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.
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CR162301/DI 77 2005