Citations Affected: IC 6-1.1-18.5-10; IC 12-15; IC 12-29-1; IC 12-29-2; IC 16-21-6-7;
IC 16-39-9-3; IC 12-29-2-6.
Synopsis: Human services. Provides that the maximum appropriation and tax levy for community mental health centers must be annually recalculated based on the increase in the assessed value growth quotient. Authorizes the office of Medicaid policy and planning to implement alternative payment methodologies for payable claim payments to a hospital under certain circumstances. Separates the laws governing the funding of community mental health centers from the laws governing the funding of community mental retardation and other developmental disabilities centers. Repeals a provision that duplicates other provisions added to the same chapter. Allows the state department of health to disclose inpatient and outpatient discharge information to hospitals that have submitted the information. Allows a hospital trade association to disclose health record information received under certain circumstances. Changes a retrieval charge to a labor charge for providing copies of medical records. Eliminates a provision under which a hospital was allowed 180 days to respond to a notice that the hospital was overpaid by the Medicaid program. Makes hospitals subject to the general provision allowing 60 days for a response. Provides alternative options to the nursing facility assessment state plan amendment and waiver request and amends the expiration of the nursing facility quality assessment. Requires the select joint commission on Medicaid oversight to study certain effects resulting from the repeal of continuous eligibility under the Indiana Medicaid program and the children's health insurance program. Requires the state budget committee to review disproportionate share payments for community mental health centers and make recommendations to the general assembly. Makes a technical correction. (This conference committee report: (1) keeps HB 1320 language concerning tax levies for community mental health centers with changes but removes DSH language; (2) changes nursing facility assessment language to provide alternative modifications to the state Medicaid plan and waiver request and extends assessment; (3) adds SB 161 as the bill left the Senate; (4) adds language from SB 428 concerning the disclosure of certain health record information, implementation of alternative payment methodologies, and changing of retrieval charges to labor charges; and (5) adds language requires the state budget committee to remove disproportionate share payments to community mental health centers and make recommendations to the general assembly.)
MADAM PRESIDENT:
Your Conference Committee appointed to confer with a like committee from the House
upon Engrossed Senate Amendments to Engrossed House Bill No. 1320 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 everything after the enacting clause and insert the following:
subsequent appeal that the provider owes the money;
the provider shall pay the amount of the overpayment, including interest
from the date of the overpayment.
(e) A hospital licensed under IC 16-21 that receives a notice and
request for repayment under subsection (a) has one hundred eighty
(180) days to elect one (1) of the actions under subsection (b)(1),
(b)(2), or (b)(3).
(f) (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 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 provider shall be paid at the rate
set by the commissioner for interest payments from the department
of state revenue to a taxpayer.
(g) (f) Proceedings under this section are subject to IC 4-21.5.
amount that is as equal as possible to the amount each
hospital would have received under section 1.5(b) STEP FIVE
(B) of this chapter for that state fiscal year.
(d) If the office determines that payments made under section
1.5(b) STEP FIVE (C) of this chapter will not be approved for
federal financial participation, the office may make alternative
payments to payments under section 1.5(b) STEP FIVE (C) of this
chapter if:
(1) the payments for a state fiscal year are made only to a
hospital that would have been eligible for a payment for that
state fiscal year under section 1.5(b) STEP FIVE (C) of this
chapter; and
(2) the payments for a state fiscal year to each hospital are an
amount that is as equal as possible to the amount each
hospital would have received under section 1.5(b) STEP FIVE
(C) of this chapter for that state fiscal year.
(e) If the office determines, based on information received from
the federal Centers for Medicare and Medicaid Services, that
payments made under subsection (b), (c), or (d) will not be
approved for federal financial participation, the office shall use
the funds that would have served as the nonfederal share of these
payments for a state fiscal year to serve as the nonfederal share
of a payment program for hospitals to be established by the office.
