SB 566-1_ Filed 04/27/2007, 18:31
CONFERENCE COMMITTEE REPORT
DIGEST FOR ESB 566
Citations Affected: IC 12-7-2-47.5; IC 12-15; IC 12-19-7.5-1; IC 12-24.
Synopsis: Health care services. Conference committee report to ESB 566. Requires an insurer
to accept a Medicaid claim for services provided a Medicaid recipient for three years after the
date the service was provided. Specifies the circumstances in which a Medicaid claim may not
be denied by an insurer. States that notice requirements may be satisfied by electronic or mail
submission (current law provides only for certified or registered mail). Requires an insurer to
accept the state's right of recovery and assignment of certain rights as required by federal law.
Adds certain less restrictive settings to the definition of children's psychiatric residential
treatment services. Requires OMPP to conduct a study of Medicaid claims eligible for payment
by a third party. Provides that if the study by OMPP reveals a percentage of at least 1%, OMPP
shall implement an automated procedure for determining whether a Medicaid claim is eligible
for payment by a third party before payment. Allows OMPP to implement a change in the office's
maximum allowable cost schedule for prescription drugs 30 days after OMPP posts the changes
on OMPP's Internet web site. (Current law requires 45 days before the change may be effective).
Allows a pharmacy to determine not to participate in the Medicaid program as a result of a
change in the schedule if the pharmacy notifies the office within 30 days of the change in the
schedule taking effect. Changes the way charges are set at state mental health institutions.
Repeals provisions concerning the per capita cost of treatment at state mental health institutions
and the per capita cost of outpatient services. (This conference committee report: (1) removes
provision prohibiting OMPP from reducing provider reimbursement rates in appropriated
money is reverted; (2) removes provisions concerning health care services provided to a
person subject to lawful detention; (3) makes changes to the coordination of benefits study;
(4) adds language from SB 318 concerning OMPP changes to the maximum allowable cost
schedule for prescription drugs and pharmacy participation in the Medicaid program; and
(5) adds language from SB 198 concerning charges at state mental health institutions.)
Effective: Upon passage; July 1, 2007.
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Adopted Rejected
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CONFERENCE COMMITTEE REPORT
MR. SPEAKER:
Your Conference Committee appointed to confer with a like committee from the Senate
upon Engrossed House Amendments to Engrossed Senate Bill No. 566 respectfully reports
that said two committees have conferred and agreed as follows to wit:
that the Senate recede from its dissent from all House amendments and that
the Senate now concur in all House amendments to the bill and that the bill
be further amended as follows:
Delete everything after the enacting clause and insert the following:
SOURCE: IC 12-7-2-47.5; (07)CC056601.1. -->
SECTION 1. IC 12-7-2-47.5 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 47.5. "Covered entity", for purposes of
IC 12-15-23.5, has the meaning set forth in IC 12-15-23.5-1.
SOURCE: IC 12-15-13-6; (07)CC056601.2. -->
SECTION 2. IC 12-15-13-6 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 6. (a) Except as
provided by IC 12-15-35-50, a notice or bulletin that is issued by:
(1) the office;
(2) a contractor of the office; or
(3) a managed care plan under the office;
concerning a change to the Medicaid program that does not require use
of the rulemaking process under IC 4-22-2 may not become effective
until forty-five (45) days after the date the notice or bulletin is mailed
to the parties affected by the notice or bulletin.
(b) The office must mail a notice or bulletin described in subsection
(a) within five (5) business days after the date on the notice or bulletin.
SOURCE: IC 12-15-23.5; (07)CC056601.3. -->
SECTION 3. IC 12-15-23.5 IS ADDED TO THE INDIANA CODE
AS A
NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]:
Chapter 23.5. Coordination of Benefits Study
Sec. 1. As used in this chapter, "covered entity" has the meaning
set forth in 45 CFR 160.103.
Sec. 2. (a) Before January 1, 2008, the office shall:
(1) examine all Medicaid claims paid after January 1, 2001,
and before July 1, 2007;
(2) determine which claims examined under subdivision (1)
were eligible for payment by a third party other than
Medicaid; and
(3) recover the claims that were determined under subdivision
(2) to be eligible for payment by a third party other than
Medicaid.
