Introduced Version
HOUSE BILL No. 1680
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 6-7-1; IC 7.1-4; IC 16-18-2; IC 16-46-5-7.5;
IC 16-48.
Synopsis: Universal health care. Creates a plan of health insurance to
provide primary coverage to every resident of Indiana. Creates the
health insurance commission (commission) to administer the plan.
Specifies minimum benefits that the commission must provide. Creates
the health insurance trust fund from which covered health services and
expenses of the commission would be paid. Raises taxes on tobacco
products and alcoholic beverages. Imposes certain payments on
individuals and employers. Provides that the commission is not
required to provide for coverage of insured services before the later of
January 1, 2008, or the date the commission has received appropriate
federal approvals, assurances, or waivers that the Medicare, Medicaid,
and veterans health programs can be integrated with the plan and that
the plan can be implemented notwithstanding the Employee Retirement
Income Security Act. Makes an appropriation to the commission.
Effective: July 1, 2007.
Brown C
January 23, 2007, read first time and referred to Committee on Public Health.
Introduced
First Regular Session 115th General Assembly (2007)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in
this style type, and deletions will appear in
this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in
this style type. Also, the
word
NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in
this style type or
this style type reconciles conflicts
between statutes enacted by the 2006 Regular Session of the General Assembly.
HOUSE BILL No. 1680
A BILL FOR AN ACT to amend the Indiana Code concerning
health and to make an appropriation.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 6-7-1-12; (07)IN1680.1.1. -->
SECTION 1. IC 6-7-1-12 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 12. (a) The following taxes are
imposed, and shall be collected and paid as provided in this chapter,
upon the sale, exchange, bartering, furnishing, giving away, or
otherwise disposing of cigarettes within the state of Indiana:
(1) On cigarettes weighing not more than three (3) pounds per
thousand (1,000), a tax at the rate of
two three and seven hundred
seventy-five fifty-five thousandths of a cent
($0.02775)
($0.03755) per individual cigarette.
(2) On cigarettes weighing more than three (3) pounds per
thousand (1,000), a tax at the rate of
three five and
six thousand
eight hundred eighty-one ten-thousandths seventeen thousandths
of a cent
($0.036881) ($0.05017) per individual cigarette, except
that if any cigarettes weighing more than three (3) pounds per
thousand (1,000) shall be more than six and one-half (6 1/2)
inches in length, they shall be taxable at the rate provided in
subdivision (1), counting each two and three-fourths (2 3/4)
inches (or fraction thereof) as a separate cigarette.
(b) Upon all cigarette papers, wrappers, or tubes, made or prepared
for the purpose of making cigarettes, which are sold, exchanged,
bartered, given away, or otherwise disposed of within the state of
Indiana (other than to a manufacturer of cigarettes for use by him the
manufacturer in the manufacture of cigarettes), the following taxes
are imposed, and shall be collected and paid as provided in this
chapter:
(1) On fifty (50) papers or less, a tax of one-half cent ($0.005).
(2) On more than fifty (50) papers but not more than one hundred
(100) papers, a tax of one cent ($0.01).
(3) On more than one hundred (100) papers, one-half cent
($0.005) for each fifty (50) papers or fractional part thereof.
(4) On tubes, one cent ($0.01) for each fifty (50) tubes or
fractional part thereof.
SOURCE: IC 6-7-1-17; (07)IN1680.1.2. -->
SECTION 2. IC 6-7-1-17 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 17. (a) Distributors who hold
certificates and retailers shall be agents of the state in the collection of
the taxes imposed by this chapter and the amount of the tax levied,
assessed, and imposed by this chapter on cigarettes sold, exchanged,
bartered, furnished, given away, or otherwise disposed of by
distributors or to retailers. Distributors who hold certificates shall be
agents of the department to affix the required stamps and shall be
entitled to purchase the stamps from the department at a discount of
one and two-tenths ninety-three hundredths percent
(1.2%) (0.93%)
of the amount of the tax stamps purchased, as compensation for their
labor and expense.
(b) The department may permit distributors who hold certificates
and who are admitted to do business in Indiana to pay for revenue
stamps within thirty (30) days after the date of purchase. However, the
privilege is extended upon the express condition that:
(1) except as provided in subsection (c), a bond or letter of credit
satisfactory to the department, in an amount not less than the sales
price of the stamps, is filed with the department; and
(2) proof of payment is made of all local property, state income,
and excise taxes for which any such distributor may be liable. The
bond or letter of credit, conditioned to secure payment for the
stamps, shall be executed by the distributor as principal and by a
corporation duly authorized to engage in business as a surety
company or financial institution in Indiana.
(c) If a distributor has at least five (5) consecutive years of good
credit standing with the state, the distributor shall not be required to
post a bond or letter of credit under subsection (b).
SOURCE: IC 6-7-1-28.1; (07)IN1680.1.3. -->
SECTION 3. IC 6-7-1-28.1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 28.1. The taxes,
registration fees, fines, or penalties collected under this chapter shall
be deposited in the following manner:
(1) Six Five and six-tenths twelve hundredths percent (6.6%)
(5.12%) of the money shall be deposited in a fund to be known as
the cigarette tax fund.
(2) Ninety-four Seventy-three hundredths percent (0.94%)
(0.73%) of the money shall be deposited in a fund to be known as
the mental health centers fund.
(3) Eighty-three Sixty-five and ninety-seven twelve hundredths
percent (83.97%) (65.12%) of the money shall be deposited in
the state general fund.
(4) Eight Six and forty-nine fifty-eight hundredths percent
(8.49%) (6.58%) of the money shall be deposited into the pension
relief fund established in IC 5-10.3-11.
(5) Twenty-two and forty-five hundredths percent (22.45%)
of the money shall be deposited into the health insurance trust
fund established by IC 16-48-6-1.
The money in the cigarette tax fund, the mental health centers fund, or
the pension relief fund at the end of a fiscal year does not revert to the
state general fund. However, if in any fiscal year, the amount allocated
to a fund under subdivision (1) or (2) is less than the amount received
in fiscal year 1977, then that fund shall be credited with the difference
between the amount allocated and the amount received in fiscal year
1977, and the allocation for the fiscal year to the fund under
subdivision (3) shall be reduced by the amount of that difference.
SOURCE: IC 7.1-4-2-1; (07)IN1680.1.4. -->
SECTION 4. IC 7.1-4-2-1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 1. An excise tax,
referred to as the beer excise tax, at the rate of eleven forty-one and
one-half cents ($.115) ($0.415) a gallon is imposed upon the sale of
beer or flavored malt beverage within Indiana.
SOURCE: IC 7.1-4-3-1; (07)IN1680.1.5. -->
SECTION 5. IC 7.1-4-3-1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 1. Rate of Tax. An
excise tax at the rate of two nine dollars and sixty-eight cents ($2.68)
($9.68) a gallon is imposed upon the sale, gift, or the withdrawal for
sale or gift, of liquor and wine that contains twenty-one percent (21%),
or more, of absolute alcohol reckoned by volume.
SOURCE: IC 7.1-4-4-1; (07)IN1680.1.6. -->
SECTION 6. IC 7.1-4-4-1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 1. An excise tax at the
rate of
one dollar and forty-seven sixty-seven cents
($0.47) ($1.67) a
gallon is imposed upon the manufacture and sale or gift, or withdrawal
for sale or gift, of wine, except hard cider, within this state.
SOURCE: IC 7.1-4-9-3; (07)IN1680.1.7. -->
SECTION 7. IC 7.1-4-9-3, AS AMENDED BY P.L.224-2005,
SECTION 25, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]: Sec. 3. (a) Except as otherwise provided in subsection
(b), this section, the chairman shall deposit the monies collected under
the authority of this chapter daily with the treasurer of the state, and not
later than the fifth day of the following month shall cover them into the
"excise fund" to be distributed as provided in this chapter.
(b) The chairman shall deposit the money received from the
collection of the fees for a three-way permit under IC 7.1-3-20-16(f)
daily with the treasurer of state, and not later than the fifth day of the
following month shall transfer the money into the enforcement and
administration fund of the commission under IC 7.1-4-11.
(c) The chairman shall deposit:
(1) thirty cents ($0.30) of the beer excise tax rate collected on
each gallon of beer or flavored malt beverage;
(2) seven dollars ($7) of the liquor excise tax rate collected on
each gallon of liquor; and
(3) one dollar twenty cents ($1.20) of the wine excise tax rate
collected on each gallon of wine;
daily with the treasurer of state and not later than the fifth day of
the following month shall transfer the money into the health
insurance trust fund established under IC 16-48-6-1.
SOURCE: IC 16-18-2-1.9; (07)IN1680.1.8. -->
SECTION 8. IC 16-18-2-1.9 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2007]: Sec. 1.9. "Adjusted gross income", for purposes of
IC 16-48, has the meaning set forth in IC 16-48-1-2.
SOURCE: IC 16-18-2-37.5; (07)IN1680.1.9. -->
SECTION 9. IC 16-18-2-37.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 37.5. "Board" for
purposes of:
(1) IC 16-22-8, has the meaning set forth in IC 16-22-8-2.1; and
(2) IC 16-48, has the meaning set forth in IC 16-48-1-3.
SOURCE: IC 16-18-2-50.5; (07)IN1680.1.10. -->
SECTION 10. IC 16-18-2-50.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 50.5. "Catastrophic illness", for
purposes of IC 16-48, has the meaning set forth in IC 16-48-1-4.
