Citations Affected: IC 12-31.
Synopsis: Indiana health care system. Imposes various requirements
on the state department of health, department of insurance, office of
Medicaid policy and planning, and secretary of family and social
services to develop and implement health care initiatives, including
chronic care planning, premium assistance, health plan access, quality
assurance, data collection and use, and study various health care issues.
Requires application for appropriate Medicaid waivers.
Effective: July 1, 2007.
January 11, 2007, read first time and referred to Committee on Health and Provider
Services.
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
data base developed under the chronic care plan that includes
information on all cases of a particular disease or health condition
in a defined population.
Sec. 5. "Chronic care management" means a system of
coordinated health care interventions and communications for an
individual with a chronic condition.
Sec. 6. "Chronic care plan" means the state's five (5) year plan
for a chronic care infrastructure, prevention of chronic conditions,
and a chronic care management program, including an integrated
approach to patient self management, community development,
health care system and professional practice change, and
information technology initiatives.
Sec. 7. "Commissioner" refers to the state health commissioner
appointed under IC 16-19-4-2.
Sec. 8. "Covered individual" means an individual entitled to
coverage under a health plan.
Sec. 9. "Employee" means an individual who is at least eighteen
(18) years of age and is employed by an employer in Indiana.
Sec. 10. "Full-time equivalent" means the number of employees
expressed as the number of employee hours worked during a
calendar quarter divided by five hundred twenty (520).
Sec. 11. "Health maintenance organization" has the meaning set
forth in IC 27-13-1-19.
Sec. 12. "Health plan" means:
(1) a policy of accident and sickness insurance;
(2) a health maintenance organization contract;
(3) Indiana health; or
(4) another plan of coverage for health services.
Sec. 13. "Health plan provider" means a person that issues,
delivers, or administers a health plan.
Sec. 14. "Health provider" means an individual, partnership,
corporation, facility, or institution licensed or certified under
Indiana law to provide health services.
Sec. 15. "Health risk assessment" means screening by a health
provider to assess an individual's health.
Sec. 16. "Health service" means a medically necessary
treatment or procedure to maintain, diagnose, or treat an
individual's physical or mental condition.
Sec. 17. "Immunization" means administration of a vaccine as
recommended by the practice guidelines for children and adults
established by the Advisory Committee on Immunization Practices
to the federal Centers for Disease Control and Prevention.
applying for premium assistance; or
(2) lost health coverage during the twelve (12) month period
before applying for premium assistance for any of the
following reasons:
(A) The individual's coverage ended due to:
(i) loss of employment;
(ii) death of the principal health plan policyholder or
subscriber;
(iii) divorce;
(iv) no longer qualifying as a dependent under a plan; or
(v) no longer qualifying for continuation coverage.
(B) College sponsored health coverage became unavailable
to the individual because the individual graduated, took a
leave of absence, or otherwise terminated studies.
Chapter 2. Administration
Sec. 1. The secretary is responsible for coordination of the
provisions of this article among necessary state agencies.
Sec. 2. (a) The secretary shall ensure that the state agencies
responsible for development and implementation of this article do
so in a timely, client focused manner emphasizing quality and
affordability of health services.
(b) The secretary shall report to the legislative council, in an
electronic format under IC 5-14-6, and the governor before
December 1, 2007, with a five (5) year strategic plan for
implementing Indiana's health care system reform initiatives
described in this article, and any recommendations for
administration or legislation.
(c) Annually, beginning January 15, 2008, the secretary shall
report to the legislative council in an electronic format under
IC 5-14-6 concerning the progress of the reform initiatives.
Chapter 3. Chronic Care Plan
Sec. 1. In coordination with the secretary, the commissioner is
responsible for the development and implementation of a chronic
care plan.
Sec. 2. The commissioner shall establish an executive committee
to advise the commissioner concerning the creation and
implementation of the chronic care plan as described in this
chapter.
Sec. 3. The executive committee shall consist of at least ten (10)
individuals, including the following:
(1) A representative of the department of insurance.
