SB 66-1_ Filed 03/24/2005, 14:26
Adopted 3/24/2005


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       Senate Bill 66     , 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:

SOURCE: Page 3, line 10; (05)CR006602.3. -->     Page 3, between lines 10 and 11, begin a new paragraph and insert:
SOURCE: IC 12-15-15-2.5; (05)CR006602.3. -->     "SECTION 3. IC 12-15-15-2.5 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 2.5. (a) Payment for physician services provided in the emergency department of a hospital licensed under IC 16-21 must be at a rate of one hundred percent (100%) of rates payable under the Medicaid fee structure.
    (b) The payment under subsection (a) must be calculated using the same methodology used for all other physicians participating in the Medicaid program.
    (c) For services rendered and documented in an individual's medical record, physicians must be reimbursed for federally required medical screening exams that are necessary to determine the presence of an emergency using the appropriate Current Procedural Terminology (CPT) codes 99281, 99282, or 99283 described in the Current Procedural Terminology Manual published annually by the American

Medical Association, without authorization by the enrollee's primary medical provider.
    (d) Payment for all other physician services provided in an emergency department of a hospital to enrollees in the Medicaid primary care case management program must be at a rate of one hundred percent (100%) of the Medicaid fee structure rates, provided the service is authorized, prospectively or retrospectively, by the enrollee's primary medical provider.
    (e) This section does not apply to a person enrolled in the Medicaid risk based managed care program.

SOURCE: IC 12-16-2.5-6.3; (05)CR006602.4. -->     SECTION 4. IC 12-16-2.5-6.3 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003 (RETROACTIVE)]: Sec. 6.3. For purposes of this article, the following definitions apply to the hospital care for the indigent program:
        (1) "Assistance" means the satisfaction of a person's financial obligation for hospital items or services, physician services, or transportation services provided to the person under IC 12-16-7.5-1.2.
        (2) "Claim" means a statement filed with the division by a hospital, physician, or transportation provider that identifies the health care items or services the hospital, physician, or transportation provider provided to a person for whom an application under IC 12-16-4.5 has been filed with the division.
        (3) "Eligible" or "eligibility", when used in regard to a person for whom an application under IC 12-16-4.5 has been filed with the division, means the extent to which:
            (A) the person, for purposes of the application, satisfies the income and resource standards established under IC 12-16-3.5; and
            (B) the person's medical condition, for purposes of the application, satisfies one (1) or more of the medical conditions identified in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3).

SOURCE: IC 12-16-2.5-6.5; (05)CR006602.5. -->     SECTION 5. IC 12-16-2.5-6.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS

[EFFECTIVE UPON PASSAGE]: Sec. 6.5. (a) Notwithstanding IC 12-16-4.5, IC 12-16-5.5, and IC 12-16-6.5, except for the functions provided for under IC 12-16-4.5-3, IC 12-16-4.5-4, IC 12-16-6.5-3, IC 12-16-6.5-4, and IC 12-16-6.5-7, the division may enter into a written agreement with a hospital licensed under IC 16-21 for the hospital's performance of one (1) or more of the functions of the division or a county office under IC 12-16-4.5, IC 12-16-5.5, and IC 12-16-6.5. Under an agreement between the division and a hospital:
        (1) if the hospital is authorized to determine:
            (A) if a person meets the income and resource requirements established under IC 12-16-3.5;
            (B) if the person's medical condition satisfies one (1) or more of the medical conditions identified in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
            (C) if the health care items or services received by the person were necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3), or were a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3);
        the determinations must be limited to persons receiving care at the hospital;
        (2) the agreement must state whether the hospital is authorized to make determination regarding physician services or transportation services provided to a person;
        (3) the agreement must state the extent to which the functions performed by the hospital include the provision of the notices required under IC 12-16-5.5 and IC 12-16-6.5;
        (4) the agreement may not limit the hearing and appeal process available to persons, physicians, transportation providers, or other hospitals under IC 12-16-6.5;
        (5) the agreement must state how determinations made by the hospital will be communicated to the division for purposes of the attributions and calculations under IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-7.5, and IC 12-16-14; and


        (6) the agreement must state how the accuracy of the hospital's determinations will be reviewed.
    (b) A hospital, its employees, and its agents are immune from civil or criminal liability arising from their good faith implementation and administration of the agreement between the division and the hospital under this section.