(b) The office shall require through an eligibility and benefit
request, and a covered entity shall provide, any information
necessary for the office to complete the examination required by
this section. The office, after notice and hearing, may impose a fine
not to exceed one thousand dollars ($1,000) for each refusal by a
covered entity to provide information concerning an eligibility and
benefit request for a Medicaid recipient requested by the office
under this section.
Sec. 3. If at least one percent (1%) of the claims were
determined under section 2 of this chapter to be eligible for
payment by a third party other than Medicaid, the office shall
develop and implement a procedure to improve the coordination
of benefits between:
(1) the Medicaid program; and
(2) any other third party source of health care coverage
provided to a recipient.
Sec. 4. If a procedure is developed and implemented under
section 3 of this chapter, the procedure:
(1) must be automated; and
(2) must provide a system for determining whether a
Medicaid claim is eligible for payment by another third party
before the claim is paid under the Medicaid program.
SOURCE: IC 12-15-29-2; (07)CC056601.4. -->
SECTION 4. IC 12-15-29-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 2. (a) Subject to
subsection (b), an insurer shall furnish records or information
pertaining to the coverage of an individual for the individual's medical
costs under an individual or a group policy or other obligation, or the
medical benefits paid or claims made under a policy or an obligation,
if the office does the following:
(1) Requests the information in writing. electronically or by
United States mail.
(2) Certifies that the individual is:
(A) a Medicaid applicant or recipient; or
(B) a person who is legally responsible for the applicant or
recipient.
(b) The office may request only the records or information necessary
to determine whether insurance benefits have been or should have been
claimed and paid with respect to items of medical care and services
that were received by a particular individual and for which Medicaid
coverage would otherwise be available.
SOURCE: IC 12-15-29-4.5; (07)CC056601.5. -->
SECTION 5. IC 12-15-29-4.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 4.5. (a) An insurer shall
accept a Medicaid claim for a Medicaid recipient for three (3)
years from the date the service was provided.
(b) An insurer may not deny a Medicaid claim submitted by the
office solely on the basis of:
(1) the date of submission of the claim;
(2) the type or format of the claim form;
(3) the method of submission of the claim; or
(4) a failure to provide proper documentation at the point of
sale that is the basis of the claim;
if the claim is submitted by the office within three (3) years from
the date the service was provided as required in subsection (a) and
the office commences action to enforce the office's rights regarding
the claim within six (6) years of the office's submission of the claim.
(c) An insurer may not deny a Medicaid claim submitted by the
office solely due to a lack of prior authorization. An insurer shall
conduct the prior authorization on a retrospective basis for claims
where prior authorization is necessary and adjudicate any claim
authorized in this manner as if the claim received prior
authorization.
SOURCE: IC 12-15-29-7; (07)CC056601.6. -->
SECTION 6. IC 12-15-29-7 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 7. (a) The notice
requirements of section 4 of this chapter are satisfied if:
(1) the insurer receives from the office, by certified electronically
or registered by United States mail, a statement of the claims
paid or medical services rendered by the office, together with a
claim for reimbursement; or
(2) the insurer receives a claim from a beneficiary stating that the
beneficiary has applied for or has received Medicaid from the
office in connection with the same claim.
(b) An insurer that receives a claim under subsection (a)(2) shall
notify the office of the insurer's obligation on the claim and shall:
(1) pay the obligation to the provider of service; or
(2) if the office has provided Medicaid, pay the office.
SOURCE: IC 12-15-29-9; (07)CC056601.7. -->
SECTION 7. IC 12-15-29-9 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 9. (a) IC 27-8-23
applies to this section.
(b) To the extent that payment for covered medical expenses has
been made under the state Medicaid program for health care items or
services furnished to a person, in a case where a third party has a legal
liability to make payments, the state is considered to have acquired the
rights of the person to payment by any other party for the health care
items or services.
(c) As required under 42 U.S.C. 1396a(a)(25), an insurer shall
accept the state's right of recovery and the assignment to the state
of any right of the individual or entity to payment for a health care
item or service for which payment has been made under the state
Medicaid plan.
SOURCE: IC 12-15-35-50; (07)CC056601.8. -->
SECTION 8. IC 12-15-35-50 IS ADDED TO THE INDIANA
CODE AS A
NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 50. (a) IC 12-15-13-6 does not
apply to this section.
(b) The office shall maintain an Internet web site and post on
the web site any changes concerning the office's maximum
allowable cost schedule for drugs.