(2) A representative of the state department of health.
conditions, to improve health outcomes, and to improve the
quality of care, including case management fees, pay for
performance, payment for technical support and data
entry associated with patient registries, the cost of staff
coordination within a medical practice, and any reduction
in a health provider's productivity;
(G) payment to a care management organization to put the
care management organization's fee at risk if the care
management organization is not successful in reducing
costs to the state;
(H) a requirement that patient data be shared, to the extent
allowable under federal law, with the secretary to provide
information on which to base the health care reform
initiatives under IC 12-31-2;
(I) a method for a care management organization to
participate closely in health care reform initiatives; and
(J) participation in pharmacy best practices and cost
control programs, including a multistate purchasing pool
and a statewide preferred drug list;
(2) a description of prevention programs and how the
programs are integrated into communities, with chronic care
management, and the chronic care plan;
(3) a plan to develop and implement reimbursement systems
aligned with the goal of managing the care for individuals
with or at risk for conditions to improve outcomes and the
quality of care;
(4) involvement of public and private groups, health
providers, health plans, third party administrators,
associations, and firms to facilitate and assure the
sustainability of a new system of care;
(5) involvement of community and consumer groups to
facilitate and assure the sustainability of health services
supporting healthy behaviors and good patient
self-management for the prevention and management of
chronic conditions;
(6) alignment of information technology needs with other
health information technology initiatives;
(7) use and development of outcome measures and reporting
requirements, aligned with existing outcome measures in the
office of the secretary, to assess and evaluate the system of
chronic care;
(8) target timelines for inclusion of specific chronic conditions
to be included in the chronic care infrastructure and for
statewide implementation of the chronic care plan;
(9) identification of resource needs for implementation and to
sustain the chronic care plan, and strategies to meet the
needs; and
(10) a strategy to ensure statewide participation not later than
January 1, 2010, by health plans, third party administrators,
health providers, other professionals, and consumers in the
chronic care plan, including common outcome measures, best
practices and protocols, data reporting requirements,
payment methodologies, and other standards.
Sec. 6. The chronic care plan must be reviewed biennially and
amended as necessary to reflect changes in priorities. Amendments
to the plan must be reported to the legislative council in an
electronic format under IC 5-14-6.
Sec. 7. (a) The commissioner shall annually report to the
legislative council in an electronic format under IC 5-14-6
concerning the status of implementation of the chronic care plan.
(b) The report must include:
(1) the number of participating health plans, health providers,
and patients;
(2) the progress for achieving statewide participation in the
chronic care plan, including the measures established under
section 5 of this chapter;
(3) the expenditures and savings for the period;
(4) the results of health provider and patient satisfaction
surveys;
(5) the progress toward creation and implementation of
privacy and security protocols; and
(6) other information as requested by the general assembly.
(c) Surveys used to evaluate the chronic care plan must be
developed in collaboration with the executive committee
established under section 2 of this chapter.
Sec. 8. If statewide participation in the chronic care plan is not
achieved by January 1, 2010, the commissioner shall evaluate the
chronic care plan and recommend to the legislative council changes
necessary to create alternative measures to ensure statewide
participation by health plans, third party administrators, and
health providers. The recommendations must be in an electronic
format under IC 5-14-6.
Chapter 4. Chronic Care Management Program
Sec. 1. The secretary shall create a chronic care management
program to be administered or provided by a private entity for
individuals who have a chronic condition and are enrolled in
Medicaid or the children's health insurance program.
Sec. 2. The chronic care management program may not include
individuals who are also eligible for Medicare.
Sec. 3. The secretary shall include a broad range of chronic
conditions in the chronic care management program.
Sec. 4. The chronic care management program must be designed
to include the components required for the chronic care plan as
described in IC 12-31-3-5(1).
Sec. 5. (a) The secretary shall issue a request for proposals for
the chronic care management program and shall review the
request for proposals with the executive committee and obtain
approval from the executive committee before issuance.
(b) A contract entered into as a result of a request for proposals
under this section may allow the contracting entity to subcontract
services to other entities if subcontracting is cost effective, efficient,
or in the best interest of individuals enrolled in the chronic care
management program.
Sec. 6. The secretary shall ensure that the chronic care
management program is modified over time to comply with the
chronic care plan.
Chapter 5. Chronic Condition Prevention Plan
Sec. 1. (a) Before January 1, 2008, the commissioner shall
develop an implementation plan for prevention of chronic
conditions and chronic care management that meets the
requirements specified in this article for the chronic care plan and
the chronic care management program.