SOURCE: IC 16-18-2-55.7; (07)IN1680.1.11. -->
SECTION 11. IC 16-18-2-55.7 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 55.7. "Chronic illness", for
purposes of IC 16-48, has the meaning set forth in IC 16-48-1-5.
SOURCE: IC 16-18-2-62; (07)IN1680.1.12. -->
SECTION 12. IC 16-18-2-62 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 62. (a) "Commission",
for purposes of IC 16-19-6, refers to the commission for special
institutions.
(b) "Commission", for purposes of IC 16-31, refers to the Indiana
emergency medical services commission.
(c) "Commission", for purposes of IC 16-46-11.1, has the meaning
set forth in IC 16-46-11.1-1.
(d) "Commission", for purposes of IC 16-48, has the meaning
set forth in IC 16-48-1-6.
SOURCE: IC 16-18-2-62.5; (07)IN1680.1.13. -->
SECTION 13. IC 16-18-2-62.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 62.5. "Committee", for purposes
of IC 16-48, has the meaning set forth in IC 16-48-1-7.
SOURCE: IC 16-18-2-92.8; (07)IN1680.1.14. -->
SECTION 14. IC 16-18-2-92.8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 92.8. "Dependent", for purposes
of IC 16-48, has the meaning set forth in IC 16-48-1-8.
SOURCE: IC 16-18-2-114; (07)IN1680.1.15. -->
SECTION 15. IC 16-18-2-114 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 114. "Employer", for
purposes of:
(1) IC 16-41-11, has the meaning set forth in IC 16-41-11-1; and
(2) IC 16-48, has the meaning set forth in IC 16-48-1-9.
SOURCE: IC 16-18-2-116.5; (07)IN1680.1.16. -->
SECTION 16. IC 16-18-2-116.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 116.5. "ERISA", for purposes of
IC 16-48, has the meaning set forth in IC 16-48-1-10.
SOURCE: IC 16-18-2-121; (07)IN1680.1.17. -->
SECTION 17. IC 16-18-2-121 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 121. "Executive
director", for purposes of:
(1) IC 16-22, means the chief administrative officer, president, or
other individual appointed under IC 16-22-3-8; and
(2) IC 16-48, has the meaning set forth in IC 16-48-1-11.
SOURCE: IC 16-18-2-143; (07)IN1680.1.18. -->
SECTION 18. IC 16-18-2-143 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 143. (a) "Fund", for
purposes of IC 16-26-2, has the meaning set forth in IC 16-26-2-2.
(b) "Fund", for purposes of IC 16-31-8.5, has the meaning set forth
in IC 16-31-8.5-2.
(c) "Fund", for purposes of IC 16-46-5, has the meaning set forth in
IC 16-46-5-3.
(d) "Fund", for purposes of IC 16-46-12, has the meaning set forth
in IC 16-46-12-1.
(e) "Fund", for purposes of IC 16-48, has the meaning set forth
in IC 16-48-1-12.
SOURCE: IC 16-18-2-150.6; (07)IN1680.1.19. -->
SECTION 19. IC 16-18-2-150.6 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 150.6. "Governmental body", for
purposes of IC 16-48, has the meaning set forth in IC 16-48-1-13.
SOURCE: IC 16-18-2-179; (07)IN1680.1.20. -->
SECTION 20. IC 16-18-2-179 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 179. (a) "Hospital",
except as provided in subsections (b) through (f), means a hospital that
is licensed under IC 16-21-2.
(b) "Hospital", for purposes of IC 16-21, means an institution, a
place, a building, or an agency that holds out to the general public that
it is operated for hospital purposes and that it provides care,
accommodations, facilities, and equipment, in connection with the
services of a physician, to individuals who may need medical or
surgical services. The term does not include the following:
(1) Freestanding health facilities.
(2) Hospitals or institutions specifically intended to diagnose,
care, and treat the following:
(A) Mentally ill individuals (as defined in IC 12-7-2-131).
(B) Individuals with developmental disabilities (as defined in
IC 12-7-2-61).
(3) Offices of physicians where patients are not regularly kept as
bed patients.
(4) Convalescent homes, boarding homes, or homes for the aged.
(c) "Hospital", for purposes of IC 16-22-8, has the meaning set forth
in IC 16-22-8-5.
(d) "Hospital" or "tuberculosis hospital", for purposes of IC 16-24,
means an institution or a facility for the treatment of individuals with
tuberculosis.
(e) "Hospital", for purposes of IC 16-34, means a hospital (as
defined in subsection (b)) that:
(1) is required to be licensed under IC 16-21-2; or
(2) is operated by an agency of the United States.
(f) "Hospital", for purposes of IC 16-41-12, has the meaning set
forth in IC 16-41-12-6.
(g) "Hospital", for purposes of IC 16-48, has the meaning set
forth in IC 16-48-1-14.
SOURCE: IC 16-18-2-190.5; (07)IN1680.1.21. -->
SECTION 21. IC 16-18-2-190.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 190.5. "Insurance contract", for
purposes of IC 16-48, has the meaning set forth in IC 16-48-1-15.
SOURCE: IC 16-18-2-190.7; (07)IN1680.1.22. -->
SECTION 22. IC 16-18-2-190.7 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 190.7. "Insured", for purposes of
IC 16-48, has the meaning set forth in IC 16-48-1-16.
SOURCE: IC 16-18-2-190.8; (07)IN1680.1.23. -->
SECTION 23. IC 16-18-2-190.8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 190.8. "Insured services", for
purposes of IC 16-48, has the meaning set forth in IC 16-48-1-17.
SOURCE: IC 16-18-2-224.5; (07)IN1680.1.24. -->
SECTION 24. IC 16-18-2-224.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 224.5. "Medicare program", for
purposes of IC 16-48, has the meaning set forth in IC 16-48-1-18.
SOURCE: IC 16-18-2-249.5; (07)IN1680.1.25. -->
SECTION 25. IC 16-18-2-249.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 249.5. "Nominal gross domestic
product", for purposes of IC 16-48, has the meaning set forth in
IC 16-48-1-19.
SOURCE: IC 16-18-2-274; (07)IN1680.1.26. -->
SECTION 26. IC 16-18-2-274 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 274. (a) "Person"
means, except as provided in subsections (b), (c), and (d), an
individual, a firm, a partnership, an association, a fiduciary, an
executor or administrator, a governmental entity, or a corporation.
(b) "Person", for purposes of IC 16-25, has the meaning set forth in
IC 16-25-1.1-8.
(c) "Person", for purposes of IC 16-31, means an individual, a
partnership, a corporation, an association, a joint stock association, or
a governmental entity other than an agency or instrumentality of the
United States.
(d) "Person", for purposes of IC 16-42-10, has the meaning set forth
in IC 16-42-10-3.
(e) "Person", for purposes of IC 16-48, has the meaning set
forth in IC 16-48-1-21.
SOURCE: IC 16-18-2-287.5; (07)IN1680.1.27. -->
SECTION 27. IC 16-18-2-287.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 287.5. "Plan", for purposes of
IC 16-48, has the meaning set forth in IC 16-48-1-22.
SOURCE: IC 16-18-2-287.8; (07)IN1680.1.28. -->
SECTION 28. IC 16-18-2-287.8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 287.8. "Poverty level", for
purposes of IC 16-48, has the meaning set forth in IC 16-48-1-23.
SOURCE: IC 16-18-2-292.3; (07)IN1680.1.29. -->
SECTION 29. IC 16-18-2-292.3 IS ADDED TO THE INDIANA
CODE AS A
NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]:
Sec. 292.3. "Primary care provider",
for purposes of IC 16-48, has the meaning set forth in
IC 16-48-1-24.
SOURCE: IC 16-18-2-295; (07)IN1680.1.30. -->
SECTION 30. IC 16-18-2-295 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 295. (a) "Provider", for
purposes of IC 16-21-8, has the meaning set forth in IC 16-21-8-0.6.
(b) "Provider", for purposes of IC 16-38-5, IC 16-39 (except for
IC 16-39-7) and IC 16-41-1 through IC 16-41-9 and IC 16-41-37,
means any of the following:
(1) An individual (other than an individual who is an employee or
a contractor of a hospital, a facility, or an agency described in
subdivision (2) or (3)) who is licensed, registered, or certified as
a health care professional, including the following:
(A) A physician.
(B) A psychotherapist.
(C) A dentist.
(D) A registered nurse.
(E) A licensed practical nurse.
(F) An optometrist.
(G) A podiatrist.
(H) A chiropractor.
(I) A physical therapist.
(J) A psychologist.
(K) An audiologist.
(L) A speech-language pathologist.
(M) A dietitian.
(N) An occupational therapist.
(O) A respiratory therapist.
(P) A pharmacist.
(2) A hospital or facility licensed under IC 16-21-2 or IC 12-25 or
described in IC 12-24-1 or IC 12-29.
(3) A health facility licensed under IC 16-28-2.
(4) A home health agency licensed under IC 16-27-1.
(5) An employer of a certified emergency medical technician, a
certified emergency medical technician-basic advanced, a
certified emergency medical technician-intermediate, or a
certified paramedic.
(6) The state department or a local health department or an
employee, agent, designee, or contractor of the state department
or local health department.
(c) "Provider", for purposes of IC 16-39-7-1, has the meaning set
forth in IC 16-39-7-1(a).
