Citations Affected: IC 4-22-2-37.1; IC 12-7-2; IC 12-15; IC 12-16;
IC 27-8-10.1; IC 34-30-2-45.2.
Synopsis: Healthier Indiana insurance program. Establishes the
healthier Indiana insurance program and the healthier Indiana
insurance program fund. Makes funding changes to the hospital care
for the indigent program, the municipal disproportionate share
program, and the Medicaid indigent care trust fund. Requires the
Indiana comprehensive health insurance association to establish the
health for high risk Hoosiers program to provide coverage to certain
individuals referred to the program by the office of the secretary of
family and social services. Requires the office of Medicaid policy and
planning to apply to the United States Department of Health and
Human Services for: (1) a demonstration waiver to develop and
implement the healthier Indiana insurance program to cover certain
individuals; and (2) an amendment to the state Medicaid plan to cover
pregnancy related services for pregnant women whose annual
household income does not exceed 200% of the federal income poverty
level. Repeals certain provisions concerning payments to hospitals and
the hospital care for the indigent program.
Effective: Upon passage; July 1, 2007.
January 23, 2007, read first time and referred to Committee on Health and Provider
Services.
A BILL FOR AN ACT to amend the Indiana Code concerning
Medicaid.
health insurance program under IC 12-17.6-2-11.
(21) An emergency rule adopted by the office of Medicaid policy
and planning under IC 12-15-41-15 or IC 12-15-44-16.
(22) An emergency rule adopted by the Indiana state board of
animal health under IC 15-2.1-18-21.
(23) An emergency rule adopted by the board of directors of the
Indiana education savings authority under IC 21-9-4-7.
(24) An emergency rule adopted by the Indiana board of tax
review under IC 6-1.1-4-34 (repealed).
(25) An emergency rule adopted by the department of local
government finance under IC 6-1.1-4-33 (repealed).
(26) An emergency rule adopted by the boiler and pressure vessel
rules board under IC 22-13-2-8(c).
(27) An emergency rule adopted by the Indiana board of tax
review under IC 6-1.1-4-37(l) (repealed) or an emergency rule
adopted by the department of local government finance under
IC 6-1.1-4-36(j) (repealed) or IC 6-1.1-22.5-20.
(28) An emergency rule adopted by the board of the Indiana
economic development corporation under IC 5-28-5-8.
(29) A rule adopted by the department of financial institutions
under IC 34-55-10-2.5.
(30) A rule adopted by the Indiana finance authority:
(A) under IC 8-15.5-7 approving user fees (as defined in
IC 8-15.5-2-10) provided for in a public-private agreement
under IC 8-15.5;
(B) under IC 8-15-2-17.2(a)(10):
(i) establishing enforcement procedures; and
(ii) making assessments for failure to pay required tolls;
(C) under IC 8-15-2-14(a)(3) authorizing the use of and
establishing procedures for the implementation of the
collection of user fees by electronic or other nonmanual
means; or
(D) to make other changes to existing rules related to a toll
road project to accommodate the provisions of a
public-private agreement under IC 8-15.5.
(b) The following do not apply to rules described in subsection (a):
(1) Sections 24 through 36 of this chapter.
(2) IC 13-14-9.
(c) After a rule described in subsection (a) has been adopted by the
agency, the agency shall submit the rule to the publisher for the
assignment of a document control number. The agency shall submit the
rule in the form required by section 20 of this chapter and with the
documents required by section 21 of this chapter. The publisher shall
determine the number of copies format of the rule and other documents
to be submitted under this subsection.
(d) After the document control number has been assigned, the
agency shall submit the rule to the secretary of state publisher for
filing. The agency shall submit the rule in the form required by section
20 of this chapter and with the documents required by section 21 of this
chapter. The secretary of state publisher shall determine the number
of copies format of the rule and other documents to be submitted under
this subsection.
(e) Subject to section 39 of this chapter, the secretary of state
publisher shall:
(1) accept the rule for filing; and
(2) file stamp and indicate electronically record the date and time
that the rule is accepted. on every duplicate original copy
submitted.
(f) A rule described in subsection (a) takes effect on the latest of the
following dates:
(1) The effective date of the statute delegating authority to the
agency to adopt the rule.
