Reprinted
April 15, 2009
ENGROSSED
HOUSE BILL No. 1572
_____
DIGEST OF HB 1572
(Updated April 14, 2009 3:44 pm - DI 104)
Citations Affected: IC 2-5; IC 12-13; IC 23-2; noncode.
Synopsis: Medicaid matters. Requires the health finance commission
to study all aspects of the health facility quality assessment fee.
Requires the health policy advisory committee to submit an annual
report to the health finance commission on the committee's findings
and recommendations. Revises the definition of "continuing care
agreement". Specifies when a person providing continuing care has to
register the continuing care retirement community with the securities
commissioner. Eliminates payments to the Indiana retirement home
guaranty fund after June 30, 2009. Removes provisions limiting the
health facilities subject to the quality assessment fee based on the
health facility's Medicaid utilization rate and annual Medicaid revenue.
Eliminates the exemption from the quality assessment fee for health
facilities that only receive Medicare revenues. Provides an exemption
for hospital based health facilities. Specifies conditions that a
(Continued next page)
Effective: Upon passage; October 1, 2008 (retroactive); January 1,
2009 (retroactive); July 1, 2009.
Welch, Brown C
, Crawford
, Turner
(SENATE SPONSORS _ MILLER, ERRINGTON)
January 16, 2009, read first time and referred to Committee on Public Health.
February 19, 2009, amended, reported _ Do Pass.
February 23, 2009, read second time, ordered engrossed. Engrossed.
February 25, 2009, read third time, passed. Yeas 97, nays 1.
SENATE ACTION
March 3, 2009, read first time and referred to Committee on Health and Provider Services.
April 9, 2009, amended, reported favorably _ Do Pass.
April 14, 2009, read second time, amended, ordered engrossed.
Digest Continued
continuing care retirement community must meet in order to be exempt
from the quality assessment fee. Eliminates the role of the department
of state revenue in collecting quality assessment fees. Specifies the
percentage distribution of money collected from the quality assessment
depending on whether the state is receiving an adjusted federal medical
assistance percentage by the federal American Recovery and
Reinvestment Act of 2009. Extends the health facility quality
assessment fee until August 1, 2011. (The fee currently expires August
1, 2009.) Requires that certain contractors for: (1) the division of
family resources; (2) the office of Medicaid policy and planning; and
(3) the office of the secretary of family and social services; that process
eligibility intake information for the federal supplemental nutrition
assistance program (SNAP), the temporary assistance to needy families
(TANF) program, and the Medicaid program review certain intake
statistics and provide certain information to the select joint commission
on Medicaid oversight. Establishes the Medicaid managed care quality
strategy committee to study issues related to Medicaid managed care.
Reprinted
April 15, 2009
First Regular Session 116th General Assembly (2009)
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 2008 Regular Session of the General Assembly.
ENGROSSED
HOUSE BILL No. 1572
A BILL FOR AN ACT to amend the Indiana Code concerning
Medicaid.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 2-5-23-4; (09)EH1572.2.1. -->
SECTION 1. IC 2-5-23-4 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2009]: Sec. 4. (a) The commission may study
any topic:
(1) directed by the chairman of the commission;
(2) assigned by the legislative council; or
(3) concerning issues that include:
(A) the delivery, payment, and organization of health care
services;
(B) rules adopted under IC 4-22-2 that pertain to health care
delivery, payment, and services that are under the authority of
any board or agency of state government; and
(C) the implementation of IC 12-10-11.5.
(b) The commission shall study all aspects of the health facility
quality assessment fee collected by the office of Medicaid policy
and planning.
SOURCE: IC 2-5-23-8; (09)EH1572.2.2. -->
SECTION 2. IC 2-5-23-8 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 8.
Beginning May 1, 1997, (a)
The health policy advisory committee is established. At the request of
the chairman of the commission, the health policy advisory committee
shall provide information and otherwise assist the commission to
perform the duties of the commission under this chapter.
(b) The health policy advisory committee members are ex officio
and may not vote.
(c) The health policy advisory committee members shall be
appointed from the general public and must include one (1) individual
who represents each of the following:
(1) The interests of public hospitals.
(2) The interests of community mental health centers.
(3) The interests of community health centers.
(4) The interests of the long term care industry.
(5) The interests of health care professionals licensed under
IC 25, but not licensed under IC 25-22.5.
(6) The interests of rural hospitals. An individual appointed under
this subdivision must be licensed under IC 25-22.5.
(7) The interests of health maintenance organizations (as defined
in IC 27-13-1-19).
(8) The interests of for-profit health care facilities (as defined in
IC 27-8-10-1).
