HB 1623-1_ Filed 02/14/2005, 09:37

Text Box

Adopted Rejected


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COMMITTEE REPORT

            
                                                        YES:

8

                                                        NO:
0

MR. SPEAKER:

    Your Committee on       Public Health     , to which was referred       House Bill 1623     , has had the same under consideration and begs leave to report the same back to the House with the recommendation that said bill be amended as follows:

    Delete everything after the enacting clause and insert the following:

SOURCE: IC 12-15-11.5-3; (05)CR162301.1. -->     SECTION 1. IC 12-15-11.5-3 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE DECEMBER 31, 2004 (RETROACTIVE)]: Sec. 3. (a) The office or the office's managed care contractor may not provide incentives or mandates to the primary medical provider to direct individuals described in section 2 of this chapter to contracted hospitals other than a hospital in a city where the patient resides.
    (b) The prohibition in subsection (a) includes methodologies that operate to lessen a primary medical provider's payment due to the provider's referral of an individual described in section 2 of this chapter to the hospital in the city where the individual resides.
    (c) If a hospital's reimbursement for nonemergency services that are provided to an individual described in section 2 of this chapter is established by:
        (1) statute; or
        (2) an agreement between the hospital and the individual's managed care contractor;
the hospital may not decline to provide nonemergency services to the individual on the basis that the individual is enrolled in the Medicaid risk based program.
    (d) A hospital that provides services to individuals described in section 2 of this chapter shall comply with eligibility verification and medical management programs negotiated under the hospital's most recent contract or agreement with the office's managed care contractor.
    (e) This section expires December 31, 2004. 2006.
    (f) Notwithstanding subsection (a), this section does not prohibit the office or the office's managed care contractor from directing individuals described in section 2 of this chapter to a hospital other than a hospital in a city where the patient resides if both of the following conditions exist:
        (1) The patient is directed to a hospital other than a hospital in a city where the patient resides for the purpose of receiving medically necessary services.
        (2) The type of medically necessary services to be received by the patient cannot be obtained in a hospital in a city where the patient resides.
SOURCE: IC 12-15-11.5-4.1; (05)CR162301.2. -->     SECTION 2. IC 12-15-11.5-4.1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE DECEMBER 31, 2004 (RETROACTIVE)]: Sec. 4.1. (a) A hospital that:
        (1) does not have a contract in effect with the office's managed care contractor; but
        (2) previously contracted or entered into an agreement with the office's managed care contractor for the provision of services under the office's managed care program;
shall be reimbursed for services provided to individuals described in section 2 of this chapter at rates equivalent to the rates negotiated under the hospital's most recent contract or agreement with the office's managed care contractor, as adjusted for inflation by the inflation adjustment factor described in subsection (b). However, the adjusted rates may not exceed the established Medicaid rates paid to Medicaid providers who are not contracted providers in the office's managed health care services program.
    (b) For each state fiscal year beginning after June 30, 2001, an

inflation adjustment factor shall be applied under subsection (a) that is the average of the percentage increase in the medical care component of the Consumer Price Index for all Urban Consumers and the percentage increase in the Consumer Price Index for all Urban Consumers, as published by the United States Bureau of Labor Statistics, for the twelve (12) month period ending in March preceding the beginning of the state fiscal year.
    (c) This section expires December 31, 2004. 2006.