(b) The commissioner's implementation plan must be revised
periodically to reflect changes to the chronic care plan.
(c) In addition to the chronic care management program, the
state department may provide additional care coordination
services to appropriate individuals as provided in the chronic care
plan.
(d) The office shall:
(1) ensure that Medicaid, Medicaid waiver programs, and the
children's health insurance program change payment
methodologies to align with the recommendations of the
chronic care plan and the request for proposals under
IC 12-31-4-5; and
(2) analyze and make recommendations to the secretary and
the commissioner concerning Medicaid waivers or waiver
modifications needed to implement the chronic care
management program.
Sec. 2. As permitted under federal law, the office shall require
recertification or reapplication for Medicaid and the children's
health insurance program only one (1) time each year.
Sec. 3. The state personnel department shall:
(1) include in any request for proposals for the administration
of the state employee health benefit plans under IC 5-10-8 a
request for a description of any chronic care management
program provided by the entity and how the program aligns
with the chronic care plan developed under IC 12-31-3; and
(2) work with the secretary and any state employee
association concerning the manner and time in which to align
the state employee health benefit plans with the goals and
statewide standards developed by the chronic care plan.
Chapter 6. Employer Sponsored Health Benefit Plan Premium
Assistance
Sec. 1. (a) Before October 1, 2008, subject to approval by the
federal Centers for Medicare and Medicaid Services, the office
shall establish a premium assistance program to assist an
uninsured individual with a family income less than three hundred
percent (300%) of the federal income poverty level, and any
dependents, to purchase coverage under an employer sponsored
health benefit plan for which the individual is eligible.
(b) The office shall determine whether to include in the
premium assistance program, at the request of a child's parents, a
child who is eligible for Medicaid or the children's health insurance
program.
(c) The office may not require a child to participate in an
employer sponsored health benefit plan.
Sec. 2. An individual is eligible for premium assistance under
this chapter if the individual:
(1) is an uninsured resident;
(2) has family income that is less than three hundred percent
(300%) of the federal income poverty level;
(3) is eligible for coverage under an employer sponsored
health benefit plan; and
(4) is at least eighteen (18) years of age and is not claimed on
a tax return as a dependent of a resident of another state.
Sec. 3. (a) The premium assistance program established under
section 1 of this chapter must provide a subsidy for premiums or
cost sharing amounts for an employer sponsored health benefit
plan based on the household income of the eligible individual, with
greater financial assistance provided to an eligible individual with
a lower family income.
(b) Until an approved employer sponsored health benefit plan
is required to meet the standard in section 4 of this chapter, a
subsidy under this chapter must include premium assistance and
assistance to cover all cost sharing amounts for chronic care.
Sec. 4. (a) In consultation with the department of insurance, the
office shall develop criteria for approving employer sponsored
health benefit plans to ensure the plans provide comprehensive and
affordable health coverage when combined with premium
assistance under this chapter.
(b) At a minimum, an approved employer sponsored health
benefit plan must include:
(1) covered benefits that are substantially similar, as
determined by the office, to the benefits covered under
Indiana health; and
(2) coverage of chronic conditions that is substantially similar
to coverage of chronic conditions under Indiana health.
Sec. 5. (a) The office shall determine whether requiring an
individual to purchase coverage under an approved employer
sponsored health benefit plan with premium assistance under this
chapter is more cost effective to the state than coverage of the
individual under Indiana health with Indiana health assistance
under IC 12-31-9.
(b) If providing the individual with assistance to purchase
Indiana health is determined to be most cost effective under
subsection (a), the state shall provide the individual the option of
purchasing Indiana health with Indiana health assistance.
(c) An individual may purchase Indiana health and receive
Indiana health assistance until an approved employer sponsored
health benefit plan has an open enrollment period. However, the
individual shall enroll in the approved employer sponsored health
benefit plan to continue to receive assistance in the form of
premium assistance under this chapter.
Sec. 6. If the office determines that the funds appropriated for
the premium assistance program under this chapter are
insufficient to meet the projected costs of enrolling new program
participants, the office shall suspend new enrollment in the
program or restrict enrollment to eligible lower income
individuals. This section does not affect eligibility for the purchase
of Indiana health.
preferred drug list;
(5) out-of-pocket maximums of eight hundred dollars ($800)
for an individual and one thousand six hundred dollars
($1,600) for a family for in-network services and one thousand
five hundred dollars ($1,500) for an individual and three
thousand dollars ($3,000) for a family for out-of-network
services; and
(6) a waiver of the deductible and other cost sharing for
chronic care for individuals participating in a chronic care
management program provided under section 2 of this
chapter and for preventive care.