SOURCE: IC 12-16-3.5-1; (05)CR006602.6. -->     SECTION 6. IC 12-16-3.5-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003 (RETROACTIVE)]: Sec. 1. (a) An Indiana resident who meets the income and resource standards established by the division under section 3 of this chapter is eligible for assistance to pay for any part of the cost of satisfy the resident's financial obligation for care provided to the resident in a hospital in Indiana that was necessitated after the onset of a medical condition that was manifested by symptoms of sufficient severity that the absence of immediate medical attention would probably result in any of the following:
        (1) Placing the individual's life in jeopardy.
        (2) Serious impairment to bodily functions.
        (3) Serious dysfunction of a bodily organ or part.
    (b) A qualified resident is also eligible for assistance to pay satisfy the resident's financial obligation for the part of the cost of care that is a direct consequence of the medical condition that necessitated the emergency care.
SOURCE: IC 12-16-3.5-2; (05)CR006602.7. -->     SECTION 7. IC 12-16-3.5-2 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003 (RETROACTIVE)]: Sec. 2. (a) An individual who is not an Indiana resident is eligible for assistance to pay satisfy the resident's financial obligation for the part of the cost of care provided to the individual in a hospital in Indiana that was necessitated after the onset of a medical condition that was manifested by symptoms of sufficient severity that the absence of immediate medical attention would probably result in any of the following:
        (1) Placing the individual's life in jeopardy.
        (2) Serious impairment to bodily functions.
        (3) Serious dysfunction of any bodily organ or part.
    (b) An individual is eligible for assistance under subsection (a) only if the following qualifications exist:
        (1) The individual meets the income and resource standards

established by the division under section 3 of this chapter.
        (2) The onset of the medical condition that necessitated medical attention occurred in Indiana.

SOURCE: IC 12-16-3.5-3; (05)CR006602.8. -->     SECTION 8. 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 12-16-4.5-1; (05)CR006602.9. -->     SECTION 9. IC 12-16-4.5-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 1. (a) To receive payment from the division for the care provided to an assistance under the hospital care for the indigent person, program under this article, a hospital, the person, or the person's representative must file an application regarding the person with the division.
    (b) Upon receipt of an application under subsection (a), the division shall determine whether the person is a resident of Indiana and, if so, the person's county of residence. If the person is a resident of Indiana, the division shall provide a copy of the application to the county office of the person's county of residence. If the person is not a resident of Indiana, the division shall provide a copy of the application to the county office of the county where the onset of the medical condition that necessitated the care occurred. If the division cannot determine whether the person is a resident of Indiana or, if the person is a resident of Indiana, the person's county of residence, the division shall provide a copy of the application to the county office of the county where the onset of the medical condition that necessitated the care occurred.
    (c) A county office that receives a request from the division shall cooperate with the division in determining whether a person is a resident of Indiana and, if the person is a resident of Indiana, the person's county of residence.".
SOURCE: Page 3, line 14; (05)CR006602.3. -->     Page 3, line 14, strike "admitted to, or otherwise".
    Page 3, line 15, strike "provided care by,".
    Page 3, between lines 17 and 18, begin a new paragraph and insert:
SOURCE: IC 12-16-4.5-3; (05)CR006602.11. -->     "SECTION 11. 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)CR006602.12. -->     SECTION 12. 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, has been 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 12-16-4.5-8.5; (05)CR006602.13. -->     SECTION 13. IC 12-16-4.5-8.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 8.5. A claim for hospital items or services, physician services, or transportation services must be filed with the division not more than forty-five (45) days after the person who received the care has been released or discharged from the hospital. For good cause as determined by the division, this forty-five (45) day limit may be extended or waived for a claim.
SOURCE: IC 12-16-5.5-1; (05)CR006602.14. -->     SECTION 14. IC 12-16-5.5-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 1. (a) 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. The division shall consider the following information obtained by the hospital regarding the

person:
        (1) Income.
        (2) Resources.
        (3) Place of residence.
        (4) Medical condition.
        (5) Hospital care.
        (6) Physician care.
        (7) Transportation to and from the hospital.
The division may rely on the hospital's information in determining the person's eligibility under the program.
    (b) The division may choose not to interview the person if, based on the information provided to the division, the division determines that it appears that the person is eligible for the program. If the division determines that an interview of the person is necessary, the division shall allow the interview to occur by telephone with the person or the person's representative if the person is not able to participate in the interview.