(d) "Provider", for purposes of IC 16-48, has the meaning set
forth in IC 16-48-1-25.
SOURCE: IC 16-18-2-317.5; (07)IN1680.1.31. -->
SECTION 31. IC 16-18-2-317.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 317.5. "Resident", for purposes
of IC 16-48, has the meaning set forth in IC 16-48-1-26.
SOURCE: IC 16-18-2-317.6; (07)IN1680.1.32. -->
SECTION 32. IC 16-18-2-317.6 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 317.6. "Resident individual", for
purposes of IC 16-48, has the meaning set forth in IC 16-48-1-27.
SOURCE: IC 16-18-2-351.5; (07)IN1680.1.33. -->
SECTION 33. IC 16-18-2-351.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 351.5. "Terminal
illness", for purposes of:
(1) IC 16-25, has the meaning set forth in IC 16-25-1.1-9; and
(2) IC 16-48, has the meaning set forth in IC 16-48-1-28.
SOURCE: IC 16-46-5-7.5; (07)IN1680.1.34. -->
SECTION 34. IC 16-46-5-7.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 7.5. (a) This section applies
beginning January 1, 2008.
(b) As used in this section, "provider" has the meaning set forth
in IC 16-48-1-23.
(c) For each provider category, the state department of health
shall annually designate the counties, cities, towns, and townships
that are underserved by the provider category.
(d) For each provider category, the state department of health
shall rank these areas according to the degree each area is
underserved by the provider category.
SOURCE: IC 16-48; (07)IN1680.1.35. -->
SECTION 35. IC 16-48 IS ADDED TO THE INDIANA CODE AS
A
NEW ARTICLE TO READ AS FOLLOWS [EFFECTIVE JULY 1,
2007]:
ARTICLE 48. HEALTH INSURANCE COVERAGE ACT
Chapter 1. Applicability and Definitions
Sec. 1. This article applies beginning January 1, 2008.
Sec. 2. "Adjusted gross income" has the meaning set forth in
IC 6-3-1-3.5.
Sec. 3. "Board" has the meaning set forth in IC 25-1-9-1.
Sec. 4. "Catastrophic illness" means any of the following:
(1) Burns on more than fifty percent (50%) of an individual's
body.
(2) An individual's premature birth.
(3) An individual's birth with low birthweight.
(4) A malignancy requiring chemical or radiation therapy.
(5) An illness with treatment costs of more than fifty thousand
dollars ($50,000) in a year.
Sec. 5. "Chronic illness" means any of the following:
(1) An autoimmune disorder.
(2) A blood disorder.
(3) Cardiomyopathy.
(4) Chronic obstructive pulmonary disease.
(5) Cirrhosis of the liver.
(6) Cystic fibrosis.
(7) Diabetes.
(8) End stage renal disease with dialysis.
(9) Severe neuromuscular disease.
(10) Status/post transplant.
(11) Polycystic kidney disease.
(12) Serious and persistent mental illness.
(13) An illness with treatment costs of more than fifty
thousand dollars ($50,000) in a year.
Sec. 6. "Commission" refers to the health insurance commission
established by IC 16-48-3-1.
Sec. 7. "Committee" refers to the health care claims review
committee appointed under IC 16-48-8-1.
Sec. 8. "Dependent" means either of the following:
(1) A child, a stepchild, or an adoptee (as defined in
IC 31-9-2-2) of an insured who is:
(A) unemancipated; and
(B) less than nineteen (19) years of age.
(2) An individual more than one-half (1/2) of whose support
is provided during a year by an insured.
Sec. 9. "Employer" means an individual or a corporation (as
defined in IC 6-3-1-10) that employs in Indiana at least one (1)
resident individual.
Sec. 10. "ERISA" refers to the federal Employee Retirement
Income Security Act (29 U.S.C. 1001 et seq.).
Sec. 11. "Executive director" refers to the executive director
employed under IC 16-48-3-12.
Sec. 12. "Fund" refers to the health insurance trust fund
established by IC 16-48-6-1.
Sec. 13. "Governmental body" means any of the following:
(1) A state agency (as defined in IC 4-13-1-1).
(2) The legislative branch of state government.
(3) The judicial branch of state government.
(4) An instrumentality of the state that performs essential
governmental functions.
(5) The state lottery commission created by IC 4-30-3-1.
(6) A political subdivision (as defined in IC 36-1-2-13).
(7) A state educational institution (as defined in
IC 20-12-0.5-1).
(8) The federal government or an agency or instrumentality
of the federal government.
(9) The government of a state or territory of the United States.
(10) A political subdivision of a state or territory of the United
States.
Sec. 14. "Hospital" refers to a hospital or an ambulatory
outpatient surgical center licensed under IC 16-21-2.
Sec. 15. "Insurance contract" means a contract for insurance
for the payment of, reimbursement of, or indemnification for any
part of the cost of an insured service provided in Indiana.
Sec. 16. "Insured" means an individual insured by the plan.
Sec. 17. "Insured services" means health care services covered
by the plan.
Sec. 18. "Medicare program" refers to Parts A, B, and D of the
Medicare program (42 U.S.C. 1395 et seq.).
Sec. 19. "Nominal gross domestic product" refers to the nominal
gross domestic product as determined by the United States
Department of Commerce and published by the Bureau of
Economic Analysis or the United States Department of Commerce.
Sec. 20. "Overserved area" refers to an area overserved by
primary care providers designated by the state department of
health under IC 16-46-5.
Sec. 21. "Person" means any of the following:
(1) An association.
(2) A corporation.
(3) An estate.
(4) A governmental body.
(5) An individual.
(6) A partnership.
(7) A professional corporation.
(8) A trust.
(9) A limited liability company.
(10) A joint venture.
(11) A proprietorship.
Sec. 22. "Plan" refers to the health insurance plan established
under IC 16-48-5-1.
Sec. 23. "Poverty level" refers to the federal income poverty
level as determined annually by the federal
Department of Health
and Human Services.
Sec. 24. "Primary care provider" means a health care provider
that provides health care services as the provider of first contact
and means of entry into the health care system.
Sec. 25. "Provider" means any of the following:
(1) A community mental health center.
(2) A community or migrant health center (as defined in
IC 16-46-5-1).
(3) A community retardation and other developmental
disabilities center.
(4) A home health agency.
(5) A hospital.
(6) A person authorized by law to provide health care or
professional services in Indiana as any of the following:
(A) A chiropractor.
(B) A dentist.
(C) A licensed practical nurse.
(D) A registered nurse.
(E) An optometrist.
(F) A pharmacist.
(G) A physical therapist.
(H) A physician.
(I) A podiatrist.
(J) A psychiatrist.
(K) A psychologist with a doctorate in psychology.
(L) A social worker.
(M) A clinical social worker.
(N) An osteopath.
Sec. 26. (a) "Resident" means an individual who:
(1) lives in Indiana; and
(2) either:
(A) has lived in Indiana continuously for at least one (1)
year; or
(B) is a dependent of an individual who has lived in
Indiana continuously for at least one (1) year.
(b) The term does not include an individual who lives in Indiana
only to attend a school, college, or university located in Indiana.
Sec. 27. "Resident individual" means an individual who is a
resident of Indiana for Indiana adjusted gross income tax
purposes.
Sec. 28. "Terminal illness" means any of the following:
(1) Acquired immune deficiency syndrome (AIDS).
(2) A malignancy that results in a diagnosis of a life
expectancy of less than six (6) months for the individual
suffering from the malignancy.
(3) An illness:
(A) with treatment costs of more than fifty thousand
dollars ($50,000) in a year; and
(B) that results in a diagnosis of a life expectancy of less
than six (6) months for the individual suffering from the
illness.
Sec. 29. "Underserved area" refers to a shortage area
underserved by providers designated by the state department of
health under IC 16-46-5-6.
Chapter 2. General Provisions
Sec. 1. This article entitles an insured the freedom to choose the
insured's own provider.
Sec. 2. Except as provided in section 3 of this chapter, this
article does not impose an obligation on a provider to treat an
insured.
Sec. 3. A provider may not deny insured services to an insured
on the basis of any of the following:
(1) Color.
(2) Income level.
(3) National origin.
(4) Nonmedical criteria.
(5) Race.
(6) Religion.
(7) Sex.
(8) Sexual orientation.
Sec. 4. The commission and the plan are not subject to
regulation by the department of insurance or the insurance
commissioner under IC 27-1.
Sec. 5. The commission is subject to IC 5-14-1.5.
Sec. 6. (a) The commission is subject to IC 5-14-3.
(b) Information relating to an insured or a provider may not be
disclosed except as provided in IC 5-14-3.
(c) The commission may publish information received under
this article in statistical form if the identities of individuals and
providers are not revealed, except as permitted by IC 5-14-3.
Sec. 7. A nonparticipating provider may not be reimbursed by
the plan for covered services in an amount greater than the amount
paid to a participating provider.
Chapter 3. Health Insurance Commission
Sec. 1. The health insurance commission is established.
Sec. 2. The commission consists of the following members:
(1) The following voting members appointed by the governor:
(A) Four (4) members representing business other than
health care or insurance. At least one (1) member
appointed under this clause must represent small business.
Not more than one (1) member appointed under this clause
may represent a particular industry.
(B) Four (4) members representing organized labor.
(C) Seven (7) members who have no interest in health care
other than as consumers. At least two (2) members
appointed under this clause must be at least sixty-five (65)
years of age.