Sec. 2. Indiana health shall:
(1) provide a chronic care management program that has
criteria substantially similar to the chronic care management
program established under IC 12-31-4; and
(2) share enrollee data, to the extent allowed under federal
law, with the secretary to inform the health care reform
initiatives under this article.
Sec. 3. (a) A carrier shall file a letter of intent to provide
coverage under the carrier's health plans for Indiana health.
(b) A person may not sell, offer, or renew Indiana health unless
the person is a carrier and has filed a letter of intent under this
chapter.
(c) Notwithstanding any other law, a carrier may use financial
or other incentives to encourage healthy lifestyles and patient
self-management for individuals covered by Indiana health.
(d) Incentives described in subsection (c) must comply with
health promotion and disease prevention program rules adopted
by the commissioner.
Sec. 4. (a) To the extent Indiana health provides coverage for a
particular health service or for a particular health condition,
Indiana health must cover the health services and conditions when
provided by any type of health provider acting within the health
provider's scope of practice under Indiana law.
(b) Indiana health may establish a term or condition that places
a greater financial burden on an individual for access to treatment
according to the type of health provider that provides the health
service only if the financial burden is related to the efficacy or cost
effectiveness of the health service as provided by the health
provider.
Sec. 5. Notwithstanding any other law, the commissioner may
establish a pay for performance demonstration project for carriers
offering Indiana health.
Sec. 6. (a) A carrier shall guarantee acceptance of:
(1) any uninsured individual for any health plan offered by
the carrier for Indiana health in Indiana; and
(2) each dependent of an uninsured individual covered under
Indiana health.
(b) An individual who is eligible for an employer sponsored
health benefit plan may not purchase Indiana health, except as
provided in section 7 of this chapter.
(c) An individual must not have coverage under any health plan
for at least twelve (12) months before the individual is eligible for
coverage under Indiana health.
(d) A dispute regarding eligibility for Indiana health must be
resolved by the state department in a manner provided for in rules
adopted under IC 4-22-2.
Sec. 7. An individual with a family income that is less than three
hundred percent (300%) of the federal income poverty level and
who is eligible for an employer sponsored health benefit plan may
purchase coverage under Indiana health if:
(1) the individual's employer sponsored health benefit plan is
not an approved employer sponsored health benefit plan
under IC 12-31-6;
(2) enrolling the individual in an approved employer
sponsored health benefit plan with premium assistance under
IC 12-31-6 is not cost effective to the state as compared to
enrolling the individual in Indiana health combined with
Indiana health assistance; or
(3) the individual is eligible for employer sponsored health
benefit plan premium assistance under IC 12-31-6, but is
unable to enroll in the employer sponsored health benefit plan
until the next open enrollment period.
Sec. 8. An individual who loses eligibility for premium
assistance under IC 12-31-6 may purchase Indiana health without
being uninsured for twelve (12) months.
Sec. 9. An individual who is at least eighteen (18) years of age
and is claimed on a tax return as a dependent of a resident of
another state is not eligible to purchase Indiana health.
Sec. 10. (a) For a twelve (12) month period from the effective
date of coverage, a carrier offering Indiana health may limit
coverage of a preexisting condition that existed during the twelve
(12) month period before the effective date of coverage, except that
the exclusion or limitation does not apply to care of a chronic
condition if the individual participates in a chronic care
management program.
(b) A carrier shall waive a preexisting condition provision for an
individual and dependents of the individual if the individual
produces evidence of continuous creditable coverage (as defined in
the federal Health Insurance Portability and Accountability Act
(26 U.S.C. 9801(c)(1)) during the previous nine (9) months.
(c) If an individual described in subsection (b) has a preexisting
condition for which coverage is excluded under Indiana health, the
Indiana health exclusion must not continue longer than the
remainder of the period for which coverage was excluded under
the creditable coverage or twelve (12) months, whichever is less.