The payment program must distribute payments to hospitals for
a state fiscal year based upon a methodology determined by the
office to be equitable under the circumstances.
amount equal to the amount, based on information obtained from the
division and the calculations and allocations made under
IC 12-16-7.5-4.5, that the office determines for the hospital under
STEP SIX of the following STEPS:
STEP ONE: Identify:
(A) each hospital that submitted to the division one (1) or more
payable claims under IC 12-16-7.5 during the state fiscal year;
and
(B) the county to which each payable claim is attributed.
STEP TWO: For each county identified in STEP ONE, identify:
(A) each hospital that submitted to the division one (1) or more
payable claims under IC 12-16-7.5 attributed to the county during
the state fiscal year; and
(B) the total amount of all hospital payable claims submitted to
the division under IC 12-16-7.5 attributed to the county during
the state fiscal year.
STEP THREE: For each county identified in STEP ONE, identify
the amount of county funds transferred to the Medicaid indigent
care trust fund under STEP FOUR of IC 12-16-7.5-4.5(b).
STEP FOUR: For each hospital identified in STEP ONE, with
respect to each county identified in STEP ONE, calculate the
hospital's percentage share of the county's funds transferred to the
Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b). Each hospital's percentage share is based on
the total amount of the hospital's payable claims submitted to the
division under IC 12-16-7.5 attributed to the county during the state
fiscal year, calculated as a percentage of the total amount of all
hospital payable claims submitted to the division under
IC 12-16-7.5 attributed to the county during the state fiscal year.
STEP FIVE: Subject to subsection (j), for each hospital identified
in STEP ONE, with respect to each county identified in STEP
ONE, multiply the hospital's percentage share calculated under
STEP FOUR by the amount of the county's funds transferred to the
Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b).
STEP SIX: Determine the sum of all amounts calculated under
STEP FIVE for each hospital identified in STEP ONE with respect
to each county identified in STEP ONE.
(d) A hospital's payment under subsection (c) is in the form of a
Medicaid add-on payment. The amount of a hospital's add-on payment
is subject to the availability of funding for the non-federal share of the
payment under subsection (e). The office shall make the payments
under subsection (c) before December 15 that next succeeds the end
of the state fiscal year.
(e) The non-federal share of a payment to a hospital under subsection
(c) is funded from the funds transferred to the Medicaid indigent care
trust fund under STEP FOUR of IC 12-16-7.5-4.5(b) of each county
to which a payable claim under IC 12-16-7.5 submitted to the division
during the state fiscal year by the hospital is attributed.
(f) The amount of a county's transferred funds available to be used
to fund the non-federal share of a payment to a hospital under
subsection (c) is an amount that bears the same proportion to the total
amount of funds of the county transferred to the Medicaid indigent care
trust fund under STEP FOUR of IC 12-16-7.5-4.5(b) that the total
amount of the hospital's payable claims under IC 12-16-7.5 attributed
to the county submitted to the division during the state fiscal year bears
to the total amount of all hospital payable claims under IC 12-16-7.5
attributed to the county submitted to the division during the state fiscal
year.
(g) Any county's funds identified in subsection (f) that remain after
the non-federal share of a hospital's payment has been funded are
available to serve as the non-federal share of a payment to a hospital
under section 9.5 of this chapter.
(h) For purposes of this section, "payable claim" has the meaning set
forth in IC 12-16-7.5-2.5(b)(1).
(i) For purposes of this section:
(1) the amount of a payable claim is an amount equal to the amount
the hospital would have received under the state's fee-for-service
Medicaid reimbursement principles for the hospital care for which
the payable claim is submitted under IC 12-16-7.5 if the individual
receiving the hospital care had been a Medicaid enrollee; and
(2) a payable hospital claim under IC 12-16-7.5 includes a payable
claim under IC 12-16-7.5 for the hospital's care submitted by an
individual or entity other than the hospital, to the extent permitted
under the hospital care for the indigent program.
(j) The amount calculated under STEP FIVE of subsection (c) for a
hospital with respect to a county may not exceed the total amount of
the hospital's payable claims attributed to the county during the state
fiscal year.
submitted by the hospital to the division during the state fiscal year;
is entitled to a payment under this section.