(2) The date and time that the rule is accepted for filing under
subsection (e).
(3) The effective date stated by the adopting agency in the rule.
(4) The date of compliance with every requirement established by
law as a prerequisite to the adoption or effectiveness of the rule.
(g) Subject to subsection (h), IC 14-10-2-5, IC 14-22-2-6,
IC 22-8-1.1-16.1, and IC 22-13-2-8(c), and except as provided in
subsections (j), and (k), and (l), a rule adopted under this section
expires not later than ninety (90) days after the rule is accepted for
filing under subsection (e). Except for a rule adopted under subsection
(a)(13), (a)(24), (a)(25), or (a)(27), the rule may be extended by
adopting another rule under this section, but only for one (1) extension
period. The extension period for a rule adopted under subsection
(a)(28) may not exceed the period for which the original rule was in
effect. A rule adopted under subsection (a)(13) may be extended for
two (2) extension periods. Subject to subsection (j), a rule adopted
under subsection (a)(24), (a)(25), or (a)(27) may be extended for an
unlimited number of extension periods. Except for a rule adopted under
subsection (a)(13), for a rule adopted under this section to be effective
after one (1) extension period, the rule must be adopted under:
(1) sections 24 through 36 of this chapter; or
(2) IC 13-14-9;
reimbursement received under section 1 of this chapter, a hospital is
entitled to reimbursement in an amount calculated as follows:
STEP ONE: The office shall identify the aggregate inpatient
hospital services, reimbursable under this article and under the
state Medicaid plan, that were provided during the state fiscal
year by hospitals established and operated under IC 16-22-2,
IC 16-22-8, or IC 16-23.
STEP TWO: For the aggregate inpatient hospital services
identified under STEP ONE, the office shall calculate the
aggregate payments made under this article and under the state
Medicaid plan to hospitals established and operated under
IC 16-22-2, IC 16-22-8, or IC 16-23, excluding payments under
IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate of
the amount that would have been paid in the aggregate by the
office for the inpatient hospital services described in STEP ONE
under Medicare payment principles.
STEP FOUR: Subtract the amount calculated under STEP TWO
from the amount calculated under STEP THREE.
STEP FIVE: Subject to subsection (g), from the amount
calculated under STEP FOUR, allocate to a hospital established
and operated under IC 16-22-8 an amount equal to one hundred
percent (100%) of the difference between:
(A) the total cost for the hospital's provision of inpatient
services covered under this article for the hospital's fiscal year
ending during the state fiscal year; and
(B) the total payment to the hospital for its provision of
inpatient services covered under this article for the hospital's
fiscal year ending during the state fiscal year, excluding
payments under IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP SIX: Subtract the amount calculated under STEP FIVE
from the amount calculated under STEP FOUR.
STEP SEVEN: Distribute an amount equal to the amount
calculated under STEP SIX to the eligible hospitals established
and operated under IC 16-22-2 or IC 16-23 described in
subsection (c) in proportion to each hospital's Medicaid shortfall
as defined in subsection (f).
(c) Subject to subsection (e), reimbursement for a state fiscal year
under this section consists of payments made after the close of each
state fiscal year. Payment for a state fiscal year ending after June 30,
2003, shall be made before December 31 following the state fiscal
year's end. A hospital is not eligible for a payment described in this
subsection unless an intergovernmental transfer is made under
subsection (d).
(d) Subject to subsection (e), a hospital may make an
intergovernmental transfer under this subsection, or an
intergovernmental transfer may be made on behalf of the hospital, after
the close of each state fiscal year. An intergovernmental transfer under
this subsection must be made to the Medicaid indigent care trust fund
in an amount equal to a percentage, as determined by the office, of the
amount to be distributed to the hospital under STEP SEVEN of
subsection (b). In determining the percentage, the office shall apply the
same percentage of not more than eighty-five percent (85%) to all
hospitals eligible for reimbursement under STEP SEVEN of subsection
(b). The office shall use the intergovernmental transfer to fund
payments made under this section and as otherwise provided under
IC 12-15-20-2(8). IC 12-15-20-2(6).
