance for the aged and disabled program under IC 12-9-7.