(D) Two (2) members representing providers. The
members appointed under this clause may not be members
of the same licensed profession.
(E) Two (2) members who are actuaries.
(2) Four (4) nonvoting advisory members appointed as
follows:
(A) The speaker of the house of representatives shall
appoint two (2) members of the commission from among
the members of the house of representatives. The members
appointed under this clause may not be members of the
same political party.
(B) The president pro tempore of the senate shall appoint
two (2) members of the commission from among the
members of the senate. The members appointed under this
clause may not be members of the same political party.
(3) The following individuals serve as nonvoting advisory
members of the commission:
(A) The commissioner of the state department of health or
the commissioner's designee.
(B) The secretary of the office of family and social services
or the secretary's designee.
(C) The commissioner of insurance or the commissioner's
designee.
(D) The commissioner of the department of state revenue
or the commissioner's designee.
Sec. 3. (a) The term of an individual appointed as a member of
the commission under section 2(1) of this chapter begins on the
later of the following:
(1) The day the term of the member whom the individual is
appointed to succeed expires.
(2) The day the individual is appointed by the governor.
(b) The term of a member of the commission appointed under
section 2(1) of this chapter expires July 1 of the fourth year after
the member's current term begins.
(c) The governor may reappoint a member of the commission
under section 2(1) of this chapter for more than one (1) term. A
member reappointed by the governor is the member's own
successor for purposes of subsection (a).
(d) The term of an individual appointed as a member of the
commission under section 2(2) of this chapter begins January 1
after the organization of the first regular session of the general
assembly from which the individual is appointed.
(e) The term of an advisory member of the commission
appointed under section 2(2) of this chapter expires upon the
election of the next general assembly.
(f) An appointing authority under section 2(2) of this chapter
may reappoint a member serving under section 2(2) of this chapter
for a new term.
(g) An individual serving as a member of the commission under
section 2(3) of this chapter serves until the individual no longer
holds the office under which the individual is a member of the
commission.
Sec. 4. (a) The governor shall appoint an individual qualified
under section 2(1) of this chapter to fill a vacancy of a member
serving under section 2(1) of this chapter for the remainder of the
unexpired term.
(b) The appropriate appointing authority under section 2(2) of
this chapter shall fill a vacancy of a member of the commission
serving under section 2(2) of this chapter for the remainder of the
unexpired term.
Sec. 5. The commission shall elect a member of the commission
serving under section 2(1) of this chapter to serve as presiding
officer of the commission. The member elected under this section
is the presiding officer of the commission until the earlier of the
following:
(1) The member's term as a member of the commission
expires.
(2) The member is replaced as presiding officer by the
commission.
Sec. 6. (a) Each member of the commission who is not a state
employee is entitled to the minimum salary per diem provided by
IC 4-10-11-2.1(b). The member is also entitled to reimbursement
for traveling expenses as provided under IC 4-13-1-4 and other
expenses actually incurred in connection with the member's duties
as provided in the state policies and procedures established by the
Indiana department of administration and approved by the budget
agency.
(b) Each member of the commission who is a state employee but
who is not a member of the general assembly is entitled to
reimbursement for traveling expenses as provided under
IC 4-13-1-4 and other expenses actually incurred in connection
with the member's duties as provided in the state policies and
procedures established by the Indiana department of
administration and approved by the budget agency.
(c) Each member of the commission who is a member of the
general assembly is entitled to receive the same per diem, mileage,
and travel allowances paid to members of the general assembly
serving on interim study committees established by the legislative
council.
(d) The expenses paid under this section shall be paid from the
fund.
Sec. 7. (a) Ten (10) voting members of the commission constitute
a quorum.
(b) The commission may take action upon the affirmative vote
of a majority of the voting members present. At least six (6)
affirmative votes are necessary to take action. However, the
election of a presiding officer requires the affirmative vote of at
least ten (10) voting members.
Sec. 8. The commission shall meet at least one (1) time every
month.
Sec. 9. At a commission meeting, the presiding officer shall
provide an individual who wishes to be heard on a matter an
adequate opportunity to present oral or written testimony.
Sec. 10. The commission shall administer this article.
Sec. 11. The commission may adopt rules under IC 4-22-2 to
implement this article.
Sec. 12. (a) The commission shall employ an executive director
who is the chief administrative officer of the commission.
(b) The executive director shall perform the duties required by
this article and implement the policies of the commission.
Sec. 13. The executive director may hire staff for the
commission.
Sec. 14. The executive director may delegate a power or duty of
the executive director under this article to a member of the staff of
the commission.
Sec. 15. (a) The commission is the ultimate authority for
purposes of a proceeding under this article and IC 4-21.5.
(b) Unless the executive director refers a matter to the
committee for a recommendation, an agency action (as defined in
IC 4-21.5-1-4) of the executive director may be appealed to the
commission under IC 4-21.5.
(c) If the executive director refers a matter to the committee for
a recommendation, a party may appeal a decision to the
commission after the committee makes a recommendation to the
executive director.
Sec. 16. The expenses of the commission shall be paid from the
fund.
Sec. 17. (a) Each voting member of the commission must attend
at least one (1) health care educational seminar each year.
(b) The reasonable costs of a member attending a seminar
required by subsection (a) shall be paid from the fund.
(c) A nonvoting member of the commission is entitled to have
the reasonable costs of attending one (1) health care educational
seminar each year paid from the fund.
Sec. 18. The commission may contract with actuaries and other
persons to implement this article. The expenses of the contract
must be paid from the fund.
Chapter 4. Powers and Duties of the Commission
Sec. 1. The commission may enter into an agreement for
payment to a provider that renders insured services to an insured
on a basis other than a fee for service.
Sec. 2. (a) This section applies only to a provider who practices
in an underserved area.
(b) The commission shall increase the negotiated fee schedule of
a provider to one hundred fifteen percent (115%) of the schedule
established for the provider's provider category.
(c) The increase required by subsection (b) is effective until the
area is no longer an underserved area.
Sec. 3. The commission may enter into an agreement with a
person for provision of insured services outside Indiana to an
insured.
Sec. 4. The commission shall provide for enrollment of
individuals in the plan.
Sec. 5. The commission shall determine eligibility for enrollment
in the plan.
Sec. 6. The commission may determine whether particular
health care services not listed in this article are insured services.
Sec. 7. The commission shall make recommendations to the
general assembly regarding revenue necessary for operation of the
plan.
Sec. 8. The commission may maintain legal actions and
negotiate settlements.
Sec. 9. The commission may require and obtain information
required under this article that is necessary to implement this
article.
Sec. 10. The commission shall:
(1) enter into appropriate agreements with; or
(2) obtain necessary waivers from;
the federal government to extend coverage of the plan to as many
residents of Indiana as possible.
Sec. 11. The commission may provide for an individual who is
not otherwise entitled to become an insured under this article to
become an insured upon payment of appropriate charges by or for
the individual.
Sec. 12. (a) The commission may process claims:
(1) through the commission's own staff; or
(2) through a fiscal agent with which the commission
contracts.
(b) The term of a contract entered into under subsection (a)(2)
may be for a period of not more than three (3) years.
(c) A contract entered into under subsection (a)(2) must provide
that notice of at least one (1) year must be given if either of the
parties to the contract does not intend to renew the contract for an
additional term.
Sec. 13. (a) This section applies only to insured individuals who
have a:
(1) catastrophic;
(2) chronic; or
(3) terminal;
illness.
(b) Before January 1, 2011, the commission shall establish or
contract for the managed care of individuals described in
subsection (a).
(c) The commission shall require that only the most cost
effective and highly qualified providers may be employed by the
managed care system required by this section.
(d) The commission shall request as an option that an individual
described in subsection (a) participate in the managed care system
established under this section.
(e) The commission shall establish a managed care capitation fee
arrangement with the commission's managed care providers to
furnish all medically necessary care.
Sec. 14. The commission shall provide public education on the
quality and cost of health care so that consumers can make
informed health care decisions.
Sec. 15. (a) The commission shall report to the general assembly
in an electronic format under IC 5-14-6 regarding the following:
(1) The quality of health care in Indiana.
(2) The commission's efforts to contain health care costs.
(b) The commission shall submit the report required by this
section in an electronic format under IC 5-14-6 to the legislative
council before July 1 of each year. The report must cover the
previous calendar year.
(c) A provider shall make available to the commission
information the commission considers necessary to make the
report required by this section.
Sec. 16. The commission shall promote development of uniform
health claims cards readable by electronic card readers.
Sec. 17. (a) Before January 1, 2011, the commission shall present
a proposal to the general assembly for inclusion of coverage of long
term care in the plan.
(b) This section expires January 1, 2012.
Chapter 5. Health Insurance Plan
Sec. 1. The health insurance plan is established.
Sec. 2. The purpose of the plan is to provide insurance against
the cost of health care services on uniform terms and conditions
available to all residents of Indiana.
Sec. 3. An individual who is a resident of Indiana is entitled to
become an insured upon application to the commission.
Sec. 4. If a dependent of an insured is not a resident, the
dependent is entitled to become an insured upon application to the
commission.
Sec. 5. (a) Subject to subsections (b) and (c), an insured is
entitled to:
(1) reimbursement for payment the insured makes for insured
services if the services are provided outside Indiana;
(2) payment on behalf of the insured for insured services; or
(3) the provision of insured services.
(b) Payment or provision of insured services is subject to
conditions required by the commission.