(e) A hospital making an intergovernmental transfer under
subsection (d) may appeal under IC 4-21.5 the amount determined by
the office to be paid the hospital under STEP SEVEN of subsection (b).
The periods described in subsections (c) and (d) for the hospital to
make an intergovernmental transfer are tolled pending the
administrative appeal and any judicial review initiated by the hospital
under IC 4-21.5. The distribution to other hospitals under STEP
SEVEN of subsection (b) may not be delayed due to an administrative
appeal or judicial review instituted by a hospital under this subsection.
If necessary, the office may make a partial distribution to the other
eligible hospitals under STEP SEVEN of subsection (b) pending the
completion of a hospital's administrative appeal or judicial review, at
which time the remaining portion of the payments due to the eligible
hospitals shall be made. A partial distribution may be based upon
estimates and trends calculated by the office.
(f) For purposes of this section:
(1) the Medicaid shortfall of a hospital established and operated
under IC 16-22-2 or IC 16-23 is calculated as follows:
STEP ONE: The office shall identify the inpatient hospital
services, reimbursable under this article and under the state
Medicaid plan, that were provided during the state fiscal year
by the hospital.
STEP TWO: For the inpatient hospital services identified
under STEP ONE, the office shall calculate the payments
made under this article and under the state Medicaid plan to
the hospital, excluding payments under IC 12-15-16,
IC 12-15-17, and IC 12-15-19.
calculated under STEP FOUR, allocate to a hospital established
and operated under IC 16-22-8 an amount equal to one hundred
percent (100%) of the difference between:
(A) the total cost for the hospital's provision of outpatient
services covered under this article for the hospital's fiscal year
ending during the state fiscal year; and
(B) the total payment to the hospital for its provision of
outpatient services covered under this article for the hospital's
fiscal year ending during the state fiscal year, excluding
payments under IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP SIX: Subtract the amount calculated under STEP FIVE
from the amount calculated under STEP FOUR.
STEP SEVEN: Distribute an amount equal to the amount
calculated under STEP SIX to the eligible hospitals established
and operated under IC 16-22-2 or IC 16-23 described in
subsection (c) in proportion to each hospital's Medicaid shortfall
as defined in subsection (f).
(c) Subject to subsection (e), the reimbursement for a state fiscal
year under this section consists of payments made before December 31
following the end of the state fiscal year. A hospital is not eligible for
a payment described in this subsection unless an intergovernmental
transfer is made under subsection (d).
(d) Subject to subsection (e), a hospital may make an
intergovernmental transfer under this subsection, or an
intergovernmental transfer may be made on behalf of the hospital, after
the close of each state fiscal year. An intergovernmental transfer under
this subsection must be made to the Medicaid indigent care trust fund
in an amount equal to a percentage, as determined by the office, of the
amount to be distributed to the hospital under STEP SEVEN of
subsection (b). In determining the percentage, the office shall apply the
same percentage of not more than eighty-five percent (85%) to all
hospitals eligible for reimbursement under STEP SEVEN of subsection
(b). The office shall use the intergovernmental transfer to fund
payments made under this section and as otherwise provided under
IC 12-15-20-2(8). IC 12-15-20-2(6).
(e) A hospital making an intergovernmental transfer under
subsection (d) may appeal under IC 4-21.5 the amount determined by
the office to be paid by the hospital under STEP SEVEN of subsection
(b). The periods described in subsections (c) and (d) for the hospital to
make an intergovernmental transfer are tolled pending the
administrative appeal and any judicial review initiated by the hospital
under IC 4-21.5. The distribution to other hospitals under STEP
SEVEN of subsection (b) may not be delayed due to an administrative
appeal or judicial review instituted by a hospital under this subsection.
If necessary, the office may make a partial distribution to the other
eligible hospitals under STEP SEVEN of subsection (b) pending the
completion of a hospital's administrative appeal or judicial review, at
which time the remaining portion of the payments due to the eligible
hospitals must be made. A partial distribution may be calculated by the
office based upon estimates and trends.
(f) For purposes of this section:
(1) the Medicaid shortfall of a hospital established and operated
under IC 16-22-2 or IC 16-23 is calculated as follows:
STEP ONE: The office shall identify the outpatient hospital
services, reimbursable under this article and under the state
Medicaid plan, that were provided during the state fiscal year
by the hospital.