(d) In determining a preexisting condition exclusion period
under Indiana health, the carrier shall credit prior coverage that
occurred without a break in coverage of sixty-three (63) days or
more.
Sec. 11. (a) Except as provided in subsection (b), a carrier shall
make payments under an Indiana health plan to health providers
using the Medicare payment methodologies plus ten percent (10%).
(b) Payments under this section must be indexed to the
Medicare economic index developed by the federal Centers for
Medicare and Medicaid Services.
(c) Payments for hospital services must be calculated using the
Medicare payment methodology adjusted for each hospital to
ensure payments at one hundred ten percent (110%) of the
hospital's actual cost for services.
(d) Payments under subsection (c) must be indexed to changes
in the Medicare payment rules, but must not be lower than one
hundred two percent (102%) of the hospital's actual cost for
services.
Sec. 12. Payments for chronic care and chronic care
management health services must meet the requirements
established under IC 12-31-3 and IC 12-31-4.
Sec. 13. If Medicare does not pay for a health service covered
under Indiana health, the commissioner shall establish another
payment amount for the health service, determined after
consultation with affected health providers and health plan
providers.
Sec. 14. A carrier offering Indiana health shall renegotiate
existing contracts with health providers as necessary to make
payments according to the requirements of this chapter.
Sec. 15. Approval of rates and forms for Indiana health plans
must be done according to the process established in this chapter
and the requirements of IC 27, including the following:
(1) Premium rates must be actuarially determined considering
differences in the demographics of the populations and the
different levels and methods of reimbursement for health
providers.
(2) A rate or form must not be approved if the rate or form
contains a provision that is unjust, unfair, inequitable,
misleading, or contrary to Indiana law.
(3) A rate must be approved if the rate:
(A) is sufficient not to threaten the financial safety and
soundness of the carrier;
(B) reflects efficient and economical management;
(C) provides Indiana health at the most reasonable price
consistent with actuarial review;
(D) is not unfairly discriminatory; and
(E) complies with the other requirements of this chapter
and IC 27.
(4) A carrier shall, with each rate filing, file a certification by
a member of the American Academy of Actuaries of the
carrier's compliance with this chapter.
Sec. 16. Indiana health must be offered with a rate structure
that at least differentiates among single person, two person, and
family rates, and the rates must be guaranteed for twelve (12)
months from the date the individual enrolls.
Sec. 17. (a) A carrier offering Indiana health shall use a
community rating method acceptable to the commissioner to
determine premiums for Indiana health plans.
(b) Indiana health plans constitute a separate market and must
be rated as a distinct pool, separate from other individual or group
health plan products.
(c) The following risk classification factors are prohibited from
use in rating individuals and dependents of individuals for Indiana
health plans:
(1) demographic rating, including age and gender rating;
(2) geographic area rating;
(3) industry rating;
(4) medical underwriting and screening;
(5) experience rating;
(6) tier rating; or
(7) durational rating.
Sec. 18. Indiana health is considered to be an individual health
plan for purposes of Indiana law, but is not subject to IC 27-8-5.
Sec. 19. (a) Indiana health must not be sold before October 1,
2008. Rates and forms may be filed and approved before October
1, 2008, and marketing and sales targeted to an effective date of
October 1, 2008, may occur as determined by the commissioner.
(b) A letter of intent, proposed rates, and proposed forms must
be filed by a carrier as required by this chapter.
(c) A carrier shall notify the department that the carrier intends
to offer Indiana health by filing written notice of intent not later
than thirty (30) days after the effective date of emergency Indiana
health rules adopted under IC 4-22-2-37.1.
(d) Forms must be filed with the department of insurance,
initially not later than five (5) months after the letter of intent
described in subsection (c), and upon any change. Forms may not
be used until the forms are approved by the department of
insurance. The department of insurance shall notify the carrier not
later than forty-five (45) days after a form is filed whether the
form meets the requirements of this chapter and IC 27.
(e) Rates must be filed with the department of insurance before
use and initially not later than five (5) months after the letter of
intent described in subsection (c). Thereafter, rates must be filed
at least annually on a schedule and in a manner established by rule.
The department of insurance shall notify the carrier not later than
forty-five (45) days after rates are filed whether the rates meet the
requirements of this chapter and IC 27.