(c) Payment for insured services rendered outside Indiana may
not exceed the amount that would have been paid for the same
service if provided within Indiana.
Sec. 6. The commission may not restrict an insured's access to
the health care system or insured services due to the type of
provider the insured first consulted for health care services.
Sec. 7. Subject to this article, the commission shall adopt rules
under IC 4-22-2 to establish the following:
(1) Plan benefits.
(2) Terms and conditions of coverage.
(3) Annual expenditure targets for fee for service providers.
(4) Allowable expenses that must be included in global and
capital budgets for the following:
(A) Institutional providers of inpatient care services.
(B) Ambulatory care facilities for diagnosis, treatment, and
care.
(5) Standards and procedures for negotiating and entering
into contracts with participating providers.
(6) Other elements of the plan the commission considers
necessary.
Sec. 8. (a) The plan must cover a service provided to an insured,
regardless of the eligibility of the insured for Medicare, if the same
service would be covered by Medicare if provided to an individual
eligible for Medicare.
(b) In addition to the services covered under subsection (a), the
plan must cover at least the following:
(1) Colorectal screening.
(2) Home care for an insured if:
(A) the insured is unable to perform at least two (2)
activities of daily living; or
(B) the insured, due to cognitive or mental impairment,
poses a health or safety risk to the insured or other
individuals.
(3) Hospice care.
(4) Immunizations.
(5) Mammography (at least one (1) time a year).
(6) Postpartum care.
(7) Prenatal care.
(8) Reproductive health care.
(9) Substance abuse rehabilitation (limited to thirty (30) days
a year as an inpatient and thirty (30) days a year as an
outpatient).
(10) Early periodic screening, diagnosis, and treatment.
(11) Treatment for musculo-skeletal disorders as covered
under the state Medicaid program, as provided in the
following:
(A) Medical services.
(B) Chiropractic services.
Sec. 9. (a) This section applies to an individual described by any
of the following:
(1) The individual is at least sixty-five (65) years of age.
(2) The individual receives benefits under the federal Social
Security Act.
(3) The individual's income is below the poverty level.
(b) In addition to the services listed in section 8 of this chapter,
the plan must cover the following for an individual described in
subsection (a):
(1) Dental services (excluding orthodontia).
(2) Prescription drugs.
(3) Vision/eye care.
Sec. 10. Subject to section 8(b) of this chapter, the plan may not
cover the following:
(1) Cosmetic surgery other than reconstructive surgery.
(2) Reports for life insurance or legal purposes.
(3) Basic care in a nursing home.
Chapter 6. Health Insurance Trust Fund
Sec. 1. The health insurance trust fund is established.
Sec. 2. (a) The fund is a trust fund.
(b) A person does not have a right to any part of the fund except
for payment for insured services as required by this article and by
the rules of the commission.
Sec. 3. The fund shall be administered by the commission.
Sec. 4. The fund consists of the following:
(1) Revenue provided by statute and money appropriated by
the general assembly.
(2) Federal funds covered by section 8 of this chapter.
(3) Other revenue received by the commission.
(4) Interest accruing from investment of money in the fund.
Sec. 5. (a) The treasurer of state shall hire a professional money
manager to invest money in the fund not currently needed to meet
the obligations of the fund in a manner similar to investment of
other trust funds governed by ERISA.
(b) Interest that accrues from investments of the fund shall be
deposited in the fund.
Sec. 6. Money in the fund at the end of a state fiscal year does
not revert to the state general fund.
Sec. 7. The fund may be used only for the following purposes:
(1) To pay the expenses of the commission.
(2) To make payments for insured services under this article.
(3) To make payments for operating and capital budgets of
hospitals.
Sec. 8. (a) The budget agency shall identify all federal programs
that provide federal money for payment of insured services.
(b) The governor shall direct the appropriate state agency to
apply to the federal government for waivers of the requirements of
any federal programs identified under subsection (a) to enable the
state to deposit money provided by that program in the fund.
(c) Money from federal programs identified under subsection
(a) for which a waiver has been obtained under subsection (b) shall
be deposited in the fund.
Sec. 9. (a) Amounts necessary for uses permitted under section
7 of this chapter are appropriated to the commission.
(b) The money in the fund is not subject to allotment under
IC 4-12 or transfer by the board of finance.
Sec. 10. (a) This section applies only after the plan has been
operating for three (3) full months.
(b) The amount of reserves in the fund at any time must equal
at least the amount of expenditures from the fund during the
previous three (3) months.
(c) If after the period described in subsection (a) the reserves in
the fund are less than the amount required by subsection (b), the
commission shall report the fact to the following:
(1) The governor.
(2) The speaker of the house of representatives.
(3) The president pro tempore of the senate.
If the commission determines that reserves in the fund will not
meet the requirement of subsection (b) before the next calendar
quarter, the commission shall make recommendations to the
governor and the general assembly for action to correct the
situation. If the recommendations require action by the general
assembly and the general assembly is not in session, the
commission shall recommend that the governor call the general
assembly into special session.
Sec. 11. (a) This section applies only after the plan has been
operating for one (1) full calendar year.
(b) Expenditures from the fund during any calendar year may
not be more than an amount determined in the last STEP of the
following formula:
STEP ONE: Determine expenditures from the fund during the
previous calendar year.
STEP TWO: Determine the population of Indiana during the
previous calendar year.
STEP THREE: Project the population of Indiana for the
current calendar year. The commission may use projections
made by an agency of the federal government or obtained by
any professionally recognized statistical means to determine
the projected population of Indiana.
STEP FOUR: Divide the number determined in STEP
THREE by the number determined in STEP TWO.
STEP FIVE: Multiply the number determined in STEP ONE
by the number determined in STEP FOUR.
STEP SIX: Determine the nominal gross domestic product
from the previous calendar year.
STEP SEVEN: Project the nominal gross domestic product
for the current calendar year. The commission may use
projections made by an agency of the federal government or
obtained by any professionally recognized economic means to
determine the projected nominal gross domestic product.
STEP EIGHT: Divide the number determined in STEP
SEVEN by the number determined in STEP SIX.
STEP NINE: Multiply the number determined in STEP FIVE
by the number determined in STEP EIGHT.
Sec. 12. The commission shall contract for an annual
independent audit of the condition of the fund. The audit must
include a review of the investment policies of the fund.
Sec. 13. The commission shall enter into appropriate agreements
with the department of state revenue under IC 6-8.1-9-14 for
collection of copayments under section 14 of this chapter and
health fees imposed on individuals and employers under section 15
of this chapter. The department of state revenue shall prescribe the
forms and procedures to be used to make payments described in
this section. The department of state revenue shall deposit
payments in the fund.
Sec. 14. (a) An insured receiving a service provided under the
plan must pay a copayment determined under this section.
(b) Subject to the maximum yearly dollar limitations provided
in subsection (c) and subject to the copayment amount specified in
subsection (d), the amount of a copayment for a service received by
the insured equals the percentage of the cost of the service listed in
the following schedule:
Insured's Adjusted
Copayment
Gross Income
Percentage
as a Percentage
for the
of the Federal
Year the
Poverty Level
Service
Is
Received
Not more than 100% 0%
Over 100% but not over 200% 3%
Over 200% but not over 300% 4%
Over 300% but not over 400% 5%
Over 400% but not over 500% 7.5%
Over 500% but not over 600% 10%
Over 600% but not over 700% 12.5%
Over 700% but not over 800% 15%
Over 800% 20%
(c) The total amount of copayments for an individual in any
year may not exceed the following:
Insured's Adjusted
Maximum
Gross Income
Copayment
as a Percentage
for the
of the Federal
Year the
Poverty Level
Service
Is
Received
Over 100% but not over 200% $150
Over 200% but not over 300% $225
Over 300% but not over 400% $300
Over 400% but not over 500% $500
Over 500% but not over 600% $700
Over 600% but not over 700% $1,100
Over 700% but not over 800% $1,500
Over 800% $2,000
(d) Subject to subsection (c), an insured shall pay a five dollar
($5) copayment for each provider visit.
(e) An individual shall annually pay the copayments required by
this section to the department of state revenue not later than the
date specified in IC 6-3-4-3.
Sec. 15. (a) The commission shall determine the costs of the plan
that are not reimbursed from taxes, grants, contributions,
copayments, and other sources and provide for the assessment of
health fees to:
(1) employers that employ individuals who reside in Indiana;
and
(2) individuals who reside in Indiana and have adjusted gross
income for the taxable year in which the health fee is imposed;
that are sufficient to cover the unreimbursed cost of the plan after
the application of all credits permitted by this article. The
commission may use projections made by an agency of the federal
government or another qualified individual or entity to calculate
fees.
(b) An individual shall annually pay the health fees required by
this section to the department of state revenue not later than the
date specified in IC 6-3-4-3 in the manner and in the form specified
by the department of state revenue.
(c) An employer shall deposit estimated payments of the health
fee at the times and in the manner provided for the payment of
estimated adjusted gross income taxes by corporations under
IC 6-3-4-4.1. The employer shall pay the total amount of the health
fee imposed for a year not later than the date specified in in
IC 6-3-4-3.
Sec. 16. (a) The health fees imposed under section 15 of this
chapter on resident individuals shall be based on a sliding scale
based on the adjusted gross income of the resident individuals. No
health fee may be imposed on a individual who has adjusted gross
income that is less than one hundred (100%) percent of the federal
poverty level.