(9) A statewide consumer organization.
(10) A statewide senior citizen organization.
(11) A statewide organization representing people with
disabilities.
(12) Organized labor.
(13) The interests of businesses that purchase health insurance
policies.
(14) The interests of businesses that provide employee welfare
benefit plans (as defined in 29 U.S.C. 1002) that are self-funded.
(15) A minority community.
(16) The uninsured. An individual appointed under this
subdivision must be and must have been chronically uninsured.
(17) An individual who is not associated with any organization,
business, or profession represented in this subsection other than
as a consumer.
(d) The chairman of the commission shall annually select a
member of the health policy advisory committee to serve as
chairperson.
(e) The health policy advisory committee shall meet at the call
of the chairperson of the health policy advisory committee.
(f) The health policy advisory committee shall submit an annual
report not later than September 15 of each year to the commission
that summarizes the committee's actions and the committee's
findings and recommendations on any topic assigned to the
committee. The report must be in an electronic format under
IC 5-14-6.
SOURCE: IC 12-13-5-14; (09)EH1572.2.3. -->
SECTION 3. IC 12-13-5-14 IS ADDED TO THE INDIANA CODE
AS A
NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2009]:
Sec. 14. (a) As used in this section, "commission" refers
to the select joint commission on Medicaid oversight (IC 2-5-26-3).
(b) A contractor for the division, office, or secretary that has
responsibility for processing eligibility intake for the federal
Supplemental Nutrition Assistance program (SNAP), the
Temporary Assistance for Needy Families (TANF) program, and
the Medicaid program shall do the following:
(1) Review the eligibility intake process for:
(A) document management issues, including:
(i) unattached documents;
(ii) number of documents received by facsimile;
(iii) number of documents received by mail;
(iv) number of documents incorrectly classified;
(v) number of documents that are not indexed or not
correctly attached to cases;
(vi) number of complaints from clients regarding lost
documents; and
(vii) number of complaints from clients resolved
regarding lost documents;
(B) direct client assistance at county offices, including the:
(i) number of clients helped directly in completing
eligibility application forms;
(ii) wait times at local offices;
(iii) amount of time an applicant is given as notice before
a scheduled applicant appointment;
(iv) amount of time an applicant waits for a scheduled
appointment; and
(v) timeliness of the tasks sent by the contractor to the
state for further action, as specified through contracted
performance standards; and
(C) call wait times and abandonment rates.
(2) Provide an update on employee training programs.
(3) Provide a copy of the monthly key performance indicator
report.
(4) Provide information on error reports and contractor
compliance with the contract.
(5) Provide oral and written reports to the commission
concerning matters described in subdivision (1):
(A) in a manner and format to be agreed upon with the
commission; and
(B) whenever the commission requests.
(c) Solely referring an individual to a computer or telephone
does not constitute the direct client assistance referred to in
subsection (b)(1)(B).
SOURCE: IC 23-2-4-1; (09)EH1572.2.4. -->
SECTION 4. IC 23-2-4-1, AS AMENDED BY P.L.27-2007,
SECTION 16, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2009 (RETROACTIVE)]: Sec. 1. As used in this
chapter, the term:
"Application fee" means the fee charged an individual, in addition
to the entrance fee or any other fee, to cover the provider's reasonable
costs in processing the individual's application to become a resident.
"Commissioner" means the securities commissioner as provided in
IC 23-19-6-1(a).
"Continuing care agreement" means
the following:
(1) For continuing care retirement communities registered
before July 1, 2009, an agreement by a provider to furnish to
at
least one (1) an individual, for the payment of an entrance fee
of
at least twenty-five thousand dollars ($25,000) and periodic
charges:
(A) accommodations in a living unit of a
home and:
continuing care retirement community;
(1) (B) meals and related services;
(2) (C) nursing care services;
(3) (D) medical services;
(4) (E) other health related services; or
(5) (F) any combination of these services;
for the life of the individual or for more than one (1) month,
unless the agreement is cancelled.
(2) For continuing care retirement communities registered
after June 30, 2009, an agreement by a provider to furnish to
an individual, for the payment of an entrance fee of at least
twenty-five thousand dollars ($25,000) and periodic charges:
(A) accommodations in a living unit of a continuing care
retirement community;
(B) meals and related services;
(C) nursing care services;
(D) medical services;
(E) other health related services; or
(F) any combination of these services;
for the life of the individual, unless the agreement is
terminated as specified under this chapter.
"Continuing care retirement community" includes both of the
following:
(1) An independent living facility.
(2) A health facility licensed under IC 16-28.
