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.
__________________________________
CR006602/DI 77 2005