STEP TWO: For the outpatient hospital services identified
under STEP ONE, the office shall calculate the payments
made under this article and under the state Medicaid plan to
the hospital, excluding payments under IC 12-15-16,
IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate
of the amount that would have been paid by the office for the
outpatient hospital services described in STEP ONE under
Medicare payment principles; and
(2) a hospital's Medicaid shortfall is equal to the amount by which
the amount calculated in STEP THREE of subdivision (1) is
greater than the amount calculated in STEP TWO of subdivision
(1).
(g) The actual distribution of the amount calculated under STEP
FIVE of subsection (b) to a hospital established and operated under
IC 16-22-8 shall be made under the terms and conditions provided for
the hospital in the state plan for medical assistance. Payment to a
hospital under STEP FIVE of subsection (b) is not a condition
precedent to the tender of payments to hospitals under STEP SEVEN
of subsection (b).
amount calculated under STEP FOUR is not distributed
following the payments made under clauses (A) and (B), the
remaining amount may be paid to hospitals described in
subsection (a) that are eligible under this clause. A hospital is
eligible for a payment under this clause only if the non-federal
share of the hospital's payment is provided by or on behalf of
the hospital. The remaining amount shall be paid to those
eligible hospitals on a pro rata basis in relation to all hospitals
eligible under this clause based on the hospitals' Medicaid
inpatient days or other payment methodology approved by the
Centers for Medicare and Medicaid Services.
(D) For purposes of the clauses (A), (B) and (C), a hospital's
Medicaid inpatient days are based on the Medicaid inpatient
days allowed for the hospital by the office for purposes of the
office's most recent determination of eligibility for the
Medicaid disproportionate payment program under
IC 12-15-16.
(c) Reimbursement for a state fiscal year under this section consists
of payments made after the close of each state fiscal year. Payment for
a state fiscal year ending after June 30, 2003, shall be made before
December 31 following the end of the state fiscal year.
(d) A hospital described in subsection (a) may appeal under
IC 4-21.5 the amount determined by the office to be paid to the hospital
under STEP FIVE of subsection (b). The distribution to other hospitals
under STEP FIVE of subsection (b) may not be delayed due to an
administrative appeal or judicial review instituted by a hospital under
this subsection. If necessary, the office may make a partial distribution
to the other eligible hospitals under STEP FIVE of subsection (b)
pending the completion of a hospital's administrative appeal or judicial
review, at which time the remaining portion of the payments due to the
eligible hospitals shall be made. A partial distribution may be based on
estimates and trends calculated by the office.
the medical condition that necessitated the care occurred in the
county; or
(3) whose residence cannot be determined by the division and for
whom the onset of the medical condition that necessitated the care
occurred in the county.
(b) For each state fiscal year ending after June 30, 2003, a hospital
licensed under IC 16-21-2:
(1) that submits to the division during the state fiscal year a
payable claim under IC 12-16-7.5; and
(2) whose payment under section 9(c) of this chapter was less
than the total amount of the hospital's payable claims under
IC 12-16-7.5 submitted by the hospital to the division during the
state fiscal year;
is entitled to a payment under this section.
(c) Except as provided in section 9.8 of this chapter and subject to
section 9.6 of this chapter, for a state fiscal year, the office shall pay to
a hospital referred to in subsection (b) an amount equal to the amount,
based on information obtained from the division and the calculations
and allocations made under IC 12-16-7.5-4.5, that the office determines
for the hospital under STEP EIGHT of the following STEPS:
STEP ONE: Identify each county whose transfer of funds to the
Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b) for the state fiscal year was less than the total
amount of all hospital payable claims attributed to the county and
submitted to the division during the state fiscal year.
STEP TWO: For each county identified in STEP ONE, calculate
the difference between the amount of funds of the county
transferred to the Medicaid indigent care trust fund under STEP
FOUR of IC 12-16-7.5-4.5(b) and the total amount of all hospital
payable claims attributed to the county and submitted to the
division during the state fiscal year.
STEP THREE: Calculate the sum of the amounts calculated for
the counties under STEP TWO.