"Contracting party" means a person or persons who enter into a
continuing care agreement with a provider.
"Entrance fee" means the sum of money or other property paid or
transferred, or promised to be paid or transferred, to a provider in
consideration for one (1) or more individuals becoming a resident of a
home continuing care retirement community under a continuing care
agreement.
"Home" means a facility where the provider undertakes, pursuant to
a continuing care agreement, to provide continuing care to five (5) or
more residents.
"Living unit" means a room, apartment, cottage, or other area within
a
home continuing care retirement community set aside for the use
of one (1) or more identified residents.
"Long term financing" means financing for a period in excess of one
(1) year.
"Omission of a material fact" means the failure to state a material
fact required to be stated in any disclosure statement or registration in
order to make the disclosure statement or registration, in light of the
circumstances under which they were made, not misleading.
"Person" means an individual, a corporation, a partnership, an
association, a limited liability company, or other legal entity.
"Provider" means a person that agrees to provide
continuing care
to
an individual under a continuing care agreement.
"Refurbishment fee" means the fee charged an individual, in
addition to the entrance fee or any other fee, to cover the provider's
reasonable costs in refurbishing a previously occupied living unit
specifically designated for occupancy by that individual.
"Resident" means an individual who is entitled to receive benefits
under a continuing care agreement.
"Solicit" means any action of a provider in seeking to have an
individual residing in Indiana pay an application fee and enter into a
continuing care agreement, including:
(1) personal, telephone, or mail communication or any other
communication directed to and received by any individual in
Indiana; and
(2) advertising in any media distributed or communicated by any
means to individuals residing in Indiana.
"Termination" refers to the cancellation of a continuing care
agreement under this chapter.
SOURCE: IC 23-2-4-2; (09)EH1572.2.5. -->
SECTION 5. IC 23-2-4-2 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]: Sec. 2. This
chapter applies to any person who:
(1) enters into a continuing care agreement in Indiana to provide
care at a home continuing care retirement community located
either inside Indiana or outside Indiana;
(2) enters into a continuing care agreement outside Indiana to
provide care at a home continuing care retirement community
located in Indiana;
(3) extends the term of an existing continuing care agreement in
Indiana to provide care at a home continuing care retirement
community located either inside Indiana or outside Indiana;
(4) extends the term of an existing continuing care agreement
outside Indiana to provide care at a home continuing care
retirement community located in Indiana; or
(5) solicits the execution of a continuing care agreement by
persons in Indiana.
SOURCE: IC 23-2-4-3; (09)EH1572.2.6. -->
SECTION 6. IC 23-2-4-3 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]: Sec. 3. (a) A
provider shall register each home continuing care retirement
community with the commissioner if:
(1) before opening the continuing care retirement community,
the provider:
(A) enters into;
(B) extends; or
(C) solicits;
a continuing care agreement; or
(2) while operating the continuing care retirement
community, the provider has entered into a continuing care
agreement with at least twenty-five percent (25%) of the
individuals living in the continuing care retirement
community.
(b) If a provider fails to register a home, continuing care
retirement community, the provider may not:
(1) enter into, or extend the term of, a continuing care agreement
to provide continuing care to any person at that home; continuing
care retirement community;
(2) provide services at that home continuing care retirement
community under a continuing care agreement; or
(3) solicit the execution, by persons residing within Indiana, of a
continuing care agreement to provide continuing care at that
home. continuing care retirement community.
(b) (c) The provider's application for registration must be filed with
the commissioner by the provider on forms prescribed by the
commissioner, and must be accompanied by an application fee of two
hundred fifty dollars ($250). The application must contain the
following information:
(1) an initial disclosure statement, as described in section 4 of this
chapter; and
(2) any other information required by the commissioner under
rules adopted under this chapter.
(c) (d) The commissioner may accept, in lieu of the information
required by subsection (b), (c), any other registration, disclosure
statement, or other document filed by the provider in Indiana, in any
other state, or with the federal government if the commissioner
determines that such document substantially complies with the
requirements of this chapter.
(d) (e) Upon receipt of the application for registration, the
commissioner shall mark the application filed. Within sixty (60) days
of the filing of the application, the commissioner shall enter an order
registering the provider or rejecting the registration. If no order of
rejection is entered within that sixty (60) day period, the provider shall
be considered registered unless the provider has consented in writing
to an extension of time; if no order of rejection is entered within the
time period as extended by consent, the provider shall be considered
registered.