(c) For a state fiscal year, Except as provided in section 9.8 of this
chapter and subject to section 9.6 of this chapter, for a state fiscal
year, the office shall pay to a hospital referred to in subsection (b) an
amount equal to the amount, based on information obtained from the
division and the calculations and allocations made under
IC 12-16-7.5-4.5, that the office determines for the hospital under
STEP EIGHT of the following STEPS:
STEP ONE: Identify each county whose transfer of funds to the
Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b) for the state fiscal year was less than the total
amount of all hospital payable claims attributed to the county and
submitted to the division during the state fiscal year.
STEP TWO: For each county identified in STEP ONE, calculate the
difference between the amount of funds of the county transferred
to the Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b) and the total amount of all hospital payable
claims attributed to the county and submitted to the division during
the state fiscal year.
STEP THREE: Calculate the sum of the amounts calculated for the
counties under STEP TWO.
STEP FOUR: Identify each hospital whose payment under section
9(c) of this chapter was less than the total amount of the hospital's
payable claims under IC 12-16-7.5 submitted by the hospital to the
division during the state fiscal year.
STEP FIVE: Calculate for each hospital identified in STEP FOUR
the difference between the hospital's payment under section 9(c) of
this chapter and the total amount of the hospital's payable claims
under IC 12-16-7.5 submitted by the hospital to the division during
the state fiscal year.
STEP SIX: Calculate the sum of the amounts calculated for each
of the hospitals under STEP FIVE.
STEP SEVEN: For each hospital identified in STEP FOUR,
calculate the hospital's percentage share of the amount calculated
under STEP SIX. Each hospital's percentage share is based on the
amount calculated for the hospital under STEP FIVE calculated as
a percentage of the sum calculated under STEP SIX.
STEP EIGHT: For each hospital identified in STEP FOUR, multiply
the hospital's percentage share calculated under STEP SEVEN by
the sum calculated under STEP THREE. The amount calculated
under this STEP for a hospital may not exceed the amount by
which the hospital's total payable claims under IC 12-16-7.5
submitted during the state fiscal year exceeded the amount of the
hospital's payment under section 9(c) of this chapter.
(d) A hospital's payment under subsection (c) is in the form of a
Medicaid add-on payment. The amount of the hospital's add-on
payment is subject to the availability of funding for the non-federal
share of the payment under subsection (e). The office shall make the
payments under subsection (c) before December 15 that next succeeds
the end of the state fiscal year.
(e) The non-federal share of a payment to a hospital under subsection
(c) is derived from funds transferred to the Medicaid indigent care trust
fund under STEP FOUR of IC 12-16-7.5-4.5(b) and not expended
under section 9 of this chapter. To the extent possible, the funds shall
be derived on a proportional basis from the funds transferred by each
county identified in subsection (c), STEP ONE:
(1) to which at least one (1) payable claim submitted by the hospital
to the division during the state fiscal year is attributed; and
(2) whose funds transferred to the Medicaid indigent care trust
fund under STEP FOUR of IC 12-16-7.5-4.5(b) were not
completely expended under section 9 of this chapter.
The amount available to be derived from the remaining funds
transferred to the Medicaid indigent care trust fund under STEP FOUR
of IC 12-16-7.5-4.5(b) to serve as the non-federal share of the payment
to a hospital under subsection (c) is an amount that bears the same
proportion to the total amount of funds transferred by all the counties
identified in subsection (c), STEP ONE, that the amount calculated for
the hospital under subsection (c), STEP FIVE, bears to the amount
calculated under subsection (c), STEP SIX.
(f) Except as provided in subsection (g), the office may not make a
payment under this section until the payments due under section 9 of
this chapter for the state fiscal year have been made.
(g) If a hospital appeals a decision by the office regarding the
hospital's payment under section 9 of this chapter, the office may make
payments under this section before all payments due under section 9 of
this chapter are made if:
(1) a delay in one (1) or more payments under section 9 of this
chapter resulted from the appeal; and
(2) the office determines that making payments under this section
while the appeal is pending will not unreasonably affect the interests
of hospitals eligible for a payment under this section.