STEP FOUR: Identify each hospital whose payment under section
9(c) of this chapter was less than the total amount of the hospital's
payable claims under IC 12-16-7.5 submitted by the hospital to
the division during the state fiscal year.
STEP FIVE: Calculate for each hospital identified in STEP FOUR
the difference between the hospital's payment under section 9(c)
of this chapter and the total amount of the hospital's payable
claims under IC 12-16-7.5 submitted by the hospital to the
division during the state fiscal year.
payment under this section until the payments due under section 9 of
this chapter for the state fiscal year have been made.
(g) If a hospital appeals a decision by the office regarding the
hospital's payment under section 9 of this chapter, the office may make
payments under this section before all payments due under section 9 of
this chapter are made if:
(1) a delay in one (1) or more payments under section 9 of this
chapter resulted from the appeal; and
(2) the office determines that making payments under this section
while the appeal is pending will not unreasonably affect the
interests of hospitals eligible for a payment under this section.
(h) Any funds transferred to the Medicaid indigent care trust fund
under STEP FOUR of IC 12-16-7.5-4.5(b) remaining after payments
are made under this section shall be used as provided in
IC 12-15-20-2(8)(D). IC 12-15-20-2(6)(D).
(i) For purposes of this section:
(1) "payable claim" has the meaning set forth in
IC 12-16-7.5-2.5(b);
(2) the amount of a payable claim is an amount equal to the
amount the hospital would have received under the state's
fee-for-service Medicaid reimbursement principles for the
hospital care for which the payable claim is submitted under
IC 12-16-7.5 if the individual receiving the hospital care had been
a Medicaid enrollee; and
(3) a payable hospital claim under IC 12-16-7.5 includes a
payable claim under IC 12-16-7.5 for the hospital's care submitted
by an individual or entity other than the hospital, to the extent
permitted under the hospital care for the indigent program.
section 9(c) of this chapter during a state fiscal year with an amount for
the state fiscal year that is as equal as possible to the amount each
hospital would have received under the payment methodology under
section 9(c) of this chapter. A payment methodology implemented
under this subsection is in place of the payment methodology under
section 9(c) of this chapter.
(c) The office may amend the state Medicaid plan to implement an
alternative payment methodology to the payment methodology under
section 9.5 of this chapter. The alternative payment methodology must
provide each hospital that would have received a payment under
section 9.5(c) of this chapter during a state fiscal year with an amount
for the state fiscal year that is as equal as possible to the amount each
hospital would have received under the payment methodology under
section 9.5(c) of this chapter. A payment methodology implemented
under this subsection is in place of the payment methodology under
section 9.5(c) of this chapter.
qualifies as a municipal disproportionate share provider under
IC 12-15-16-1 shall receive a disproportionate share adjustment,
subject to the provider's hospital specific limits described in subsection
(b), as follows:
(1) For each state fiscal year ending on or after June 30, 1998, an
amount shall be distributed to each provider qualifying as a
municipal disproportionate share provider under IC 12-15-16-1.
The total amount distributed shall not exceed the sum of all
hospital specific limits for all qualifying providers.
(2) For each municipal disproportionate share provider qualifying
under IC 12-15-16-1 to receive disproportionate share payments,
the amount in subdivision (1) shall be reduced by the amount of
disproportionate share payments received by the provider under
IC 12-15-16-6 or sections 1 or 2.1 of this chapter. The office shall
develop a disproportionate share provider payment methodology
that ensures that each municipal disproportionate share provider
receives disproportionate share payments that do not exceed the
provider's hospital specific limit specified in subsection (b). The
methodology developed by the office shall ensure that a
municipal disproportionate share provider receives, to the extent
possible, disproportionate share payments that, when combined
with any other disproportionate share payments owed to the
provider, equals the provider's hospital specific limits.