(e) (f) If the commissioner determines that the application for
registration complies with all of the requirements of this chapter, the
commissioner shall enter an order registering the provider. If the
commissioner determines that such requirements have not been met,
the commissioner shall notify the provider of the deficiencies and shall
inform the provider that it has sixty (60) days to correct them. If the
deficiencies are not corrected within sixty (60) days, the commissioner
shall enter an order rejecting the registration. The order rejecting the
registration shall include the findings of fact upon which the order is
based. The provider may petition for reconsideration, and is entitled to
a hearing upon that petition.
SOURCE: IC 23-2-4-4; (09)EH1572.2.7. -->
SECTION 7. IC 23-2-4-4 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]: Sec. 4. The
initial disclosure statement shall contain the following information:
(1) The name and business address of the provider.
(2) If the provider is a partnership, corporation, limited liability
company, or association, the names and duties of its officers,
directors, trustees, partners, members, or managers.
(3) The name and business address of any person having a five
percent (5%) or greater ownership interest in the provider or
manager of the home. continuing care retirement community.
(4) A description of the business experience of the provider and
its officers, directors, trustees, partners, or managers.
(5) A statement as to whether the provider or any of its officers,
directors, trustees, partners, or managers, within ten (10) years
prior to the date of the initial disclosure statement:
(A) was convicted of a crime;
(B) was a party to any civil action for fraud, embezzlement,
fraudulent conversion, or misappropriation of property that
resulted in a judgment against him; the provider or
individual;
(C) had a prior discharge in bankruptcy or was found insolvent
in any court action; or
(D) had any state or federal licenses or permits suspended or
revoked in connection with any health care or continuing care
activities, or related business activities.
(6) The identity of any other home continuing care retirement
community currently or previously operated by the provider or
manager of the home. continuing care retirement community.
(7) The location and description of other properties, both existing
and proposed, of the provider in which the provider owns a
twenty-five percent (25%) ownership interest, and on which
homes continuing care retirement communities are or are
intended to be located.
(8) A statement as to whether the provider is, or is affiliated with,
a religious, charitable, or other nonprofit association, and the
extent to which the affiliate organization is responsible for the
financial and contractual obligations of the provider.
(9) A description of all services to be provided by the provider
under its continuing care agreements with contracting parties, and
a description of all fees for those services, including conditions
under which the fees may be adjusted.
(10) A description of the terms and conditions under which the
continuing care agreement can be cancelled, or fees refunded.
(11) Financial statements of the provider prepared in accordance
with generally accepted accounting principles applied on a
consistent basis and certified by an independent certified or
public accountant, including a balance sheet as of the end of the
provider's last fiscal year and income statements for the last three
(3) fiscal years, or such shorter period of time as the provider has
been in operation.
(12) If the operation of the home continuing care retirement
community has not begun, a statement of the anticipated source
and application of funds to be used in the purchase or
construction of the home, continuing care retirement
community, and an estimate of the funds, if any, which are
anticipated to be necessary to pay for start-up losses.
(13) A copy of the forms of agreement for continuing care used by
the provider.
(14) Any other information that the commissioner may require by
rule or order.
SOURCE: IC 23-2-4-5; (09)EH1572.2.8. -->
SECTION 8. IC 23-2-4-5 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]: Sec. 5. (a) Each
year after the initial year in which a home continuing care retirement
community is registered under section 3 of this chapter, the provider
shall file with the commissioner within four (4) months after the end of
the provider's fiscal year, unless otherwise extended by the written
consent of the commissioner, an annual disclosure statement which
shall consist of the financial information set forth in section 4(11) of
this chapter.
(b) The annual disclosure statement required to be filed with the
commissioner under this section shall be accompanied by an annual
filing fee of one hundred dollars ($100).
SOURCE: IC 23-2-4-6; (09)EH1572.2.9. -->
SECTION 9. IC 23-2-4-6 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]: Sec. 6. (a) A
provider shall amend its initial or annual disclosure statement filed
with the commissioner under section 3 and section 5 of this chapter at
any time if necessary to prevent the initial or annual disclosure
statement from containing any material misstatement of fact or
omission of a material fact.
(b) Upon the sale of a home continuing care retirement
community to a new provider, the new provider shall amend the
currently filed disclosure statement to reflect the fact of sale and any
other fact that would be required to be disclosed under section 4 of this
chapter if the new provider were filing an initial disclosure statement.
SOURCE: IC 23-2-4-7.5; (09)EH1572.2.10. -->
SECTION 10. IC 23-2-4-7.5 IS ADDED TO THE INDIANA CODE
AS A
NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2009 (RETROACTIVE)]: Sec. 7.5. (a) This section
does not apply to a continuing care retirement community
registered before July 1, 2009.