(f) The insurance commissioner shall provide a hearing under
IC 4-21.5 for a denial of a rate or form filing.
(g) A carrier may discontinue sales of Indiana health upon at
least six (6) months written notice to the insurance commissioner.
Following the notice, the insurance commissioner may approve
premium rates adjusted by the average Indiana individual health
plan trends for cost and utilization for the previous six (6) months
if there are any individuals who continue to be covered by Indiana
health for whom the carrier does not have approved premium
rates.
Chapter 9. Indiana Health Assistance Program
Sec. 1. The Indiana health assistance program is established to
provide uninsured residents financial assistance in purchasing
Indiana health.
Sec. 2. Except as provided in sections 3 and 4 of this chapter, an
individual is eligible for Indiana health assistance if the individual
is an uninsured resident who is not eligible for coverage under an
approved employer sponsored health benefit plan.
Sec. 3. (a) An individual who is eligible for coverage under an
employer sponsored health benefit plan is eligible for the Indiana
health assistance program only if the individual is not approved for
premium assistance IC 12-31-6 or if it is more cost effective to the
state for the individual to purchase Indiana health with Indiana
health assistance than for the state to provide premium assistance
under IC 12-31-6.
(b) An individual may receive temporary Indiana health
assistance until the individual is able to enroll in an approved
employer sponsored health benefit plan and receive premium
assistance under IC 12-31-6.
Sec. 4. An individual is not eligible for Indiana health assistance
if the individual is at least eighteen (18) years old and is claimed on
a tax return as a dependent of a resident of another state.
Sec. 5. An individual who is covered under Medicaid, the
children's health insurance program, or receives premium
assistance under IC 12-31-6 during the (12) months immediately
preceding the individual's application for Indiana health assistance
is not required to wait twelve (12) months to be eligible for Indiana
health assistance.
Sec. 6. The secretary shall adopt rules under IC 4-22-2 to
establish specific criteria to demonstrate eligibility consistent with
the requirements essential for federal financial participation,
including criteria for and proof of residency, income, and
insurance status.
Sec. 7. If the secretary determines that the funds appropriated
for Indiana health assistance are insufficient to meet the projected
costs of enrolling new program participants, the secretary shall
suspend new enrollment in the program or restrict enrollment to
eligible lower income individuals.
Sec. 8. The secretary shall provide assistance to individuals
eligible under this chapter to purchase Indiana health. The amount
of the assistance is the difference between the premium for Indiana
health and the individual's contribution determined under section
9 of this chapter.
Sec. 9. (a) Subject to amendment in each biennial budget, the
secretary shall establish individual and family contribution
amounts for Indiana health under this chapter for the first year of
Indiana health assistance and shall index the contributions in
future years to the overall growth in spending per enrollee in
Indiana health.
the commission in odd numbered years.
Sec. 3. The commission shall operate under the policies
governing study committees adopted by the legislative council.
Sec. 4. The affirmative votes of a majority of the voting
members appointed to the committee are required for the
committee to take action on any measure, including final reports.
Sec. 5. From July 1, 2007, through June 30, 2008, the committee
shall:
(1) monitor the development, implementation, and ongoing
operation of health care reform initiatives under this article;
(2) study areas of health care reform as required by the
general assembly; and
(3) receive input and make recommendations, not later than
October 31, 2008, to the legislative council in an electronic
format under IC 5-14-6 regarding the long term development
of policies and programs designed to ensure that, by 2011,
Indiana has an integrated system of care that provides all
residents with access to affordable, high quality health
coverage that is financed in a fair and equitable manner.
Sec. 6. This chapter expires December 31, 2008.
Chapter 13. Immunizations
Sec. 1. (a) If funding is available under the Indiana health fund,
the secretary shall provide payment for any resident to receive
immunizations without cost to the resident.
(b) The secretary is the secondary payer to Medicaid, Medicare,
the children's health insurance program, and any public program
that covers immunizations.
Sec. 2. (a) The commissioner shall study methods to ensure that
all residents have access to immunizations.
(b) In conducting the study under subsection (a), the
commissioner shall consult with the secretary, the office, the
department of insurance and other interested parties.
(c) The study must include the following:
(1) Effective strategies for improving immunization rates,
including options for:
(A) enhancing access to vaccination services in medical and
public health settings; and
(B) strengthening school and child care immunization
requirements.