(b) The health fee schedule shall provide for a credit against the
individual's health fee liability equal to the total copayments
charged to the individual under section 14 of this chapter and each
dependent of the individual, as determined under IC 6-3-1-3.5.
(c) If an individual and the individual's spouse file separate
returns, the credit for the dependent shall be allowed on only one
(1) of the returns in the manner specified by the department of
state revenue.
Sec. 17. (a) The health fees imposed under section 15 of this
chapter on employers shall be based on a sliding scale of health fees
for employers that is based on the number of resident individuals
employed by the employer in Indiana and the adjusted gross
income of the taxpayer.
(b) The health fee schedule shall provide for a credit for
employers that incur health care costs under an enforceable
insurance contract, collective bargaining agreement, or other
health care program permitted under IC 16-48-10.
(c) The commission shall specify the maximum permissible
credit that an employer may apply to the employer's liability for
health fees.
Chapter 7. Payment for Insured Services
Sec. 1. (a) The commission shall develop payment methodologies
for payment of providers that are consistent with the payment
methodologies of the Medicare program, including the following:
(1) Diagnosis related group classifications.
(2) Resource based relative value scales for providers.
(b) The commission shall develop all of the following for the
Indiana population less than sixty-five (65) years of age:
(1) New diagnosis related group classifications.
(2) New resource based relative value scales for providers.
(3) New weights for each of subdivisions (1) and (2) to reflect
different consumption patterns among the Indiana population
less than sixty-five (65) years of age.
(c) Subject to this chapter, a provider shall be paid according to
the payment methodologies developed by the commission under
this section.
Sec. 2. Subject to this chapter and the rules of the commission,
a provider shall bill the commission for insured services provided
to insureds.
Sec. 3. When a provider bills the commission under this chapter,
the following apply:
(1) The commission shall make direct payment to the provider
for insured services in accordance with the commission's
coding standards.
(2) The provider may not bill an insured for any amount for
the insured services.
(3) Payment by the commission for the insured services
performed is payment in full for the insured services.
Sec. 4. (a) The commission may not make direct payment to a
provider that does not bill the commission for payment under this
chapter.
(b) Subject to limitations in this article on payments for insured
services, an insured is entitled to reimbursement of payments for
insured services from a provider who does not bill the commission.
Sec. 5. A provider must bill for insured services performed by
the provider in the form prescribed by the commission.
Sec. 6. (a) A bill for insured services must be submitted to the
commission not later than six (6) months from the date of
performance of the insured services.
(b) The bill of a provider that performs an insured service for
an insured must describe the particulars of the insured service as
required by this article and the rules of the commission.
Sec. 7. (a) An insured is considered to have authorized a
provider that performed insured services to provide the
commission with the information regarding the insured services
required by this article and the rules of the commission.
(b) Upon enrolling in the plan, an insured must sign a consent
to release of information required under this article and the rules
of the commission.
Sec. 8. Subject to section 10 of this chapter, the executive
director shall:
(1) review and approve claims for insured services; and
(2) authorize payment for insured services;
in accordance with this article and the rules of the commission.
Sec. 9. (a) The executive director may recover an overpayment
made to a provider for insured services.
(b) The executive director may deduct from the amount payable
for insured services performed by a provider any overpayments
previously made to the provider.
Sec. 10. If the executive director finds that, with respect to a bill
for insured services, all or part of the services were not:
(1) performed;
(2) medically necessary;
(3) provided in accordance with accepted professional
standards or practice; or
(4) as represented;
the executive director shall refer the matter to the committee for
recommendation under IC 16-48-8.
Sec. 11. (a) If the executive director takes action under sections
8 through 10 of this chapter, other than to review and pay a bill as
submitted, the executive director shall give notice of the action
under this section to both of the following:
(1) The insured.
(2) The affected provider.
(b) In a notice under this section, the executive director shall
provide the following information:
(1) The name of the insured.
(2) The name of the provider.
(3) A description of the services for which the claim was
made.
(4) The dates services were claimed to have been provided.
(5) The amount payable under the plan for insured services.
(6) The action the executive director will take.
(7) The reasons for the action.
(8) How the insured or the provider may appeal the action of
the executive director.
(9) Other information the executive director considers
relevant.
Sec. 12. (a) Independent providers and noninstitutional
providers shall be reimbursed on a fee for service schedule.
(b) Representatives of each provider specialty shall negotiate a
fee for service rate of reimbursement annually with the
commission.
Sec. 13. (a) Each hospital and institutional provider shall
annually negotiate an operating budget with the commission.
(b) An operating budget may be used only for operating
expenses.
Sec. 14. (a) Each hospital and institutional provider shall
annually negotiate a capital budget with the commission.
(b) A capital budget may be used only for capital expenditures.
Chapter 8. Health Care Claims Review Committee
Sec. 1. (a) The commission shall appoint a health care claims
review committee consisting of the following:
(1) Ten (10) members who represent providers. Not more
than one (1) member appointed under this subdivision may be
a member of the same licensed profession.
(2) Five (5) members who may not be providers or represent
providers.
(b) A member or an employee of the commission may not be a
member of the committee.
(c) A member of the committee serves on the committee until
the member resigns or is replaced by the commission.
Sec. 2. The members of the committee shall be paid for services
as determined by the commission.
Sec. 3. (a) Except as provided in sections 4 and 5 of this chapter,
the committee shall sit in panels of three (3) members as follows:
(1) One (1) member of each panel must be a member
appointed under section 1(a)(1) of this chapter.
(2) One (1) member of each panel must be a member
appointed under section 1(a)(2) of this chapter.
(b) The commission may designate the individuals who sit on a
particular panel of the committee.
(c) Unless the whole committee hears a matter under section 4
of this chapter, the recommendation of a panel is considered a
recommendation of the committee.
Sec. 4. The commission or the executive director may require
the entire committee to make a recommendation on a matter.
Sec. 5. If a matter referred to the committee concerns a provider
category that is not represented on the committee, the executive
director shall form a special panel to hear the matter consisting of
the following members:
(1) One (1) member appointed under section 1(a)(1) of this
chapter.
(2) One (1) member appointed under section 1(a)(2) of this
chapter.
(3) One (1) individual selected at random from a list of
representatives:
(A) of the provider category not represented on the
committee; and
(B) approved by the commission.
Sec. 6. The committee shall make a recommendation to the
executive director regarding a matter referred to the committee
under IC 16-48-7.
Sec. 7. (a) Except as provided under section 10 of this chapter,
proceedings of the committee are not subject to IC 4-21.5.
(b) The commission shall adopt rules under IC 4-22-2 to specify
procedures for the committee. The rules must include procedures
for designating a panel to hear a matter.
(c) The commission shall adopt rules under IC 4-22-2 to
implement this article.
Sec. 8. The committee may refer a matter to a board for advice
on a recommendation.
Sec. 9. The committee may recommend that the executive
director take any of the following actions:
(1) Pay a claim.
(2) Not pay a claim.
(3) Reduce the payment of the amount of a claim.
(4) Require reimbursement of an overpayment made on a
claim.
Sec. 10. (a) The executive director shall give notice to a party of
a recommendation of the committee.
(b) A recommendation of the committee is subject to review by
the commission under IC 4-21.5.
Sec. 11. Subject to section 10 of this chapter, the executive
director shall implement a recommendation of the committee.
Sec. 12. The commission shall provide support and
administrative services to the committee.
Chapter 9. Investigations
Sec. 1. The executive director shall establish an audit division to
implement this chapter.
Sec. 2. The audit division has the following duties:
(1) To examine books, accounts, and reports of providers.
(2) To review medical records maintained by providers with
respect to services provided to an insured.
(3) As directed by the commission, to audit loans made under
the loan program established under IC 16-48-14.
Sec. 3. (a) The executive director shall establish as a program of
the commission, and the audit division shall implement, the current
applicable provisions of the Medicare fraud and abuse program.
(b) The attorney general shall assist the audit division in
enforcement of the fraud and abuse program established under
subsection (a).
Sec. 4. A person shall make all books, accounts, records, and
other data required for an audit available to the commission at a
convenient location within thirty (30) days after a written request
made by the executive director.
Sec. 5. A person may not obstruct an employee of the division
who is performing duties under this article.
Sec. 6. The executive director may apply for a search warrant
under IC 35-33-5 to implement this article.
Sec. 7. To the extent practical, audits must be coordinated with
other audits performed by the state.
Sec. 8. An audit performed under this chapter is at the expense
of the commission.
Chapter 10. Private Health Insurance Contracts
Sec. 1. This chapter does not apply to any of the following:
(1) A contract entered into by the commission to provide
insured services to insureds.
(2) A contract for administrative services entered into by the
commission.
(3) A contract for reinsurance entered into by the commission.
(4) A contract relating to providing health care outside
Indiana.
(5) A contract relating to providing health care that is not an
insured service.
(6) A contract to provide compensation for the loss of time
from usual or normal activities because of disabilities
requiring insured services.
(7) A contract that is an insurance contract for the benefit of
an Indiana resident:
(A) whose principal employment is:
(i) outside Indiana; or
(ii) with the federal government or an agency or
instrumentality of the federal government; and
(B) who is covered by the contract because of employment.
(8) A contract relating to providing health care for an
individual who is not a resident.
Sec. 2. (a) This section does not apply to a health insurance
contract entered into before January 1, 2011.
(b) A health insurance contract is unenforceable in Indiana.