(b) A continuing care agreement may be terminated for any of
the following reasons:
(1) The provider has determined that the resident is
inappropriate for living in the care setting.
(2) The resident is unable to fully pay the periodic charges
because the resident inappropriately divested the assets and
income the resident identified at the time of admission to meet
the ordinary and customary living expenses for the resident.
(3) Providing assistance to the resident would jeopardize the
financial solvency of the provider and the other residents
being served by the provider.
(4) The resident has requested a termination of the agreement
as allowed under the agreement.
SOURCE: IC 23-2-4-10; (09)EH1572.2.11. -->
SECTION 11. IC 23-2-4-10 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]:
Sec. 10. (a) Except as provided by section 11 of this chapter, the
commissioner shall require, as a condition of registration, that:
(1) the provider establish an interest-bearing escrow account with
a bank, trust company, or other escrow agent approved by the
commissioner; and
(2) any entrance fees received by the provider prior to the date the
resident is permitted to occupy the living unit in the
home
continuing care retirement community be placed in the escrow
account, subject to release as provided by subsection (b).
(b) If the entrance fee gives the resident the right to occupy a living
unit that has been previously occupied, the entrance fee and any
income earned thereon shall be released to the provider when the living
unit is first occupied by the new resident. If the entrance fee applies to
a living unit that has not been previously occupied by any resident, the
entrance fee and any income earned thereon shall be released to the
provider when the commissioner is satisfied that:
(1) aggregate entrance fees received or receivable by the provider
pursuant to executed continuing care agreements, plus:
(A) anticipated proceeds of any first mortgage loan or other
long term financing commitment; and
(B) funds from other sources in the actual possession of the
provider;
are equal to at least fifty percent (50%) of the aggregate cost of
constructing, purchasing, equipping, and furnishing the
home
continuing care retirement community and equal to at least
fifty percent (50%) of the estimate of funds necessary to fund
startup losses of the home, continuing care retirement
community, as reported under section 4(12) of this chapter; and
(2) a commitment has been received by the provider for any
permanent mortgage loan or other long term financing described
in the statement of anticipated source and application of funds to
be used in the purchase or construction of the home continuing
care retirement community under section 4(12) of this chapter,
and any conditions of the commitment prior to disbursement of
funds thereunder, other than completion of the construction or
closing of the purchase of the home, continuing care retirement
community, have been substantially satisfied.
(c) If the funds in an escrow account under this section and any
interest earned thereon are not released within the time provided by this
section or by rules adopted by the commissioner, then the funds shall
be returned by the escrow agent to the persons who made the payment
to the provider.
(d) An entrance fee held in escrow shall be returned by the escrow
agent to the person who paid the fee in the following instances:
(1) At the election of the person who paid the fee, at any time
before the fee is released to the provider under subsection (b).
(2) Upon receipt by the escrow agent of notice from the provider
that the person is entitled to a refund of the entrance fee.
(e) This section does not require a provider to place a nonrefundable
application fee charged to prospective residents in escrow.
(f) A provider is not required to place a refurbishment fee of a
prospective resident in escrow if a continuing care agreement provides
that the prospective resident:
(1) will occupy the living unit within sixty (60) days after the
refurbishment fee is paid; and
(2) will receive a refund of any portion of the refurbishment fee
not expended for refurbishment if the continuing care agreement
is cancelled before occupancy.
SOURCE: IC 23-2-4-12; (09)EH1572.2.12. -->
SECTION 12. IC 23-2-4-12 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]:
Sec. 12. Any money or property received by a provider as an entrance
fee to a
home continuing care retirement community constructed or
purchased after August 31, 1982, or any income earned thereon, may
be used by the provider only for purposes directly related to the
construction, maintenance, or operation of that particular
home.
continuing care retirement community. A
home continuing care
retirement community in operation on September 1, 1982, may not
use the entrance fees or income earned thereon after August 31, 1982,
for the construction, operation, or maintenance of another home
continuing care retirement community constructed or purchased
after August 31, 1982.
SOURCE: IC 23-2-4-13; (09)EH1572.2.13. -->
SECTION 13. IC 23-2-4-13, AS AMENDED BY P.L.2-2006,
SECTION 180, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2009]: Sec. 13. (a) There is established the
Indiana retirement home guaranty fund. The purpose of the fund is to
provide a mechanism for protecting the financial interests of residents
and contracting parties in the event of the bankruptcy of the provider.