     (c) 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 12-16-5.5-1.2; (05)CR006602.15. -->     SECTION 15. IC 12-16-5.5-1.2 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 1.2. (a) The division shall, upon receipt of a claim pertaining to a person:
        (1) who was admitted to, or who was otherwise provided care by, a hospital; and

         (2) whose medical condition satisfies one (1) or more of the medical conditions identified in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3);
promptly review the claim to determine if the health care items or services identified in the claim were necessitated by the person's medical condition or, if applicable, if the items or services were a direct consequence of the person's medical condition.
    (b) In conducting the review of a claim referenced in subsection (a), the division shall calculate the amount of the claim. For purposes of this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, and IC 12-16-7.5, the amount of a claim shall be calculated by applying the office's applicable Medicaid fee-for-service reimbursement rate to each of the items and services identified in the claim that are determined:
        (1) to have been necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
        (2) to be a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).

SOURCE: IC 12-16-5.5-3; (05)CR006602.16. -->     SECTION 16. 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 pending expiration of the period specified in IC 12-16-6.5-1.5 is not a valid reason for denying 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
        (2) 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.
         (2) the specific efforts undertaken to obtain the information or verification; and
        (3) the statute or rule requiring the information or verification identified under subdivision (1).
    (c) The division must provide the hospital at least ten (10) days beyond the deadline established under IC 12-16-6.5-1.5 to provide the division with information concerning the person's eligibility. If

the division does not make a determination of the person's eligibility within ten (10) days after receiving the information under this subsection, the person is eligible for the hospital care for the indigent care program.

SOURCE: IC 12-16-5.5-3.2; (05)CR006602.17. -->     SECTION 17. IC 12-16-5.5-3.2 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 3.2. (a) Subject to subsection (b), if the division is unable to determine that a health care item or service identified in a claim:
        (1) was necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
        (2) was a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3);
the division may deny assistance to the person under the hospital care for the indigent program for that item or service. The pending expiration of the period specified in IC 12-16-6.5-1.7 is not a valid reason for determining that an item or a service was not necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3), or was not a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
    (b) Before denying assistance under the hospital care for the indigent program for an item or a service described in subsection (a), the division must provide the provider of the item or service written notice of:
        (1) the specific item or service in question; and
        (2) an explanation of the basis for the division's inability to determine that the health care item or service was:
            (A) necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
            (B) a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through

IC 12-16-3.5-1(a)(3);
        including, if applicable, an explanation of the basis for a conclusion by the division that the item or service, in fact, was not necessitated by, or, as applicable, not a direct consequence of, one (1) or more of such medical conditions.

The division must grant the provider of the item or service time to provide the division with information or materials bearing on whether the item or service was necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3), or a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3), but time granted by the division may not be less than ten (10) days beyond the deadline established under IC 12-16-6.5-1.7. If the division does not make its determination regarding the item or service within ten (10) days after receiving information or materials provided for in this section, the item or service is considered to have been necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3), or a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).

SOURCE: IC 12-16-6.5-1; (05)CR006602.18. -->     SECTION 18. IC 12-16-6.5-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 1. If the division determines that a person is not eligible for payment of assistance for medical care, hospital care, or transportation services, an affected person, physician, hospital, or transportation provider may appeal to the division not later than ninety (90) days after the mailing of notice of that determination to the affected person, physician, hospital, or transportation provider at to the last known address of the person, physician, hospital, or transportation provider.
SOURCE: IC 12-16-6.5-1.2; (05)CR006602.19. -->     SECTION 19. IC 12-16-6.5-1.2 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 1.2. (a) If the division determines that an item or service identified in a claim:
        (1) was not necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through

IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
        (2) was not a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3);
the affected person, physician, hospital, and transportation provider may appeal to the division not later than ninety (90) days after the mailing of the notice of that determination to the affected person, physician, hospital, or transportation provider to the last known address of the person, physician, hospital, or transportation provider.
    (b) If the division determines that an item or service identified in a claim:
        (1) was necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
        (2) was a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3);
but the affected physician, hospital, or transportation provider disagrees with the amount of the claim calculated by the division under IC 12-16-5.5-1.2(b), the affected physician, hospital, or transportation provider may appeal the calculation to the division not later than ninety (90) days after the mailing of the notice of that calculation to the affected physician, hospital, or transportation provider to the last known address of the physician, hospital, or transportation provider.