(b) Total disproportionate share payments to a provider under this
chapter and IC 12-15-16 shall not exceed the hospital specific limit
provided under 42 U.S.C. 1396r-4(g). The hospital specific limit for
state fiscal years ending on or before June 30, 1999, shall be
determined by the office taking into account data provided by each
hospital for the hospital's most recent fiscal year or, if a change in fiscal
year causes the most recent fiscal period to be less than twelve (12)
months, twelve (12) months of data compiled to the end of the
provider's fiscal year that ends within the most recent state fiscal year,
as certified to the office by an independent certified public accounting
firm. The hospital specific limit for all state fiscal years ending on or
after June 30, 2000, shall be determined by the office taking into
account data provided by each hospital that is deemed reliable by the
office based on a system of periodic audits, the use of trending factors,
and an appropriate base year determined by the office. The office may
require independent certification of data provided by a hospital to
determine the hospital's hospital specific limit.
(c) For each of the state fiscal years:
(1) beginning July 1, 1998, and ending June 30, 1999; and
Medicaid payments to hospitals licensed under IC 16-21
pursuant to a methodology adopted by the office.
(C) Of the intergovernmental transfers deposited into the
Medicaid indigent care trust fund, for state fiscal years
beginning July 1, 2001, and July 1, 2002, an amount equal to:
(i) one hundred percent (100%) of the total
intergovernmental transfers deposited into the Medicaid
indigent care trust fund for the state fiscal year beginning
July 1, 1998; minus
(ii) an amount equal to the amount deposited into the
Medicaid indigent care trust fund under IC 12-15-15-9(d)
(before its repeal) for the state fiscal years beginning July
1, 2001, and July 1, 2002;
shall be used to fund the state's share of disproportionate share
payments to providers under IC 12-15-19-2.1. The remainder
of the intergovernmental transfers, if any, must be used to fund
the state's share of additional Medicaid payments to hospitals
licensed under IC 16-21 pursuant to a methodology adopted by
the office.
(D) Of the intergovernmental transfers, which shall include
amounts transferred under IC 12-16-7.5-4.5(b), STEP FOUR,
deposited into the Medicaid indigent care trust fund for state
fiscal years ending after June 30, 2003, an amount equal to:
(i) one hundred percent (100%) of the total
intergovernmental transfers deposited into the Medicaid
indigent care trust fund for the state fiscal year beginning
July 1, 1998, and ending June 30, 1999; minus
(ii) an amount equal to the amount deposited into the
Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b) for the state fiscal year ending after June
30, 2003;
shall be used to fund the non-federal share of disproportionate
share payments to providers under IC 12-15-19-2.1. The
remainder of the intergovernmental transfers, if any, for the
state fiscal years shall be used to fund, in descending order of
priority, the non-federal share of payments to hospitals under
IC 12-15-15-9, the non-federal share of payments to hospitals
under IC 12-15-15-9.5, the amount to be transferred under
clause (F), and the non-federal share of payments under
clauses (A) and (B) of STEP FIVE of IC 12-15-15-1.5(b).
(E) The total amount of intergovernmental transfers used to
fund the non-federal share of payments to hospitals under
IC 12-15-15-9 and IC 12-15-15-9.5 shall not exceed the
amount calculated under STEP TWO of the following formula:
STEP ONE: Calculate the total amount of funds transferred to
the Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b).
STEP TWO: Multiply the state Medicaid medical assistance
percentage for the state fiscal year for which the payments
under IC 12-15-15-9 and IC 12-15-15-9.5 are to be made by
the amount calculated under STEP ONE.
(F) (E) As provided in clause (D), for each fiscal year ending
after June 30, 2003, but before July 1, 2006, an amount equal
to the amount calculated under STEP THREE of the following
formula shall be transferred to the office:
STEP ONE: Calculate the product of thirty-five million dollars
($35,000,000) multiplied by the federal medical assistance
percentage for federal fiscal year 2003.
STEP TWO: Calculate the sum of the amounts, if any,
reasonably estimated by the office to be transferred or
otherwise made available to the office for the state fiscal year,
and the amounts, if any, actually transferred or otherwise made
available to the office for the state fiscal year, under
arrangements whereby the office and a hospital licensed under
IC 16-21-2 agree that an amount transferred or otherwise made
available to the office by the hospital or on behalf of the
hospital shall be included in the calculation under this STEP.
STEP THREE: Calculate the amount by which the product
calculated under STEP ONE exceeds the sum calculated under
STEP TWO.