(b) To create the fund, a guaranty association fund fee of one
hundred dollars ($100) shall be levied on each contracting party who
enters into a continuing care agreement after August 31, 1982, and
before July 1, 2009. The fee shall be collected by the provider and
forwarded to the commissioner within thirty (30) days after occupancy
by the resident. Failure of the provider to collect and forward such fee
to the commissioner within that thirty (30) day period shall result in the
imposition by the commissioner of a twenty-five dollar ($25) penalty
against the provider. In addition, interest payable by the provider shall
accrue on the unpaid fee at the rate of two percent (2%) a month.
(c) Any money received by the commissioner under subsection (b)
shall be forwarded to the treasurer of state. The fund, and any income
from it, shall be held in trust, deposited in a segregated account,
invested and reinvested by the treasurer of state in the same manner as
provided in IC 20-49-3-10 for investment of the common school fund.
(d) All reasonable expenses of collecting and administering the fund
shall be paid from the fund.
(e) Money in the fund at the end of the state's fiscal year shall
remain in the fund and shall not revert to the general fund.
SOURCE: IC 23-2-4-16; (09)EH1572.2.14. -->
SECTION 14. IC 23-2-4-16 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]:
Sec. 16. (a) If a
home continuing care retirement community is
bankrupt and the operation of the
home continuing care retirement
community is terminated, the board of directors shall, subject to the
approval of the commissioner, distribute from the guaranty association
fund established in section 13 to the living residents of the
home
continuing care retirement community an aggregate amount not to
exceed one-half (1/2) of the amount in the fund at the time of
disbursement. The amount each living resident is entitled to receive
shall be prorated, based on the total amount paid on behalf of the
resident by the contracting party under the continuing care agreement.
In no event may the amount paid to an individual resident under this
section exceed the total amount paid on behalf of that resident under
the continuing care agreement, less the total value of services received
under the agreement.
(b) Any living resident of the home continuing care retirement
community shall be eligible to receive distributions under subsection
(a), regardless of whether any contribution to the guaranty association
fund has been made on behalf of the resident.
(c) A resident compensated under this section assigns his the
resident's rights under the continuing care agreement, to the extent of
compensation received under this section, to the board of directors on
behalf of the fund. The board of directors may require an assignment
of those rights by a resident to the board, on behalf of the fund, as a
condition precedent to the receipt of compensation under this section.
The board of directors, on behalf of the fund, is subrogated to these
rights against the assets of a bankrupt or dissolved provider. Any
monies or property collected by the board of directors under this
subsection shall be deposited in the fund.
(d) The subrogation rights of the board of directors, on behalf of the
fund, have the same priority against the assets of the bankrupt or
dissolved provider as those possessed by the resident under the
continuing care agreement.
SOURCE: IC 23-2-4-21; (09)EH1572.2.15. -->
SECTION 15. IC 23-2-4-21 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JANUARY 1, 2009 (RETROACTIVE)]:
Sec. 21. If the commissioner has reason to believe that a home
continuing care retirement community is insolvent, the
commissioner may petition the superior or circuit court of the county
in which the home continuing care retirement community is located,
or the superior or circuit court of Marion County, for the appointment
of a receiver to assume the management and possession of the home
continuing care retirement community and its assets.
SOURCE: ; (09)EH1572.2.16. -->
SECTION 16. P.L.3-2007, SECTION 1, IS AMENDED TO READ
AS FOLLOWS [EFFECTIVE OCTOBER 1, 2008 (RETROACTIVE)]:
SECTION 1. (a)
As used in this SECTION, "continuing care
retirement community" means a health care facility that:
(1) provides independent living services and health facility
services in a campus setting with common areas;
(2) holds continuing care agreements with at least twenty-five
percent (25%) of its residents (as defined in IC 23-2-4-1);
(3) uses the money described in subdivision (2) to provide
services to the resident before the resident may be eligible for
Medicaid under IC 12-15; and
(4) meets the requirements of IC 23-2-4.
(b) As used in this SECTION, "health facility" refers to a health
facility that is licensed under IC 16-28 as a comprehensive care facility.
(b) (c) As used in this SECTION, "nursing facility" means a health
facility that is certified for participation in the federal Medicaid
program under Title XIX of the federal Social Security Act (42 U.S.C.
1396 et seq.).
(c) (d) As used in this SECTION, "office" refers to the office of
Medicaid policy and planning established by IC 12-8-6-1.
(d) As used in this SECTION, "total annual revenue" does not
include revenue from Medicare services provided under Title XVIII of
the federal Social Security Act (42 U.S.C. 1395 et seq.).