SOURCE: IC 12-16-6.5-1.5; (05)CR006602.20. -->     SECTION 20. 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(c), if the division fails to complete an investigation and determination of a person's financial and medical eligibility for the hospital care for the indigent program not later than forty-five (45) days after receipt of the application filed under IC 12-16-4.5, the person is considered to be eligible for assistance under the program.
SOURCE: IC 12-16-6.5-1.7; (05)CR006602.21. -->     SECTION 21. IC 12-16-6.5-1.7 IS ADDED TO THE INDIANA

CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 1.7. Subject to IC 12-16-5.5-3.2(b), if the division fails to complete an investigation and determination of one (1) or more health care items or services identified in a claim within forty-five (45) days after receipt of the claim filed under IC 12-16-4.5, the item or service is considered to have been:
        (1) necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
        (2) a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).

SOURCE: IC 12-16-6.5-5; (05)CR006602.22. -->     SECTION 22. IC 12-16-6.5-5 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 5. (a) If the division receives an application that was filed on behalf of a person under IC 12-16-4.5, the division shall determine:
         (1) the eligibility of the person for payment of the cost of medical or hospital care assistance under the hospital care for the indigent program; and
        (2) if the health care items or services provided to the person and identified in a claim filed with the division under IC 12-16-4.5 were:
            (A) necessitated by at least one (1) medical condition listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
            (B) the direct consequence of at least one (1) of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).

    (b) If:
         (1) the person is found eligible the division shall pay the reasonable cost of the care covered under IC 12-16-3.5-1 or IC 12-16-3.5-2 to the physicians furnishing the covered medical care and the transportation providers furnishing the covered transportation services, subject to the limitations in IC 12-16-7.5. for assistance; and
        (2) at least one (1) of the items or services identified in the claim is determined:
            (A) to have been necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
            (B) to be a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3);
        the person must receive assistance for those items and services.

    (c) If the person is found eligible, the payment for the hospital services and items covered under IC 12-16-3.5-1 or IC 12-16-3.5-2 shall be calculated using the office's applicable Medicaid fee-for-service reimbursement principles. Payment to the hospital shall be made:
        (1) under IC 12-15-15-9; and
        (2) if the hospital is eligible, under IC 12-15-15-9.5.
SOURCE: IC 12-16-6.5-6; (05)CR006602.23. -->     SECTION 23. IC 12-16-6.5-6 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 6. A person, hospital, physician, or transportation provider aggrieved by a determination of an appeal taken under section 5(a) section 1 or 1.2 of this chapter may appeal the determination under IC 4-21.5.".
SOURCE: Page 3, line 18; (05)CR006602.3. -->     Page 3, delete lines 18 through 26, begin a new paragraph and insert:
SOURCE: IC 12-16-7.5-1.2; (05)CR006602.24. -->     "SECTION 24. IC 12-16-7.5-1.2 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003 (RETROACTIVE)]: Sec. 1.2. (a) A person determined to be eligible under the hospital care for the indigent program is not financially obligated for hospital items or services, physician services, or transportation services provided to the person during the person's eligibility under the program, if the items or services were:
        (1) identified in a claim filed with the division under IC 12-16-4.5; and
        (2) determined:
            (A) to have been necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
            (B) to be a direct consequence of one (1) or more of the

medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
    (b) Based on a hospital's items or services identified in a claim under subsection (a), the hospital must receive a payment from the office calculated and made under IC 12-15-15-9 and IC 12-15-15-9.5.
    (c) Based on a physician's services identified in a claim under subsection (a), the physician must receive a payment from the division calculated and made under section 5 of this chapter.
    (d) Based on the transportation services identified in a claim under in subsection (a), the transportation provider must receive a payment from the division calculated and made under section 5 of this chapter.
".