(F) For each fiscal year ending after June 30, 2006, the
entirety of the intergovernmental transfers deposited into
the Medicaid indigent care trust fund shall be used for
Medicaid supplemental payments, disproportionate share
payments, and the transfer of twenty-eight million dollars
($28,000,000) to the office for the Medicaid budget.
hospitals and Medicaid outpatient payments for safety-net
hospitals.
(4) Fourth, payments under IC 12-15-15-1.1 and 12-15-15-1.3.
(5) Fifth, (3) Third, payments under IC 12-15-19-8 for municipal
disproportionate share hospitals.
(6) Sixth, (4) Fourth, payments under IC 12-15-19-2.1 for
disproportionate share hospitals.
(7) Seventh, payments under clause (C) of STEP FIVE of
IC 12-15-15-1.5(b).
covered under the program.
(b) The program is not an entitlement program, and the number
of individuals who may participate in the program is dependent
upon the funds appropriated for use for the plan.
Sec. 10. The program has the following per recipient coverage
limitations:
(1) An annual individual maximum coverage limitation of
three hundred thousand dollars ($300,000).
(2) A lifetime individual maximum coverage of one million
dollars ($1,000,000).
Sec. 11. (a) An individual who is approved to participate in the
program is eligible for a twelve (12) month period. Once the
individual has been approved for participation, the individual may
not be turned down for renewal into the program for the sole
reason that the program has reached the maximum number of
participants.
(b) If the individual chooses to renew participation in the
program, the individual shall complete a renewal application, any
necessary documentation, and submit the documentation and
application on a form prescribed by the office to the office in order
to continue participating in the program.
(c) If the individual chooses not to renew participation in the
program, the individual may not reapply to participate in the
program for at least eighteen (18) months.
Sec. 12. An insurer or health maintenance organization that has
contracted with the office to provide health insurance for
individuals under this program:
(1) bears the risk of the health insurance program;
(2) is responsible for the claim processing under the program;
(3) shall reimburse providers at a reimbursement rate of:
(A) at least the federal Medicare reimbursement rate for
the service provided; or
(B) at a rate of one hundred thirty percent (130%) of the
Medicaid reimbursement rate for a service that does not
have a Medicare reimbursement rate; and
(4) may not deny coverage to an eligible individual who has
been approved by the office to participate in the program,
except if the maximum coverage rates are met as described in
section 10 of this chapter.
Sec. 13. (a) A participant in the program has coverage for a
period of twelve (12) months. If the participant would like to
continue participating in the program, the participant must submit
an application for renewal with the office as required in section 11
of this chapter.
(b) At the end an individual's twelve (12) month program
period, and if the individual's health care account contains a
balance of more than five hundred dollars ($500), the individual
may withdraw the money that exceeds five hundred dollars ($500)
from the account if the criteria specified in subsection (c) are met.
(c) The individual may only withdraw money from the
individual's health care account if the following criteria are met:
(1) The account has more than five hundred dollars ($500)
remaining.
(2) The money being withdrawn is money that the individual,
not the state, contributed to the account and may not exceed
the total of the individual's contribution. The office shall
determine this amount by prorating the remaining amount
with the amount contributed by the individual.
(3) The individual has completed the individual's preventative
care services.
(4) The money is used to pay for dental services or vision
services that are not covered under the program's plan.
(d) Money remaining in the account at the end of the
individual's twelve (12) month period that is not withdrawn as
allowed under subsection (c):
(1) remains in the account if the individual renews
participation in the program and the amount the individual
needs to contribute to the account in the following program
year is prorated based on the amount remaining in the
account; or
(2) is forfeited by the individual and reverts back to the state
if the individual:
(A) does not continue to participate in the program; or
(B) is terminated from the program under section 6 of this
chapter.
Sec. 14. (a) The healthier Indiana insurance fund is established
for the following purposes:
(1) Administering a program created by the general assembly
to provide health insurance for low income residents of the
state under this chapter.
(2) Providing copayments, preventative care services, and
premiums for individuals enrolled in the program.
(3) Funding tobacco use prevention and cessation programs
and programs designed to promote the general health and
well being of Indiana residents.
(4) Promoting research in the health and life sciences field,
including grants to universities for operating and capital
expenses.
The fund is apart from the state general fund.
(b) The fund shall be administered by the office of the secretary
of family and social services.