(e) Effective August 1,
2003, 2009, the office shall collect a quality
assessment from each
nursing health facility.
that has:
(1) a Medicaid utilization rate of at least twenty-five percent
(25%); and
(2) at least seven hundred thousand dollars ($700,000) in annual
Medicaid revenue, adjusted annually by the average annual
percentage increase in Medicaid rates.
The office shall offset the collection of the assessment for a health
facility:
(1) against a Medicaid payment to the health facility by the
office; or
(2) in another manner determined by the office.
(f)
If The office shall implement the waiver approved by the
United States Centers for Medicare and Medicaid Services
determines
not to approve payments under this SECTION using the methodology
described in subsection (e), the office shall revise the state plan
amendment and waiver request submitted under subsection (l) as soon
as possible to demonstrate compliance with 42 CFR 433.68(e)(2)(ii).
The revised state plan amendment and waiver request must provide
that provides for
the following:
(1) Effective August 1, 2003, collection of a quality assessment
by the office from each nursing facility.
(2) Effective August 1, 2003, collection of a quality assessment
by the department of state revenue from each health facility that
is not a nursing facility.
(3) An an exemption from collection of a quality assessment from
the following:
(A)
(1) A continuing care retirement community
as follows:
(A) A continuing care retirement community that was
registered with the securities commissioner as a continuing
care retirement community on January 1, 2007, is not
required to meet the definition of a continuing care
retirement community in subsection (a).
(B) A continuing care retirement community that, for the
period January 1, 2007, through June 30, 2009, operates
independent living units, at least twenty-five percent (25%)
of which are provided under contracts that require the
payment of a minimum entrance fee of at least twenty-five
thousand dollars ($25,000).
(C) An organization registered under IC 23-2-4 before July
1, 2009, that provides housing in an independent living unit
for a religious order.
(D) A continuing care retirement community that meets
the definition set forth in subsection (a).
(B) A health facility that only receives revenue from Medicare
services provided under 42 U.S.C. 1395 et seq.
(C)
(2) A hospital based health facility. that has less than seven
hundred fifty thousand dollars ($750,000) in total annual revenue,
adjusted annually by the average annual percentage increase in
Medicaid rates.
(D)
(3) The Indiana Veterans' Home.
Any revision to the state plan amendment or waiver request under this
subsection is subject to and must comply with the provisions of this
SECTION.
(g) If the United States Centers for Medicare and Medicaid Services
determines not to approve payments under this SECTION using the
methodology described in subsections (d) and (e), and (f), the office
shall revise the state plan amendment and waiver request submitted
under subsection (l) this SECTION as soon as possible to demonstrate
compliance with 42 CFR 433.68(e)(2)(ii) and to provide for collection
of a quality assessment from health facilities effective August 1, 2003.
2009. In amending the state plan amendment and waiver request under
this subsection, the office may modify the parameters described in
subsection (f)(3). However, if the office determines a need to modify
the parameters described in subsection (f)(3), the office shall modify
the parameters in order to achieve a methodology and result as similar
as possible to the methodology and result described in subsection (f).
Any revision of the state plan amendment and waiver request under
this subsection is subject to and must comply with the provisions of
this SECTION.
(h) The money collected from the quality assessment may be used
only to pay the state's share of the costs for Medicaid services provided
under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.) as follows:
(1) At the following percentages when the state's regular
federal medical assistance percentage (FMAP) applies,
excluding the time frame in which the adjusted FMAP is
provided to the state by the federal American Recovery and
Reinvestment Act of 2009:
(A) Twenty percent (20%) as determined by the office.
(2) (B) Eighty percent (80%) to nursing facilities.
(2) At the following percentages when the state's federal
medical assistance percentage (FMAP) is adjusted by the
federal American Recovery and Reinvestment Act of 2009:
(A) Forty percent (40%) as determined by the office.
(B) Sixty percent (60%) to nursing facilities.
(i) After:
(1) the amendment to the state plan and waiver request submitted
under this SECTION is approved by the United States Centers for
Medicare and Medicaid Services; and
(2) the office calculates and begins paying enhanced
reimbursement rates set forth in this SECTION;
the office and the department of state revenue shall begin the collection
of the quality assessment set under this SECTION. The office and the
department of state revenue shall may establish a method to allow a
facility to enter into an agreement to pay the quality assessment
collected under this SECTION subject to an installment plan.
(j) If federal financial participation becomes unavailable to match
money collected from the quality assessments for the purpose of
enhancing reimbursement to nursing facilities for Medicaid services
provided under Title XIX of the federal Social Security Act (42 U.S.C.
1396 et seq.), the office and department of state revenue shall cease
collection of the quality assessment under this SECTION.