(c) A change in the office's maximum allowable cost schedule for
drugs may not take effect less than thirty (30) days after the change
is posted on the office's Internet web site.
(d) The office is not required to mail a notice to providers
concerning a change in the office's maximum allowable cost
schedule for drugs.
(e) A pharmacy may determine not to participate in the
Medicaid program because of a change to the office's maximum
allowable cost schedule for drugs if the pharmacy notifies the office
not less than thirty (30) days after the changes take effect.
SOURCE: IC 12-19-7.5-1; (07)CC056601.9. -->
SECTION 9. IC 12-19-7.5-1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 1. As used in this
chapter, "children's psychiatric residential treatment services" means
services that are:
(1) eligible for federal financial participation under the state
Medicaid plan; and
(2) provided to individuals less than twenty-one (21) years of age
who are:
(A) eligible for services under the state Medicaid plan;
(B) approved by the office as eligible for admission to and
treatment in a private psychiatric residential treatment facility;
and
(C) either residing in a:
(i) private psychiatric residential facility for the purposes of
treatment for a mental health condition, based on an
approved treatment plan that complies with applicable
federal and state Medicaid rules and regulations; or
(ii) less restrictive setting and participating in a federally
approved community alternatives to psychiatric
residential treatment facilities demonstration grant that
provides safe, intensive, and appropriate services under
an approved treatment plan that complies with federal
and state Medicaid law.
SOURCE: IC 12-24-13-4; (07)CC056601.10. -->
SECTION 10. IC 12-24-13-4 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 4. (a) Each
patient
in a state institution
and the responsible parties of the patient,
individually or collectively, shall
pay for the ensuing fiscal year an
amount not to exceed the per capita cost at that state institution.
establish a charge structure for institutional services and
treatment. The charge structure must be approved by the director
of the division before July 1 of each year and, once approved, the
charge structure must be effective for the following state fiscal
year.
(b) Except as provided in section 5 of this chapter, each patient in
a state institution and the responsible parties, individually or
collectively, are liable for the payment of the
cost of charges for the
treatment and maintenance of the patient.
SOURCE: IC 12-24-13-7; (07)CC056601.11. -->
SECTION 11. IC 12-24-13-7 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 7. If a patient in a
state institution has insurance coverage that covers hospitalization or
medical services in psychiatric hospitals, all benefits under the
insurance coverage in an amount not to exceed the cost of treatment
and maintenance of the patient, shall be assigned to the appropriate
division.
SOURCE: IC 12-24-13-10; (07)CC056601.12. -->
SECTION 12. IC 12-24-13-10 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 10. The appropriate
division shall issue to any party liable under this chapter for any type
of psychiatric service statements of sums due as maintenance charges.
The division shall require the liable party to pay monthly, quarterly, or
otherwise as may be arranged an amount not exceeding the maximum
cost charge as determined under this chapter.
SOURCE: IC 12-24-13-11; (07)CC056601.13. -->
SECTION 13. IC 12-24-13-11 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 11. The estate of
a patient who receives care, treatment, maintenance, or any other
service furnished by the division at the state's expense is liable for
payment of the cost of the charges as determined under this chapter
for the service. The estate is exempt from the requirements of section
10 of this chapter or any part of this chapter directly in conflict with the
intent of the chapter to hold a patient's estate liable for payment.
SOURCE: IC 12-24-14-2; (07)CC056601.14. -->
SECTION 14. IC 12-24-14-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 2. The billing and
collection of maintenance expenses charges under this article shall be
made by the division or a unit of the division designated by the
director.
SOURCE: IC 12-24-13-3; IC 12-24-13-8; IC 12-24-13-9.
; (07)CC056601.15. -->
SECTION 15. THE FOLLOWING ARE REPEALED [EFFECTIVE
UPON PASSAGE]: IC 12-24-13-3; IC 12-24-13-8; IC 12-24-13-9.
SOURCE: ; (07)CC056601.16. -->
SECTION 16.
An emergency is declared for this act.
(Reference is to ESB 566 as reprinted April 10, 2007.)
Conference Committee Report
on
Engrossed Senate Bill 566
Text Box
S
igned by:
____________________________ ____________________________
Senator DillonRepresentative Brown C
Chairperson
____________________________ ____________________________
Senator MrvanRepresentative Brown T
Senate Conferees House Conferees