(h) Any funds transferred to the Medicaid indigent care trust fund
under STEP FOUR of IC 12-16-7.5-4.5(b) remaining after payments
are made under this section shall be used as provided in
IC 12-15-20-2(8)(D).
(i) For purposes of this section:
(1) "payable claim" has the meaning set forth in
IC 12-16-7.5-2.5(b);
(2) the amount of a payable claim is an amount equal to the amount
the hospital would have received under the state's fee-for-service
Medicaid reimbursement principles for the hospital care for which
the payable claim is submitted under IC 12-16-7.5 if the individual
receiving the hospital care had been a Medicaid enrollee; and
(3) a payable hospital claim under IC 12-16-7.5 includes a payable
claim under IC 12-16-7.5 for the hospital's care submitted by an
individual or entity other than the hospital, to the extent permitted
under the hospital care for the indigent program.
1, 2003 (RETROACTIVE)]: Sec. 9.8. (a) This section applies only if
the office determines, based on information received from the
United States Centers for Medicare and Medicaid Services, that a
state Medicaid plan amendment implementing the payment
methodology in:
(1) section 9(c) of this chapter; or
(2) section 9.5(c) of this chapter;
will not be approved by the United States Centers for Medicare
and Medicaid Services.
(b) The office may amend the state Medicaid plan to implement
an alternative payment methodology to the payment methodology
under section 9 of this chapter. The alternative payment
methodology must provide each hospital that would have received
a payment under section 9(c) of this chapter during a state fiscal
year with an amount for the state fiscal year that is as equal as
possible to the amount each hospital would have received under
the payment methodology under section 9(c) of this chapter. A
payment methodology implemented under this subsection is in
place of the payment methodology under section 9(c) of this
chapter.
(c) The office may amend the state Medicaid plan to implement
an alternative payment methodology to the payment methodology
under section 9.5 of this chapter. The alternative payment
methodology must provide each hospital that would have received
a payment under section 9.5(c) of this chapter during a state fiscal
year with an amount for the state fiscal year that is as equal as
possible to the amount each hospital would have received under
the payment methodology under section 9.5(c) of this chapter. A
payment methodology implemented under this subsection is in
place of the payment methodology under section 9.5(c) of this
chapter.
disproportionate share provider if the hospital:
(1) has a Medicaid utilization rate greater than one percent (1%);
and
(2) is established and operated under IC 16-22-2 or IC 16-23.
(c) A community mental health center that:
(1) is identified in IC 12-29-2-1;
(2) receives funding under:
(A) IC 12-29-1-7(b) before January 1, 2004; or
(B) IC 12-29-2-20(c) after December 31, 2003;
or from other county sources; and
(3) provides inpatient services to Medicaid patients;
is a community mental health center disproportionate share provider if
the community mental health center's Medicaid inpatient utilization rate
is greater than one percent (1%).
(d) A disproportionate share provider under IC 12-15-17 must have
at least two (2) obstetricians who have staff privileges and who have
agreed to provide obstetric services under the Medicaid program. For
a hospital located in a rural area (as defined in Section 1886 of the
Social Security Act), an obstetrician includes a physician with staff
privileges at the hospital who has agreed to perform nonemergency
obstetric procedures. However, this obstetric service requirement does
not apply to a provider whose inpatients are predominantly individuals
less than eighteen (18) years of age or that did not offer nonemergency
obstetric services as of December 21, 1987.
(e) The determination of a provider's status as a disproportionate
share provider under this section shall be based on utilization and
revenue data from the most recent year for which an audited cost
report from the provider is on file with the office.
required to make intergovernmental transfers under this section. The
trustees and a municipal health and hospital corporation may make
additional transfers to the Medicaid indigent care trust fund to the extent
necessary to make additional payments from the Medicaid indigent care
trust fund apply to a prior federal fiscal year as provided in
IC 12-15-19-1(b).