SOURCE: Page 3, line 31; (05)CR006602.3. -->     Page 3, line 31, delete "care;" and insert " services;".
    Page 4, between lines 10 and 11, begin a new paragraph and insert:
SOURCE: IC 12-16-7.5-2.7; (05)CR006602.26. -->     "SECTION 26. IC 12-16-7.5-2.7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003 (RETROACTIVE)]: Sec. 2.7. (a) Except as provided in subsection (f), this section applies to state fiscal years beginning after June 30, 2004.
    (b) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5, and IC 12-16-14 the following definitions apply:
        (1) "Amount" refers to a payable claim in an amount calculated under STEP THREE of the following formula:
            STEP ONE: Identify the items and services comprising a payable claim.
            STEP TWO: Using the applicable Medicaid fee for service reimbursement rates, calculate the reimbursement amounts for each of the items and services identified in STEP ONE.
            STEP THREE: Calculate the sum of the amounts identified in STEP TWO.
        (2) "Payable claim" means a claim for hospital items or services, physician care, or transportation services:
            (A) provided to a person under the hospital care for the indigent program under this article during the person's eligibility under the program;
            (B) identified in a claim filed with the division; and
            (C) determined to:
                (i) have been necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
                (ii) to be a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
    (c) Payable claims shall be segregated by state fiscal year.
    (d) The division shall calculate the amount of a payable claim at the time referenced in IC 12-16-5.5-1.2.
    (e) A physician, hospital, or transportation provider that submits a payable claim to the division is considered to have submitted the payable claim during the state fiscal year during which the division determined, initially or upon appeal, the amount of a payable claim.
    (f) Hospital items or services, physician care, or transportation services provided between July 1, 2003, and June 30, 2004, are governed by section 2.5 of this chapter.

SOURCE: IC 12-16-7.5-12; (05)CR006602.27. -->     SECTION 27. IC 12-16-7.5-12 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 12. All providers receiving payment under section 1.2 of this chapter agree to accept, as payment in full, the amount paid for the hospital care for the indigent program payment identified in section 1.2 of this chapter for those claims submitted for payment under the program, with the exception of authorized deductibles, co-insurance, co-payment, or similar cost-sharing charges. health care items or services identified in payable claims submitted to the division.
SOURCE: IC 12-16-12.5-2; (05)CR006602.28. -->     SECTION 28. IC 12-16-12.5-2 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 2. The division is responsible for the emergency medical care given in a hospital to an individual who qualifies for assistance under this chapter, subject to the limitations in IC 12-16-7.5.
SOURCE: IC 12-16-12.5-4; (05)CR006602.29. -->     SECTION 29. IC 12-16-12.5-4 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 4. (a) If a hospital owned by the health and hospital corporation is:
        (1) unable to care for a patient; or
        (2) unable to treat a patient at the time a transfer is requested by

the hospital initiating treatment;
the hospital may continue to treat the patient until the patient's discharge.
    (b) Subject to the limitations in IC 12-16-7.5, the division shall pay the costs of be responsible for care.

SOURCE: IC 12-16-12.5-5; (05)CR006602.30. -->     SECTION 30. IC 12-16-12.5-5 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 5. The division is not responsible hospital care for the indigent program under this article does not apply to the following:
        (1) The payment of Nonemergency medical costs, care, except as provided under the hospital care for the indigent program. this article.
        (2) The payment of medical costs accrued Care provided at a hospital owned or operated by a health and hospital corporation, except for hospital care provided under this chapter to a person not residing in Marion County.
SOURCE: IC 12-16-14-3; (05)CR006602.31. -->     SECTION 31. IC 12-16-14-3 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003 (RETROACTIVE)]: Sec. 3. (a) For purposes of this section, the following definitions apply:
        (1) "Amount"
"payable claim" has the meaning set forth in IC 12-16-7.5-2.5(b)(1). IC 12-16-7.5-2.7(b)(1).
        (2) "Payable claim" has the meaning set forth in IC 12-16-7.5-2.7(b)(2).

    (b) For taxes first due and payable in 2003, each county shall impose a hospital care for the indigent property tax levy equal to the product of:
        (1) the county's hospital care for the indigent property tax levy for taxes first due and payable in 2002; multiplied by
        (2) the county's assessed value growth quotient determined under IC 6-1.1-18.5-2 for taxes first due and payable in 2003.
    (c) For taxes first due and payable in 2004, 2005, and 2006, 2007, and 2008, each county shall impose a hospital care for the indigent property tax levy equal to the product of:
        (1) the county's hospital care for the indigent property tax levy for taxes first due and payable in the preceding year; multiplied by
        (2) the assessed value growth quotient determined in the last STEP of the following STEPS:
        STEP ONE: Determine the three (3) calendar years that most immediately precede the ensuing calendar year and in which a