Sec. 3. (a) A health insurance contract in force before January
1, 2008, may not be renewed after December 31, 2010.
(b) An insurance contract renewed after December 31, 2010, is
unenforceable.
Sec. 4. After December 31, 2010, a person may not enter into or
renew an insurance contract.
Sec. 5. A resident may not accept or receive a benefit under an
insurance contract that is unenforceable under section 2 or 3 of this
chapter.
Sec. 6. This article does not prohibit a collective bargaining
agreement from providing for health care services or benefits to
employees of an employer in addition to health care services or
benefits that are insured services.
Sec. 7. A collective bargaining agreement may provide that an
employer reimburse or compensate employees for costs incurred
by employees for health care services that are insured services,
including the following costs:
(1) Copayments and other charges that are required to be
paid by an insured under this article.
(2) Any taxes for which employees are liable under
IC 16-48-6-15.
Sec. 8. An employer that provides health care services or
benefits to employees of an employer in addition to health care
services or benefits that are insured services may not reduce the
services or benefits.
Chapter 11. Subrogation
Sec. 1. (a) If an insured suffers personal injuries or death:
(1) caused by the wrongful act or omission of another person;
and
(2) for which the insured receives insured services under the
plan;
the commission shall contract out to recover the cost incurred for
past insured services and the cost that will be incurred for future
insured services. However, the commission is entitled to negotiate
and establish a fee schedule for payment of legal service costs
incurred in any recovery action.
(b) The commission claiming subrogation or reimbursement
rights under this section shall pay out of the amount received from
the insured the commission's pro rata share of the costs and
expenses of asserting the third party claim. The commission shall
negotiate the expenses of a third party claim based on the costs and
expenses of asserting the third party claim. The costs and expenses
include the following:
(1) Deposition costs.
(2) Witness fees.
(3) Attorney's fees.
(c) If the commission claims subrogation or reimbursement as
a result of the payment of medical expenses or other benefits
related to a claim for personal injuries or death and the insured's
recovery is diminished by:
(1) comparative fault; or
(2) the uncollectibility of the full value of the claim for
personal injuries or death that results from limited liability
insurance or another cause;
the claim for subrogation and reimbursement must be diminished
in the same proportion as the claimant's recovery is diminished.
The commission shall pay a pro rata share of the claimant's
attorney's fees and litigation expenses.
Sec. 2. (a) This section does not apply if the executive director
grants a waiver.
(b) A person who commences an action to recover for loss or
damages for injuries:
(1) arising out of the negligence or wrongful act of a third
person; and
(2) for which insured services have been paid by the
commission;
must include a claim on behalf of the commission for the cost of
insured services.
Sec. 3. (a) This section applies to an action, including a claim for
the cost of insured services required under section 2 of this
chapter.
(b) The court shall, if the evidence permits, apportion the
elements of the insured's loss and damages to designate both of the
following:
(1) The amount of the commission's recovery for the past
costs of insured services.
(2) The amount of the commission's recovery of future costs
of insured services, if any.
Sec. 4. Unless the commission has approved the release or
settlement, a release or settlement of a claim for damages for
personal injuries in a case in which an insured has received insured
services is not binding on the commission.
Sec. 5. (a) A liability insurer must notify the commission of
negotiations for settlement of a claim for damages, including
insured services for an insured.
(b) A liability insurer may pay to the commission any amount
of the cost of insured services relating to a claim for recovery of the
cost of the insured services for an insured. Payment by a liability
insurer under this subsection discharges the obligation of the
liability insurer to pay that amount to the person insured under the
policy of liability insurance.
Sec. 6. If a judgment or settlement includes the future cost of
insured services, the plan shall provide for the future insured
services included in the judgment or settlement.
Sec. 7. If a person recovers a sum in respect of the cost of
insured services paid by the commission, the person shall pay the
sum to the commission as soon as possible.
Sec. 8. The commission is subrogated to the right of a provider
or an insured to recover the cost of insured services provided to an
insured who has an insurance contract not prohibited by
IC 16-48-10.
Sec. 9. The commission may bring an action in the commission's
own name to recover costs for which the commission has the right
of subrogation under this chapter.
Chapter 12. Employer Health Payments by Governmental
Bodies
Sec. 1. Subject to section 6 of this chapter, this chapter does not
apply to the following governmental bodies:
(1) The federal government or an agency or instrumentality
of the federal government.
(2) The government of a state of the United States other than
the government of Indiana.
(3) A political subdivision of a state other than a political
subdivision of Indiana.
Sec. 2. As used in this chapter, "employee" has the meaning set
forth in IC 6-3-1-6.
Sec. 3. A governmental body shall pay to the department of state
revenue the amount equal to the amount required by IC 16-48-6-15
to be paid by employers subject to IC 16-48-6-15 for each
individual employed for each month or part of a month as an
employee by the governmental body.
Sec. 4. A governmental body shall report and pay the amount
required by section 3 of this chapter before the fifteenth day of the
month following the month for which the payment is required.
Sec. 5. (a) There is annually appropriated from each
appropriate fund of the state an amount necessary to pay the
amounts required to be paid by the state under this chapter.
(b) Each political subdivision shall appropriate the amount
required to be paid under section 3 of this chapter from the
appropriate funds of the political subdivision.
Sec. 6. (a) A governmental body of the type listed in section 1 of
this chapter may make a contribution to the fund for the benefit of
employees of the governmental body who are insureds.
(b) A contribution made under this section shall be made to the
department of state revenue.
(c) The department of state revenue may not accept a
contribution from a governmental body under this section unless
the governmental body agrees to do all the following:
(1) Pay an amount equal to the amount required by
IC 16-48-6-15 to be paid by employers subject to
IC 16-48-6-15 for each insured employed for each month or
part of a month by the governmental body during the
calendar year.
(2) Pay the amounts required to be paid to the department of
state revenue before the fifteenth day of the month following
the month for which payment is required.
(3) Withhold, report (including reports to insured employees
required by IC 16-48-15), and pay the individual health
insurance contribution assessment for insureds employed by
the governmental body at any time during the calendar year
as provided in IC 16-48-15.
Sec. 7. The department of state revenue shall deposit revenue
derived from payments and contributions made under this chapter
into the fund.
Chapter 13. Clinical Panels
Sec. 1. The commission shall develop information concerning
the best available knowledge about the provision of health care
under given circumstances and distribute the knowledge to
providers throughout Indiana.
Sec. 2. The commission may establish panels of practitioners
from a variety of health care practices to develop the information
described in section 1 of this chapter.
Sec. 3. The commission shall establish panels to consider high
cost, high risk, and high volume procedures.
Sec. 4. (a) The governor shall appoint the members of a panel
established by the commission.
(b) A member of a panel must have the following qualifications:
(1) Superior clinical, health care, or scientific expertise.
(2) Recognition by the individual's peers as an outstanding
practitioner or scientist.
(c) A panel must include all the following:
(1) Generalist physician providers.
(2) Specialty providers.
(3) Providers other than those specified in subdivisions (1) and
(2).
(d) When establishing a panel, the commission must provide for
both of the following:
(1) Initial terms of members that expire on a staggered basis.
(2) Four (4) year terms for members after expiration of initial
terms.
Sec. 5. A panel established under this chapter may do the
following:
(1) Review existing and new practice guidelines developed by
nationally recognized organizations.
(2) Develop new practice guidelines at the direction of the
commission.
(3) Make recommendations to the commission for adoption of
the best practice guidelines.
Sec. 6. In making recommendations of guidelines to the
commission, a panel shall rely on the following in the following
order of priority:
(1) Medical outcomes studies when available.
(2) Clinical practice guidelines (patterns of practice and
collective judgment of health care providers).
(3) Normative data.
Sec. 7. (a) Each member of a panel who is not a state employee
is entitled to the minimum salary per diem provided by
IC 4-10-11-2.1(b). The member is also entitled to reimbursement
for traveling expenses as provided under IC 4-13-1-4 and other
expenses actually incurred in connection with the member's duties
as provided in the state policies and procedures established by the
Indiana department of administration and approved by the budget
agency.
(b) Each member of a panel who is a state employee is entitled
to reimbursement for traveling expenses as provided under
IC 4-13-1-4 and other expenses actually incurred in connection
with the member's duties as provided in the state policies and
procedures established by the Indiana department of
administration and approved by the budget agency.
Sec. 8. The costs of the work of a panel shall be paid from the
fund as determined by the commission.
Chapter 14. Primary Care Provider Education Loan Program
Sec. 1. This chapter applies only to primary care providers
practicing in the following areas:
(1) Family practice.
(2) General practice.
(3) Internal medicine.
(4) Obstetrics and gynecology.
(5) Pediatrics.
(6) Nursing, including as a nurse practitioner or nurse
midwife.
(7) Physician assistants regulated by IC 25-27.5.
(8) Social work.
(9) Osteopathic medicine.
(10) A health care practice considered necessary by the
commission.
Sec. 2. The commission may establish a loan program for
students who meet the following criteria:
(1) The student plans to become a primary care provider.
(2) The student agrees to practice as a primary care provider
in an underserved area (for that primary care provider
category) in Indiana for seven (7) years.
(3) The student attends a school that, to the satisfaction of the
commission, has established programs to increase the number
of primary care provider graduates from the school.
(4) Any other qualification established by the commission
related to the goal of increasing the number of primary care
providers in underserved areas of Indiana.