(d) A municipal disproportionate share provider (as defined in
IC 12-15-16-1) shall transfer to the Medicaid indigent care trust fund
an amount determined jointly by the office and the municipal
disproportionate share provider. A municipal disproportionate share
provider is not required to make intergovernmental transfers under this
section. A municipal disproportionate share provider may make
additional transfers to the Medicaid indigent care trust fund to the extent
necessary to make additional payments from the Medicaid indigent care
trust fund apply to a prior federal fiscal year as provided in
IC 12-15-19-1(b).
(e) A county making a payment under:
(1) IC 12-29-1-7(b) before January 1, 2004; or
(2) IC 12-29-2-20(c) after December 31, 2003;
or from other county sources to a community mental health center
qualifying as a community mental health center disproportionate share
provider shall certify that the payment represents expenditures that are
eligible for federal financial participation under 42 U.S.C.
1396b(w)(6)(A) and 42 CFR 433.51. The office shall assist a county
in making this certification.
purposes described in section 1(b) of this chapter.
(b) Upon the request of the county executive of the county, the
county fiscal body of each county may appropriate annually from the
county's general fund the money to provide financial assistance for the
purposes described in section 1(b) of this chapter. The appropriation of
each county may not exceed the amount that could be collected from
an annual tax levy of three and thirty-three hundredths cents ($0.0333)
on each one hundred dollars ($100) of taxable property within the
county.
for a community mental retardation and other developmental
disabilities center; and
(3) (2) the president of the board of directors of each center;
the amount of money that will be provided to the center under this
chapter.
(b) The county payment to the center shall be paid by the county
treasurer to the treasurer of each center's board of directors in the
following manner:
(1) One-half (1/2) of the county payment to the center shall be
made on the second Monday in July.
(2) One-half (1/2) of the county payment to the center shall be
made on the second Monday in December.
A county making a payment under this subsection or from other county
sources to a community mental health center that qualifies as a
community mental health center disproportionate share provider under
IC 12-15-16-1 shall certify that the payment represents expenditures
eligible for financial participation under 42 U.S.C. 1396b(w)(6)(A) and
42 CFR 433.51. The office shall assist a county in making this
certification.
(c) Payments by the county fiscal body
(1) must be in the amounts:
(A) determined by IC 12-29-2-1 through IC 12-29-2-6; and
(B) authorized by section 1 of this chapter; and
(2) are in place of grants from agencies supported within the
county solely by county tax money.
(a) may not exceed the following:
(1) For 2004, the product of the amount determined under
section 2(b)(1) of this chapter multiplied by one and five
hundred four thousandths (1.504).
(2) For 2005 and each year thereafter, the product of the
amount determined under section 2(b)(2) of this chapter for
that year multiplied by one and five hundred four thousandths
(1.504).
determined in STEP THREE, the actual percentage increase
(rounded to the nearest one-hundredth percent (0.01%)) in the
assessed value (before the adjustment, if any, under
IC 6-1.1-4-4.5) of the taxable property from the preceding year.
STEP FIVE: Divide the sum of the three (3) quotients computed in
STEP FOUR by three (3).
STEP SIX: Determine the greater of the following:
(A) Zero (0).
(B) The result of the STEP TWO percentage minus the STEP
FIVE percentage.
STEP SEVEN: Determine the quotient of:
(A) the STEP ONE tax rate; divided by
(B) one (1) plus the STEP SIX percentage increase.
This maximum rate is the maximum rate under this section until a new
maximum rate is computed under this subsection for the next year in
which an annual adjustment under IC 6-1.1-4-4.5 or a general
reassessment of property will take effect.
(c) With respect to a county to which subsection (b) does not apply,
the maximum tax rate permitted under subsection (a) for taxes first due
and payable in calendar year 2004 and calendar year 2005 is the
maximum tax rate that would have been determined under subsection
(d) for taxes first due and payable in 2003 if subsection (d) had applied
to the county for taxes first due and payable in 2003.