(2) Recommendations for expanding immunization programs
to adults.
(3) Recommendations for improving quality assurance and
quality improvement in assuring proper vaccine storage and
handling, measuring immunization coverage rates, and
addressing barriers to coverage.
(4) Options for sustainable funding for the purchase and
administration of vaccines, including:
(A) equitable sharing of cost of the state's immunization
program between public and private resources; and
(B) payment by the state of a reasonable fee to health
providers for individuals receiving coverage for
immunizations through Indiana health.
(d) The commissioner shall report the findings and
recommendations of the study to the legislative council in an
electronic format under IC 5-14-6 not later than January 15, 2008.
Chapter 14. Hospital Uncompensated Care Study
Sec. 1. (a) The commissioner and the insurance commissioner,
in consultation with representatives of the Indiana Hospital and
Health Association, third party payers, other interested parties,
and consumers, shall review the uncompensated care and bad debt
policies of Indiana's hospitals and recommend a standard
statewide uniform uncompensated care and bad debt policy.
(b) The standard policy must include criteria for payment
forgiveness for the cost of health services received by low income
patients, criteria for a sliding scale payment amount for patients
with family incomes less than certain income levels, a method for
calculating the amount of health services received by the patient,
and other criteria necessary for ensuring that health services
received by uninsured and underinsured patients is billed in a
uniform and consistent manner.
(c) In addition to a standard policy, the commissioners may
recommend:
(1) reasons for and a method of approving deviations from the
standard policy by a hospital; or
(2) a set of standard policies to be applied to hospitals based
on particular criteria, such as a designation as a critical access
hospital, the income median in an area, or other rationale.
Sec. 2. (a) The commissioners, in consultation with the
representatives listed in section 1(a) of this chapter, shall determine
a fair and thorough method for calculating and reporting
information about uncompensated health services and bad debt to
the state department to ensure accurate accounting in hospital
budgets and other health care facility planning, as well as
collecting information about the types of patients accessing
uncompensated health services or who are unable to pay for the
health services received.
(b) The commissioners shall consider collecting information
about each patient receiving health services, including the patient's
primary insurance status and employer, the actual cost of the
health services received, any amount paid for the health services,
and any discounts provided to the patient by the hospital.
Sec. 3. The commissioners shall report findings and
recommendations to the legislative council in an electronic format
under IC 5-14-6 not later than January 15, 2008.
Chapter 15. Individual Health Plan Market Study
Sec. 1. The department of insurance, in consultation with
individual health plan providers, shall, not later than January 15,
2008, recommend to the legislative council in an electronic format
under IC 5-14-6 the best method to consolidate the individual
health plan market into a single risk pool of insured residents with
access to health plans equivalent to or better than Indiana health
plans.
Chapter 16. Health Care Reform Report
Sec. 1. Not later than January 15, 2010, the secretary shall
report to the legislative council in an electronic format under
IC 5-14-6, concerning:
(1) the percentage of uninsured residents and the number of
insured residents by coverage type based on a survey
conducted by the state department;
(2) an analysis of the trends of Indiana health costs and trends
in the revenue sources for Indiana health;
(3) the feasibility of allowing individuals who are not
uninsured and employers to purchase coverage under Indiana
health plans at full premium cost; and
(4) the number of individuals enrolled in any chronic care
management program which complies with the requirements
of this article, including individuals covered by private health
plans.
Chapter 17. Healthy Lifestyle Discounts
Sec. 1. A carrier shall use a community rating method
acceptable to the commissioner of the department of insurance to
determine premiums for small group plans. Except as provided in
subdivision (2), the following risk classification factors may not be
used in rating small groups, employees, or members of small
groups, and dependents of the employees or members:
(1) demographic rating, including age and gender rating;
coverage tier, if the sum of rate deviations does not exceed
thirty percent (30%);
(2) be designed to promote good health or prevent disease for
individuals in the program and not be used to impose higher
costs on an individual based on a health factor;
(3) provide that a reward under the program is available to
all similarly situated individuals;
(4) provide a reasonable alternative standard to obtain a
reward to an individual for whom it is unreasonably difficult,
due to a medical condition or other reasonable mitigating
circumstance, to satisfy the otherwise applicable standard for
the discount and disclose in all plan materials that describe
the discount program the availability of a reasonable
alternative standard;
(5) include standards and procedures for health promotion
and disease prevention programs based on the best scientific,
evidence based medical practices;
(6) include standards and procedures for evaluating an
individual's adherence to programs of health promotion and
disease prevention; and
(7) include other standards and procedures necessary to
implement this chapter.