Sec. 3. A program established under this chapter may not
provide a loan to a student for more than the total actual cost of
tuition incurred by the student for the student's education as a
primary care provider.
Sec. 4. The commission shall provide for the interest rates to be
paid on loans made under the program. The commission shall fix
interest rates for the loans to advance the purposes of the program.
Sec. 5. The commission shall provide that a loan and the interest
on a loan may be forgiven as provided by the commission if the
student meets the requirements of the program.
Sec. 6. A student or primary care provider who materially
violates the requirements of this chapter or of the program is liable
for the following, as determined by the commission:
(1) The full amount of the loan.
(2) All interest.
(3) All expenses incurred, including attorney's fees, in
collection of the amounts described in subdivisions (1) and (2).
Chapter 15. Prohibition Against Self Referrals
Sec. 1. As used in this chapter, "facility" means any of the
following:
(1) A clinical laboratory.
(2) A comprehensive rehabilitation center.
(3) A diagnostic imaging center.
(4) A radiation therapy center.
Sec. 2. Except as provided in section 3 of this chapter, a provider
may not receive any consideration for referring a patient to a
facility in which the provider has a financial interest.
Sec. 3. A provider may receive consideration for referring a
patient to a facility in which the provider has a financial interest
only if all of the following apply:
(1) The facility is owned by, or under the control of, a
corporation.
(2) Stock in the corporation is traded over the counter or on
a national exchange.
(3) The assets of the corporation are more than fifty million
dollars ($50,000,000).
(4) The provider holds less than fifty percent (50%) of the
value of the stock of the corporation.
(5) Any conditions for purchase of the stock of the
corporation do not require referral of patients.
(6) Income from investment in the corporation is not related
to volume of referrals.
Sec. 4. (a) The commission may impose a civil penalty on a
provider that the commission finds has violated section 2 of this
chapter.
(b) IC 4-21.5 applies to a proceeding under this section.
(c) A civil penalty imposed under this section may not exceed
fifteen thousand dollars ($15,000) for each violation.
(d) A civil penalty imposed under this section shall be paid into
the fund.
SOURCE: ; (07)IN1680.1.36. -->
SECTION 36. [EFFECTIVE JULY 1, 2007] (a) As used in this
SECTION, "commission" refers to the health insurance
commission established by IC 16-48-3-1, as added by this act.
(b) The governor shall appoint the members of the commission
under IC 16-48-3-2(1), as added by this act, before January 1, 2008.
(c) Notwithstanding IC 16-48-3-3, as added by this act, the
initial terms of the members of the commission expire as follows:
(1) The term of one (1) member appointed under each of the
following statutes expires July 1, 2009:
(A) IC 16-48-3-2(1)(A), as added by this act.
(B) IC 16-48-3-2(1)(B), as added by this act.
(C) IC 16-48-3-2(1)(C), as added by this act.
(D) IC 16-48-3-2(1)(D), as added by this act.
(2) The term of one (1) member appointed under each of the
following statutes expires July 1, 2010:
(A) IC 16-48-3-2(1)(A), as added by this act.
(B) IC 16-48-3-2(1)(B), as added by this act.
(C) IC 16-48-3-2(1)(E), as added by this act.
(3) The terms of two (2) members appointed under
IC 16-48-3-2(1)(C), as added by this act, expire July 1, 2010.
(4) The term of one (1) member appointed under each of the
following statutes expires July 1, 2011:
(A) IC 16-48-3-2(1)(A), as added by this act.
(B) IC 16-48-3-2(1)(B), as added by this act.
(C) IC 16-48-3-2(1)(D), as added by this act.
(5) The terms of two (2) members appointed under
IC 16-48-3-2(1)(C), as added by this act, expire July 1, 2011.
(6) The term of one (1) member appointed under each of the
following statutes expires July 1, 2012:
(A) IC 16-48-3-2(1)(A), as added by this act.
(B) IC 16-48-3-2(1)(B), as added by this act.
(C) IC 16-48-3-2(1)(E), as added by this act.
(7) The terms of two (2) members appointed under
IC 16-48-3-2(1)(C), as added by this act, expire July 1, 2011.
(d) Subject to this SECTION, when appointing a member of the
commission under this SECTION, the governor shall specify when
the term of a member expires.
(e) This SECTION expires July 1, 2013.
SOURCE: ; (07)IN1680.1.37. -->
SECTION 37. [EFFECTIVE JULY 1, 2007] (a) As used in this
SECTION, "commission" refers to the health insurance
commission established by IC 16-48-3-1, as added by this act.
(b) The speaker of the house of representatives and the
president pro tempore of the senate shall appoint the advisory
members of the commission under IC 16-48-3-2(2), as added by
this act, before January 1, 2008.
(c) This SECTION expires January 1, 2009.
SOURCE: ; (07)IN1680.1.38. -->
SECTION 38. [EFFECTIVE JULY 1, 2007]
(a) As used in this
SECTION, "commission" refers to the health insurance
commission established by IC 16-48-3-1, as added by this act.
(b) As used in this SECTION, "ERISA" refers to the federal
Employee Retirement Income Security Act (29 U.S.C. 1001 et seq.).
(c) As used in this SECTION, "insured services" has the
meaning set forth in IC 16-48-1-17, as added by this act.
(d) As used in this SECTION, "Medicaid program" refers to the
program established under IC 12-15 and 42 U.S.C. 1396 et seq.
(e) As used in this SECTION, "Medicare program" refers to
Parts A, B, and D of the Medicare program (42 U.S.C. 1395 et
seq.).
(f) As used in this SECTION, "plan" refers to the Indiana
health insurance plan established by IC 16-48-5-1, as added by this
act.
(g) As used in this SECTION, "veterans benefits" refers to
health care benefits that a veteran (as defined in 38 U.S.C. 101) is
entitled to under 38 U.S.C. 1701 et seq.
(h) Notwithstanding IC 16-48, as added by this act, the
commission is not required to provide for coverage of insured
services before the later of the following:
(1) January 1 of the year after the state has obtained
appropriate approvals, assurances, or waivers from the
federal government for all the following:
(A) That the plan may be implemented, notwithstanding
ERISA.
(B) That money paid to the state under the Medicaid
program may be paid to the commission for
reimbursement of insured services:
(i) paid by the plan; and
(ii) covered by the Medicaid program.
(C) That money paid to providers under the Medicare
program will be paid to the commission for reimbursement
of insured services:
(i) paid by the plan; and
(ii) covered by the Medicare program.
(D) That money paid to providers as veterans benefits will
be paid to the commission for reimbursement of insured
services.
(2) The budget agency determines that there are sufficient
federal, state, and local funds to operate the plan as required
by IC 16-48, as added by this act, including the reserve
requirements of IC 16-48-6-10, as added by this act. Before
July 1, 2009, the commission and the budget agency shall
report to the governor and the budget committee concerning
funding of the plan. The budget committee may hold hearings
and exercise other powers of the budget committee under
IC 4-12 regarding the funding of the plan.
(i) If all the approvals, assurances, or waivers described in
subsection (h)(1) have not been obtained before October 1, 2009,
the commission shall make appropriate recommendations to the
2010 regular session of the general assembly for legislation to
modify or, if necessary, to repeal the plan.
(j) If the report of the commission and the budget agency made
under subsection (h)(2) concludes that there are not sufficient
funds to operate the plan as required by IC 16-48, as added by this
act, the commission and the budget agency shall recommend
introduction of legislation in the 2010 regular session of the general
assembly to repeal the plan.
(k) This SECTION expires July 1, 2012.
SOURCE: ; (07)IN1680.1.39. -->
SECTION 39. [EFFECTIVE JULY 1, 2007] (a) As used in this
SECTION, "governmental body" has the meaning set forth in
IC 16-48-1-13, as added by this act.
(b) Notwithstanding IC 16-48-12-3, as added by this act, a
governmental body required to make a payment to the department
of state revenue under IC 16-48-12-3, as added by this act, is not
required to make a payment before January 1, 2009.
(c) This SECTION expires January 1, 2010.
SOURCE: ; (07)IN1680.1.40. -->
SECTION 40. [EFFECTIVE JULY 1, 2007]
(a) Notwithstanding
IC 16-48-3-12, as added by this act, the commissioner of the state
department of health shall serve as a temporary executive director
until the health insurance commission has employed a full-time
executive director.
(b) Notwithstanding IC 16-48-3-13, as added by this act, the
state department of health shall provide staff for the health
insurance commission until a full-time executive director has been
employed.
(c) This SECTION expires July 1, 2009.
SOURCE: ; (07)IN1680.1.41. -->
SECTION 41. [EFFECTIVE JULY 1, 2007] (a) As used in this
SECTION, "commission" refers to the health insurance
commission established by IC 16-48-3-1, as added by this act.
(b) There is appropriated to the commission forty-nine thousand
dollars ($49,000) from the state general fund to carry out the
commission's duties under this act beginning January 1, 2008, and
ending December 31, 2010.
(c) This SECTION expires January 1, 2012.
SOURCE: ; (07)IN1680.1.42. -->
SECTION 42. [EFFECTIVE JULY 1, 2007]
Notwithstanding
IC 6-7-1-14, revenue stamps paid for before July 1, 2007, and in the
possession of a distributor may be used after June 30, 2007, only if
the full amount of the tax imposed by IC 6-7-1-12, as effective after
June 30, 2007, and as amended by this act, is remitted to the
department of state revenue under procedures prescribed by the
department.