(d) This subsection applies only to a county to which subsection (b)
does not apply. The tax rate permitted under subsection (a) for taxes
first due and payable after calendar year 2005 is the tax rate permitted
under subsection (c) as adjusted under this subsection. For each year
in which an annual adjustment of the assessed value of real property
will take effect under IC 6-1.1-4-4.5 or a general reassessment of
property will take effect, the department of local government finance
shall compute the maximum rate permitted under subsection (a) as
follows:
STEP ONE: Determine the maximum rate for the year preceding
the year in which the annual adjustment or general reassessment
takes effect.
STEP TWO: Determine the actual percentage increase (rounded to
the nearest one-hundredth percent (0.01%)) in the assessed value
(before the adjustment, if any, under IC 6-1.1-4-4.5) of the taxable
property from the year preceding the year the annual adjustment or
general reassessment takes effect to the year that the annual
adjustment or general reassessment is effective.
STEP THREE: Determine the three (3) calendar years that
immediately precede the ensuing calendar year and in which a
statewide general reassessment of real property does not first
become effective.
STEP FOUR: Compute separately, for each of the calendar years
determined under STEP THREE, the actual percentage increase
(rounded to the nearest one-hundredth percent (0.01%)) in the
assessed value (before the adjustment, if any, under
IC 6-1.1-4-4.5) of the taxable property from the preceding year.
amount determined under section 2(b)(2) of this chapter for
that year multiplied by seven hundred fifty-two thousandths
(0.752).
(c) The receipts from the tax levied under this section shall be used
for the leasing, purchasing, constructing, or operating of community
residential facilities for the chronically mentally ill (as defined in
IC 12-7-2-167).
(d) Money appropriated under this section must be:
(1) budgeted under IC 6-1.1-17; and
(2) included in the center's budget submitted to the division of
mental health and addiction.
(e) Permission for a levy increase in excess of the levy limitations
may be ordered under IC 6-1.1-18.5-15 only if the levy increase is
approved by the division of mental health and addiction for a
community mental health center.
of bonds.
JULY 1, 2003 (RETROACTIVE)]: Sec. 7. (a) The reports filed under
section 3 of this chapter:
(1) may not contain information that personally identifies a patient
or a consumer of health services; and
(2) must be open to public inspection.
(b) The state department shall provide copies of the reports filed
under section 3 of this chapter to the public upon request, at the state
department's actual cost.
(c) The following apply to information that is filed under section 6 of
this chapter:
(1) Information filed with the state department's designated
contractor:
(A) is confidential; and
(B) must be transferred by the contractor to the state department
in a format determined by the state department.
(2) Information filed with the state department or transferred to the
state department by the state department's designated contractor is
not confidential, except that information that:
(A) personally identifies; or
(B) may be used to personally identify;
a patient or consumer may not be disclosed to a third party other
than to a hospital that has filed inpatient and outpatient
discharge information.
(d) An analysis completed by the state department of information that
is filed under section 6 of this chapter:
(1) may not contain information that personally identifies or may be
used to personally identify a patient or consumer of health services,
unless the information is determined by the state department to be
necessary for a public health activity;
(2) must be open to public inspection; and
(3) must be provided to the public by the state department upon
request at the state department's actual cost.
involved in incidents that are reported or required to be reported to
governmental agencies and not required to be kept confidential by
the governmental agencies.
READ AS FOLLOWS [EFFECTIVE JULY 1, 2003 (RETROACTIVE)]:
SECTION 70. (a) As used in this SECTION, "high Medicaid utilization
nursing facility" means the smallest number of those nursing facilities
with the greatest number of Medicaid patient days for which it is
necessary to assess a lower quality assessment to satisfy the statistical
test set forth in 42 CFR 433.68(e)(2)(ii). "health facility" refers to
a health facility is licensed under IC 16-28 as a comprehensive
care facility.
(b) As used in this SECTION, "nursing facility" means a health
facility that is
(1) licensed under IC 16-28 as a comprehensive care facility; and
(2) certified for participation in the federal Medicaid program under
Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.).
(c) As used in this SECTION, "office" refers to the office of
Medicaid policy and planning established by IC 12-8-6-1.
(d) As used in this SECTION, "total annual revenue" does not include
revenue from Medicare services provided under Title XVIII of the
federal Social Security Act (42 U.S.C. 1395 et seq.).