statewide general reassessment of real property does not first become effective.
        STEP TWO: Compute separately, for each of the calendar years determined in STEP ONE, the quotient (rounded to the nearest ten-thousandth) of the county's total assessed value of all taxable property in the particular calendar year, divided by the county's total assessed value of all taxable property in the calendar year immediately preceding the particular calendar year.
        STEP THREE: Divide the sum of the three (3) quotients computed in STEP TWO by three (3).
    (d) Except as provided in subsection (e):
        (1) for taxes first due and payable in 2007, 2009, each county shall impose a hospital care for the indigent property tax levy equal to the average of the annual amount of payable claims attributed to the county under IC 12-16-7.5-4.5 during the state fiscal years beginning:
            (A) July 1, 2003;
            (B) July 1, 2004; and
            (C) (A) July 1, 2005; and
             (B) July 1, 2006; and
            (C) July 1, 2007; and

        (2) for all subsequent annual levies under this section, the average annual amount of payable claims attributed to the county under IC 12-16-7.5-4.5 during the three (3) most recently completed state fiscal years.
    (e) A county may not impose an annual levy under subsection (d) in an amount greater than the product of:
        (1) The greater of:
            (A) the county's hospital care for the indigent property tax levy for taxes first due and payable in 2006; 2008; or
            (B) the amount of the county's maximum hospital care for the indigent property tax levy determined under this subsection for taxes first due and payable in the immediately preceding year; multiplied by
        (2) the assessed value growth quotient determined in the last STEP of the following STEPS:
        STEP ONE: Determine the three (3) calendar years that most immediately precede the ensuing calendar year and in which a

statewide general reassessment of real property does not first become effective.
        STEP TWO: Compute separately, for each of the calendar years determined in STEP ONE, the quotient (rounded to the nearest ten-thousandth) of the county's total assessed value of all taxable property in the particular calendar year, divided by the county's total assessed value of all taxable property in the calendar year immediately preceding the particular calendar year.
        STEP THREE: Divide the sum of the three (3) quotients computed in STEP TWO by three (3).
     (f) For purposes of this section, a payable claim is attributed to the state fiscal year during which the division determined, under IC 12-16-5.5-1.2(b) or upon appeal, the amount of the payable claim.

SOURCE: IC 29-2-16-1; (05)CR006602.32. -->     SECTION 32. IC 29-2-16-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 1. Except where the context clearly indicates a different meaning, the terms used in this chapter shall be construed as follows:
    (a) "Bank or storage facility" means a facility licensed, accredited, or approved under the laws of any state for storage of human bodies or parts thereof.
    (b) "Decedent" means a deceased individual and includes a stillborn infant or fetus.
    (c) "Donor" means an individual who makes a gift of all or part of his the decedent's body.
    (d) "Hospital" means a hospital licensed, accredited, or approved under the laws of any state. The term includes a hospital operated by the United States government, a state, or a subdivision thereof, although not required to be licensed under state laws.
    (e) "Part" means organs, tissues, eyes, bones, arteries, blood, other fluids, and any other portions of a human body.
    (f) "Person" means an individual, corporation, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity.
    (g) "Physician" or "surgeon" means a physician or surgeon licensed or authorized to practice under the laws of any state.
     (h) "Procurement organization" means an organization qualified to recover anatomical gifts from donors.
    (h) (i) "State" includes any state, district, commonwealth, territory, insular possession, and any other area subject to the legislative authority of the United States of America.
SOURCE: IC 29-2-16-3; (05)CR006602.33. -->     SECTION 33. IC 29-2-16-3 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 3. The following persons may become donees of gifts of bodies or parts thereof for the purposes stated:
        (1) any hospital, surgeon, or physician for medical or dental education, research, advancement of medical or dental science, therapy, or transplantation; or
        (2) any accredited medical or dental school, college or university for education, research, advancement of medical or dental science, or therapy; or
        (3) any bank procurement organization or storage facility, for medical or dental education, research, advancement of medical or dental science, therapy, or transplantation; or
        (4) any specified individual for therapy or transplantation needed
        by him. the individual.
SOURCE: IC 29-2-16-4.5; (05)CR006602.34. -->     SECTION 34. IC 29-2-16-4.5 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 4.5. (a) A coroner may release and permit shall attempt to facilitate permission for the removal of a part from a body organs, tissues, or eyes within the coroner's custody, for transplantation, or therapy, only, or research by providing information to or seeking information from the procurement organization that would assist the procurement organization in the evaluation of the viability for transplantation of any organ, tissue, or eye if all of the following occur:
        (1) The coroner receives a request for a part from a hospital, physician, surgeon, or procurement organization.
        (2) The coroner makes a reasonable effort, taking into account the useful life of a part, to locate and examine the decedent's medical records and inform individuals listed in section 2(b) of this chapter of their option to make or object to making a gift under this chapter.
         (3) The decision to allow the removal of organs, tissues, or eyes is based on a medical decision made by the pathologist or forensic pathologist. If the pathologist or forensic pathologist considers withholding one (1) or more organs or tissues of a