(k) To implement this SECTION, the
(1) office shall adopt rules under IC 4-22-2. and
(2) office and department of state revenue shall adopt joint rules
under IC 4-22-2.
(l) Not later than July 1, 2003, August 1, 2009, the office shall do
the following:
(1) Request the United States Department of Health and Human
Services under 42 CFR 433.72 to approve waivers of 42 CFR
433.68(c) and 42 CFR 433.68(d) by demonstrating compliance
with 42 CFR 433.68(e)(2)(ii).
(2) Submit any state Medicaid plan amendments to the United
States Department of Health and Human Services that are
necessary to implement this SECTION.
(m) After approval of the waivers and state Medicaid plan
amendment applied for under subsection (l), this SECTION, the office
and the department of state revenue shall implement this SECTION
effective July 1, 2003. August 1, 2009.
(n) The select joint commission on Medicaid oversight, established
by IC 2-5-26-3, shall review the implementation of this SECTION. The
office may not make any change to the reimbursement for nursing
facilities unless the select joint commission on Medicaid oversight
recommends the reimbursement change.
(o) A nursing facility or a health facility may not charge the facility's
residents for the amount of the quality assessment that the facility pays
under this SECTION.
(p) The office may withdraw a state plan amendment submitted
under subsection (e), (f), or (g) this SECTION only if the office
determines that failure to withdraw the state plan amendment will
result in the expenditure of state funds not funded by the quality
assessment.
(q) If a health facility fails to pay the quality assessment under this
SECTION not later than ten (10) days after the date the payment is due,
the health facility shall pay interest on the quality assessment at the
same rate as determined under IC 12-15-21-3(6)(A).
(r) The following shall be provided to the state department of health:
(1) The office shall report to the state department of health each
nursing facility and each health facility that fails to pay the
quality assessment under this SECTION not later than one
hundred twenty (120) days after payment of the quality
assessment is due.
(2) The department of state revenue shall report each health
facility that is not a nursing facility that fails to pay the quality
assessment under this SECTION not later than one hundred
twenty (120) days after payment of the quality assessment is due.
(s) The state department of health shall do the following:
(1) Notify each nursing facility and each health facility reported
under subsection (r) that the nursing facility's or health facility's
license under IC 16-28 will be revoked if the quality assessment
is not paid.
(2) Revoke the nursing facility's or health facility's license under
IC 16-28 if the nursing facility or the health facility fails to pay
the quality assessment.
(t) An action taken under subsection (s)(2) is governed by:
(1) IC 4-21.5-3-8; or
(2) IC 4-21.5-4.
(u) The office shall report the following information to the select
joint commission on Medicaid oversight established by IC 2-5-26-3 at
every meeting of the commission:
(1) Before the quality assessment is approved by the United States
Centers for Medicare and Medicaid Services:
(A) an update on the progress in receiving approval for the
quality assessment; and
(B) a summary of any discussions with the United States
Centers for Medicare and Medicaid Services.
(2) After the quality assessment has been approved by the United
States Centers for Medicare and Medicaid Services:
(A) an update on the collection of the quality assessment;
(B) a summary of the quality assessment payments owed by a
nursing facility or a health facility; and
(C) any other relevant information related to the
implementation of the quality assessment.
(v) This SECTION expires August 1, 2009. 2011.
SOURCE: ; (09)EH1572.2.17. -->
SECTION 17. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "committee" refers to the Medicaid managed care
quality strategy committee created by this SECTION.
(b) The Medicaid managed care quality strategy committee is
created to provide information on policy issues concerning
Medicaid. The committee shall study issues related to the
following:
(1) Emergency room utilization.
(2) Prior authorization.
(3) Standardization of procedures, forms, and service
descriptions.
(4) Effectiveness and quality of care.
(c) The members of the committee shall include at least one (1)
individual representing each of the following:
(1) Medicaid providers.
(2) Public hospitals.
(3) Medicaid managed care organizations.
(4) Mental health professions.
(5) The office of Medicaid policy and planning, who shall act
as chairperson of the committee.
(6) Other state agencies.
The governor shall appoint the committee members. The
committee may not consist of more than seven (7) members.
(d) The office of the secretary of family and social services shall
staff the committee.
(e) The affirmative votes of a majority of the members are
required for the committee to take make recommendations.
(f) Before October 1, 2009, the committee shall report to the
select joint commission on Medicaid oversight established by
IC 2-5-26-3 concerning the committee's recommendations.
(g) This SECTION expires December 31, 2009.
SOURCE: ; (09)EH1572.2.18. -->
SECTION 18.
An emergency is declared for this act.