(e) Effective August 1, 2003, the office shall collect a quality
assessment from each nursing facility that has:
(1) a Medicaid utilization rate of at least twenty-five percent (25%);
and
(2) at least seven hundred thousand dollars ($700,000) in annual
Medicaid revenue, adjusted annually by the average annual
percentage increase in Medicaid rates.
(f) If the United States Centers for Medicare and Medicaid
Services determines not to approve payments under this
SECTION using the methodology described in subsection (e), the
office shall revise the state plan amendment and waiver request
submitted under subsection (l) as soon as possible to demonstrate
compliance with 42 CFR 433.68(e)(2)(ii). In amending the state
plan amendment and waiver request under this subsection, the
office shall collect a quality assessment effective August 1, 2003,
from each health facility except the following:
(1) A continuing care retirement community.
(2) A health facility that only receives revenue from Medicare
services provided under 42 USC 1395 et seq.
(3) A health facility that has less than seven hundred fifty
thousand dollars ($750,000) in total annual revenue, adjusted
annually by the average annual percentage increase in
Medicaid rates.
(4) The Indiana Veterans' Home.
Any revision to the state plan amendment or waiver request
under this subsection is subject to and must comply with the
provisions of this SECTION.
(g) If the United States Centers for Medicare and Medicaid
Services determines not to approve payments under this
SECTION using the methodology described in subsections (e) and
(f), the office shall revise the state plan amendment and waiver
request submitted under subsection (l) as soon as possible to
demonstrate compliance with 42 CFR 433.68(e)(2)(ii) and to collect
a quality assessment from health facilities effective August 1,
2003. In amending the state plan amendment and waiver request
under this subsection, the office may modify the parameters
described in subsection (f)(1) through (f)(4). However, if the office
determines a need to modify the parameters described in
subsection (f)(1) through (f)(4), the office shall modify the
parameters in order to achieve a methodology and result as
similar as possible to the methodology and result described in
subsection (f). Any revision of the state plan amendment and
waiver request under this subsection is subject to and must
comply with the provisions of this SECTION.
(h) The money collected from the quality assessment may be used
only to pay the state's share of the costs for Medicaid services provided
under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.) as follows:
(1) Twenty percent (20%) as determined by the office.
(2) Eighty percent (80%) to nursing facilities.
(g) (i) The office may not begin collection of the quality assessment
set under this SECTION before the office calculates and begins paying
enhanced reimbursement rates set forth in this SECTION.
(h) (j) If federal financial participation becomes unavailable to match
money collected from the quality assessments 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
under the SECTION.
(i) (k) The office shall adopt rules under IC 4-22-2 to implement this
act.
(j) (l) Not later than July 1, 2003, the office shall do the following:
(1) Request the United States Department of Health and Human
Services under 42 CFR 433.72 to approve waivers of 42 CFR
433.68(c) and 42 CFR 433.68(d) by demonstrating compliance
with 42 CFR 433.68(e)(2)(ii).
(2) Submit any state Medicaid plan amendments to the United
States Department of Health and Human Services that are necessary
to implement this SECTION.
(k) (m) After approval of the waivers and state Medicaid plan
amendment applied for under subsection (j), (l), the office shall
implement this SECTION effective July 1, 2003.
(l) (n) The select joint commission on Medicaid oversight, established
by IC 2-5-26-3, shall review the implementation of this SECTION. The
office may not make any change to the reimbursement for nursing
facilities unless the select joint commission on Medicaid oversight
recommends the reimbursement change.
health centers for state fiscal year 2004-2005.
(b) As part of the budget build up process for the 2005 session
of the general assembly, the state budget committee shall make
recommendations to the general assembly concerning
disproportionate share funding for mental health institutions and
community mental health centers for the 2005-2007 biennial
budget.
(c) This SECTION expires December 31, 2005.
____________________________ ____________________________
Representative Hasler Senator Miller
Chairperson
____________________________ ____________________________
Representative Scholer Senator Simpson
House Conferees Senate Conferees