potential donor, the pathologist or forensic pathologist:
            (A) shall be present during the removal of the organs or tissues;
            (B) may request a biopsy of the removed organs; and
            (C) after viewing the removed organs or tissues and determining that removal may interfere with the death investigation, may prohibit removal and shall provide a written explanation to the procurement organization.
        If it is determined that prior removal will interfere with the death investigation, the procurement organization may remove the tissues and eyes after the autopsy.

        (3) (4) The coroner does not know of a refusal or contrary indication by the decedent or an objection by an individual having priority to act as listed in section 2(b) of this chapter.
        (4) (5)The removal will be by:
            (A) a physician licensed under IC 25-22.5; or
            (B) in the case of removal of an eye or part of an eye, by an individual described in section 4(e) of this chapter; and under IC 36-2-14-19.
        (5) (6) The removal will not interfere with any autopsy or investigation.
        (6) (7) The removal will be in accordance with accepted medical standards.
        (7) (8) Cosmetic restoration will be done, if appropriate.
         (9) If the pathologist or forensic pathologist is required to be present to examine the decedent before or during the removal of the parts, the procurement organization shall reimburse the pathologist or forensic pathologist for actual costs, but the amount may not exceed one thousand dollars ($1,000). The county is not responsible for any costs incurred by the pathologist, forensic pathologist, or procurement organization under this subdivision.
        (10) If requested by the coroner, pathologist, or forensic pathologist, the procurement organization shall provide a surgeon's report detailing the condition of the organs and the relationship of the organs to the cause of death, if any.

    (b) If the body is not within the custody of the coroner, the medical examiner pathologist or forensic pathologist may release and permit

the removal of any part from a body in the medical examiner's custody for transplantation or therapy if the requirements of subsection (a) are met.
    (c) A person under this section who releases or permits the removal of a part shall maintain a permanent record of the name of the decedent, the individual making the request, the date and purpose of the request, the body part requested, and the person to whom it was released.

SOURCE: IC 29-2-16-6.5; (05)CR006602.35. -->     SECTION 35. IC 29-2-16-6.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 6.5. (a) Except for a gift made by a donor to a specific donee, a procurement organization that holds an agreement with a hospital to perform anatomical gift donation services for the hospital under 42 U.S.C. 1329b-8 and 42 CFR Part 482 is considered to be the donee of all gifts from patients who have died in the hospital.
    (b) An investigation by a coroner or a medical examiner does not change the rights of a procurement organization to act as the donee.

SOURCE: IC 34-30-2-45.2; (05)CR006602.36. -->     SECTION 36. IC 34-30-2-45.2 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 45.2. IC 12-16-2.5-6.5 (Concerning administering agreements between the hospital and the division of family and children under the hospital care for the indigent program).".
SOURCE: Page 4, line 13; (05)CR006602.4. -->     Page 4, between lines 13 and 14, begin a new paragraph and insert:
SOURCE: IC 12-16-2.5-3; IC 12-16-6.5-2; IC 12-16-7.5-1; IC 12- 16-11.5-1; IC 12-16-11.5-2.".
; (05)CR006602.38. -->     "SECTION 38. THE FOLLOWING ARE REPEALED
[EFFECTIVE UPON PASSAGE]: IC 12-16-2.5-3; IC 12-16-6.5-2; IC 12-16-7.5-1; IC 12-16-11.5-1; IC 12-16-11.5-2.".
    Renumber all SECTIONS consecutively.
    (Reference is to SB 66 as reprinted March 1, 2005.)

and when so amended that said bill do pass.

__________________________________

Representative Becker


CR006602/DI 77    2005