SOURCE: IC 12-16-3.5-3; (05)CR162301.3. -->     SECTION 3. IC 12-16-3.5-3 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 3. (a) The division shall adopt rules under IC 4-22-2 to establish income and resource eligibility standards for patients whose care is to be paid under the hospital care for the indigent program.
    (b) To the extent possible and subject to this article, rules adopted under this section must meet the following conditions:
        (1) Be consistent with IC 12-15-21-2 and IC 12-15-21-3.
        (2) Be adjusted at least one (1) time every two (2) years.
    (c) The income and eligibility standards established under this section do not include any spend down provisions available under IC 12-15-21-2 or IC 12-15-21-3.
    (d) In addition to the conditions imposed under subsection (b), rules adopted under this section must exclude a Holocaust victim's settlement payment received by an eligible individual from the income and eligibility standards for patients whose care is to be paid for under the hospital care for the indigent program.
SOURCE: IC 12-16-4.5-2; (05)CR162301.4. -->     SECTION 4. IC 12-16-4.5-2 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 2. A hospital must file the application with the division not more than thirty (30) forty-five (45) days after the person has been admitted to, or otherwise provided care by, released or discharged from the hospital, unless the person is medically unable and the next of kin or legal representative is unavailable.
SOURCE: IC 12-16-4.5-3; (05)CR162301.5. -->     SECTION 5. IC 12-16-4.5-3 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 3. Subject to this article, the division shall adopt rules under IC 4-22-2 prescribing the following:
        (1) The form of an application.
        (2) The establishment of procedures for applications.
        (3) The time for submitting and processing claims.
SOURCE: IC 12-16-4.5-8; (05)CR162301.6. -->     SECTION 6. IC 12-16-4.5-8 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 8. (a) A person may file an application directly with the division if the application is filed not more than thirty (30) forty-five (45) days after the person was admitted to, or provided care by, released or discharged from the hospital.
    (b) Reimbursement for the costs incurred in providing care to an eligible person may only be made to the providers of the care.
SOURCE: IC 12-16-5.5-1; (05)CR162301.7. -->     SECTION 7. IC 12-16-5.5-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 1. The division shall, upon receipt of an application of or for a person who was admitted to, or who was otherwise provided care by, a hospital, promptly investigate to determine the person's eligibility under the hospital care for the indigent program. Information regarding the person obtained by the hospital must be accepted by the division for purposes of determining the person's eligibility under the program. The division shall permit the person, or the person's representative if the person is not available, to be interviewed by telephone. The county office located in:
        (1) the county where the person is a resident; or
        (2) the county where the onset of the medical condition that necessitated the care occurred if the person's Indiana residency or Indiana county of residence cannot be determined;
shall cooperate with the division in determining the person's eligibility under the program.
SOURCE: IC 12-16-5.5-3; (05)CR162301.8. -->     SECTION 8. IC 12-16-5.5-3 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 3. (a) Subject to subsection (b), if the division is unable after prompt and diligent efforts to verify information contained in the application that is reasonably necessary to determine eligibility, the division may deny assistance under the hospital care for the indigent program. The division's failure to act within the time limit under IC 12-16-6.5-1.5 is not a valid reason to deny assistance under the hospital care for the indigent program.
    (b) Before denying assistance under the hospital care for the indigent program, the division must provide the person and the hospital written notice of:
        (1) the specific information or verification needed to determine eligibility and the statute or rule requiring the information or verification;
         (2) the specific efforts taken to obtain the information or verification; and
        (2) (3) the date on which the application will be denied if the information or verification is not provided within ten (10) days after the date of the notice.
SOURCE: IC 12-16-6.5-1.5; (05)CR162301.9. -->     SECTION 9. IC 12-16-6.5-1.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 1.5. Subject to IC 12-16-5.5-3(b)(3), if the division does not complete an investigation and determination of a person's financial and medical eligibility under the hospital care for the indigent program under IC 12-16-3.5 within forty-five (45) days after receipt of the application filed under IC 12-16-4.5, the person shall be considered to be financially and medically eligible under the program, and the hospital, medical, and transportation services that are part of the application must be covered by the program.
SOURCE: IC 12-16-6.5-2; (05)CR162301.10. -->     SECTION 10. IC 12-16-6.5-2 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 2. If the division
        (1) fails to complete an investigation and determination of eligibility under the hospital care for the indigent program not more than forty-five (45) days after the receipt of the application filed under IC 12-16-4.5; or
        (2) fails or refuses to accept responsibility for payment of medical or hospital care under the hospital care for the indigent program,
a person, physician, hospital, or transportation provider affected may appeal to the division not more than ninety (90) days after the receipt of the application filed under IC 12-16-4.5.

SOURCE: IC 12-16-11.5-1; (05)CR162301.11. -->     SECTION 11. IC 12-16-11.5-1 IS REPEALED [EFFECTIVE UPON PASSAGE].
SOURCE: ; (05)CR162301.12. -->     SECTION 12. An emergency is declared for this act.
    (Reference is to HB 1623 as introduced.)

and when so amended that said bill do pass.

__________________________________

Representative Becker


CR162301/DI 77    2005