Chapter 18. Common Claims and Procedures and Health Care
Data
Sec. 1. Not later than July 1, 2009, the commissioner and the
insurance commissioner shall adopt rules under IC 4-22-2 to
establish common claim forms and procedures for use by all health
providers in submitting claims to health plan providers and
Indiana health plan carriers.
Sec. 2. The commissioner shall establish and maintain a unified
health care data base to enable the commissioner to do the
following:
(1) Determine the capacity and distribution of existing
resources.
(2) Identify health care needs and inform health care policy.
(3) Evaluate the effectiveness of intervention programs on
improving patient outcomes.
(4) Compare costs between various treatment settings and
approaches.
(5) Provide information to consumers and purchasers of
health care.
(6) Improve the quality and affordability of patient health
care and health care coverage.
Sec. 3. (a) The program must include a consumer health care
price and quality information system designed to make available
to consumers transparent health care price information, quality
information, and other information determined by the
commissioner to be necessary to provide individuals sufficient
information to make economically sound and medically
appropriate decisions.
(b) The commissioner may collaborate with other state agencies
and interested parties to implement the requirement of subsection
(a).
(c) The commissioner may require a health plan provider that
covers at least five percent (5%) of individuals covered by health
plans in Indiana to file with the commissioner a consumer health
care price and quality information plan in accordance with rules
adopted by the commissioner under IC 4-22-2.
(d) The commissioner shall adopt rules under IC 4-22-2 that the
commissioner determines necessary to implement this chapter. The
rules:
(1) may permit the gradual implementation of the consumer
health care price and quality information system, beginning
with health care price and quality information that the
commissioner determines is most needed by consumers or
that can be most practically provided to the consumer in an
understandable manner;
(2) shall permit health plan providers to use security measures
designed to allow covered individuals access to price and
other information without disclosing trade secrets to
individuals and entities that are not covered individuals; and
(3) shall avoid unnecessary duplication of efforts relating to
price and quality reporting by health plan providers, health
providers, and others.
Sec. 4. Health plan providers, health providers, and government
agencies shall electronically file reports, data, schedules, statistics,
or other information determined by the commissioner to be
necessary to implement this chapter. The information may include:
(1) health coverage claims and enrollment information used
by health plan providers, including cross matched claims data
on requested covered individuals;
(2) information related to health provider budget reviews;
(3) covered individual information necessary to determine
third party liability for health services provided; and
publicly disclose data that contains personally identifiable
information.
(f) The commissioner may adopt rules under IC 4-22-2 to
implement this chapter.
Chapter19. Master Provider Index
Sec. 1. Not later than September 1, 2007, a work group
composed of interested parties must be convened by the state
department for the purpose of making recommendations for the
creation of a master provider index designed to assure uniform and
consistent identification and cross reference of all health providers
in Indiana.
Sec. 2. The work group shall:
(1) compile recommendations regarding data fields that must
be included in a database that allows for comprehensive cross
referencing of multiple unique identification codes applied to
health providers through licensure, credentialing, and billing
and claims processing mechanisms to support the
implementation of health information exchange and public
health and policy research, analysis, and planning;
(2) provide cost and time estimates for development and
implementation of the index; and
(3) develop recommendations for governance of the index and
the relationship of the index to other state health information
data systems, technologies, and records.
Sec. 3. The work group shall, not later than January 15, 2008,
report to the legislative council in an electronic format under
IC 5-14-6 concerning the information described in section 2 of this
chapter and the work group's recommendations regarding creating
and sustaining a master provider index.
affidavit under this subsection not later than five (5) days after the
office is notified that the waiver is approved.
(e) If the federal Centers for Medicare and Medicaid Services
approves the waiver requested under this SECTION and the
governor receives the affidavit filed under subsection (d), the office
shall implement the waiver not more than sixty (60) days after the
governor receives the affidavit.
(f) The office may adopt rules under IC 4-22-2 necessary to
implement this SECTION.