(c) The expenses of administering the fund shall be paid from
money in the fund.
(d) The fund shall consist of the following:
(1) Cigarette tax revenues designated by the general assembly
to be part of the fund.
(2) Other funds designated by the general assembly to be part
of the fund.
(3) Federal funds available for the purposes of the fund.
(4) Gifts or donations to the fund.
(e) Money from each source going into the fund must be placed
into a separate account within the fund. Any unencumbered
balance in an account at the end of the state fiscal year that was
previously used for another program but diverted for use in this
program must be transferred back to the previous program.
(f) The treasurer of state shall invest the money in the fund not
currently needed to meet the obligations of the fund in the same
manner as other public money may be invested.
(g) Money must be appropriated before funds are available for
use.
(h) Money in the fund does not revert to the state general fund
at the end of any fiscal year.
Sec 15. (a) The office may not:
(1) enroll applicants;
(2) approve any contracts with vendors to provide services or
administer the program;
(3) incur costs other than those necessary to study and plan
for the implementation of the program; or
(4) create financial obligations for the state;
unless there is a specific appropriation from the general assembly
to implement the program.
(b) The office may not operate the program in a way that would
obligate the state to financial participation beyond the level of state
appropriations authorized for this purpose.
(c) The office shall:
(1) modify limitations on participation;
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) 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) For purposes of this chapter IC 12-15-15-9, IC 12-15-15-9.5, and
IC 12-16-14, "amount" when used in regard to a claim or payable claim
means an amount calculated under STEP THREE of the following
formula:
STEP ONE: Identify the items and services identified in a
claim or 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.
(d) For purposes of this chapter IC 12-15-15-9, IC 12-15-15-9.5, and
IC 12-16-14, a physician, hospital through June 30, 2005, or
transportation provider that submits a claim to the division is
considered to have submitted the claim during the state fiscal year
during which the amount of the claim was determined under
IC 12-16-5.5-1.2(b) or, if successfully appealed by a physician,
hospital, or transportation provider, the state fiscal year in which the
appeal was decided.
(e) The division shall determine the amount of a claim under
IC 12-16-5.5-1.2(b).
for purposes of IC 12-15-20-2(8)(D) IC 12-15-20-2(6)(D) an
amount equal to the amount calculated under STEP ONE, minus
an amount equal to the amount calculated under STEP THREE.
STEP FIVE: The division shall retain an amount equal to the
amount remaining in the state hospital care for the indigent fund
after the transfer in STEP FOUR for purposes of making
payments under section 5 of this chapter.
(c) Beginning in state fiscal years after June 30, 2006, funds
must be distributed on the following basis and in the following
order:
(1) Three million dollars ($3,000,000) must be distributed to
physicians and transportation providers.
(2) Twenty million six hundred twenty-five thousand dollars
($20,625,000) must be used for the state match for hospital
care for the indigent upper payment limit payments. The
payment under this subdivision must equal the 2006 claim
payments with the remainder of the money being split on a
prorated basis among private hospitals based on Medicaid
days.
(3) Twenty-eight million dollars ($28,000,000) to the state
Medicaid program.
(4) Any remaining money must be used for additional upper
payment limit payments to Lake County historical
disproportionate share hospitals.
(c) (d) The costs of administering the hospital care for the indigent
program, including the processing of claims, shall be paid from the
funds transferred to the state hospital care for the indigent fund.
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 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, 2005;
(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 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).
state's Medicaid plan that is necessary to do the following:
(1) Include coverage under the state's Medicaid program for
pregnancy related services for a pregnant woman whose
annual household income does not exceed two hundred
percent (200%) of the federal income poverty level.
(2) Amend the state's upper payment limit program.
(3) Make changes to the state's disproportionate share
hospital program.
(c) The office may not implement an approved amendment to
the state plan until the office files an affidavit with the governor
attesting that the state plan amendment applied for under
subsection (b)(1), (b)(2), or (b)(3) of this SECTION is in effect. The
office shall file the affidavit under this subsection not later than
five (5) days after the office is notified that the state plan
amendment is approved.
(d) The office may adopt rules under IC 4-22-2 necessary to
implement this SECTION.
(e) This SECTION expires December 31, 2013.