Introduced Version






SENATE BILL No. 218

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 5-10-8-7.3; IC 12-7-2; IC 12-12.7-2-17; IC 12-28-5; IC 21-38-6; IC 27-8-27.

Synopsis: Developmental disabilities. Changes the definition of "developmental disabilities" to conform to the federal definition. Repeals the community residential council and gives the duties of the council to the division of disability and rehabilitative services. Changes the requirement for third party payors for the first steps program. Eliminates priority criteria for formal categories for developmental disability waiver slots.

Effective: July 1, 2011.





Lawson C




    January 5, 2011, read first time and referred to Committee on Health and Provider Services.







Introduced

First Regular Session 117th General Assembly (2011)


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.
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SENATE BILL No. 218



    A BILL FOR AN ACT to amend the Indiana Code concerning human services.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 5-10-8-7.3; (11)IN0218.1.1. -->     SECTION 1. IC 5-10-8-7.3, AS AMENDED BY P.L.93-2006, SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 7.3. (a) As used in this section, "covered individual" means an individual who is:
        (1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) entitled to services under a contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.
    (b) As used in this section, "early intervention services" means services provided to a first steps child under IC 12-12.7-2 and 20 U.S.C. 1432(4).
    (c) As used in this section, "first steps child" means an infant or toddler from birth through two (2) years of age who is enrolled in the Indiana first steps program and is a covered individual.
    (d) As used in this section, "first steps program" refers to the program established under IC 12-12.7-2 and 20 U.S.C. 1431 et seq. to

meet the needs of:
        (1) children who are eligible for early intervention services; and
        (2) their families.
The term includes the coordination of all available federal, state, local, and private resources available to provide early intervention services within Indiana.
    (e) As used in this section, "health benefits plan" means a:
        (1) self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.
    (f) A health benefits plan that provides coverage for early intervention services shall reimburse the first steps program for payments made by the program for early intervention services that are covered under the health benefits plan. a monthly fee established by the division of disability and rehabilitative services established by IC 12-9-1-1. The monthly fee shall be provided instead of claims processing of individual claims.
    (g) The reimbursement required under subsection (f) may not be applied to any annual or aggregate lifetime limit on the first steps child's coverage under the health benefits plan.
    (h) The first steps program may pay required deductibles, copayments, or other out-of-pocket expenses for a first steps child directly to a provider. A health benefits plan shall apply any payments made by the first steps program to the health benefits plan's deductibles, copayments, or other out-of-pocket expenses according to the terms and conditions of the health benefits plan.
    (h) The monthly fee required under subsection (f) may not be reduced or denied as a result of:
        (1) a required deductible;
        (2) copayments;
        (3) coinsurance; or
        (4) other out-of-pocket expenses.

SOURCE: IC 12-7-2-44; (11)IN0218.1.2. -->     SECTION 2. IC 12-7-2-44, AS AMENDED BY P.L.130-2009, SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 44. "Council" means the following:
        (1) For purposes of IC 12-9-4, the meaning set forth in IC 12-9-4-1.
        (2) For purposes of IC 12-12-8, the meaning set forth in IC 12-12-8-2.5.
        (3) For purposes of IC 12-13-4, the meaning set forth in IC 12-13-4-1.
        (4) For purposes of IC 12-15-41 and IC 12-15-42, the Medicaid work incentives council established by IC 12-15-42-1.
        (5) For purposes of IC 12-12.7-2, the meaning set forth in IC 12-12.7-2-2.
        (6) For purposes of IC 12-21-4, the meaning set forth in IC 12-21-4-1.
        (7) For purposes of IC 12-28-5, the meaning set forth in IC 12-28-5-1.
SOURCE: IC 12-7-2-61; (11)IN0218.1.3. -->     SECTION 3. IC 12-7-2-61 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 61. "Developmental disability" means the following:
        (1) Except as provided in subdivision (2), before July 1, 1993, the term means a severe, chronic disability of an individual that meets all of the following conditions:
        (A) (1) Is attributable to:
            (i) (A) mental retardation, cerebral palsy, epilepsy, or autism; or
            (ii) (B) any other condition (other than a sole diagnosis of mental illness) found to be closely related to mental retardation, because this condition results in similar impairment of general intellectual functioning or adaptive behavior or requires similar treatment and or services similar to those required for mentally retarded persons. or
                (iii) dyslexia resulting from a disability described in this subdivision;
            (B) originates before the person is eighteen (18) years of age;
            (C) has continued or is expected to continue indefinitely; and
            (D) constitutes a substantial disability to the individual's ability to function normally in society.
        (2) For purposes of IC 12-10-7 and IC 12-28-1 before July 1, 1993, and for purposes of IC 12 after June 30, 1993, the term means a severe, chronic disability of an individual that:
            (A) is attributable to a mental or physical impairment, or a combination of mental and physical impairments (other than a sole diagnosis of mental illness);
        (B) (2) Is manifested before the individual is twenty-two (22) years of age.
        (C) (3) Is likely to continue indefinitely.
            (D) reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are of lifelong or extended duration and are individually planned and coordinated; and
        (E) (4) Results in substantial functional limitations in at least three (3) of the following areas of major life activities:
            (i) (A) Self-care.
            (ii) (B) Receptive and expressive Understanding and use of language.
            (iii) (C) Learning.
            (iv) (D) Mobility.
            (v) (E) Self-direction.
            (vi) (F) Capacity for independent living.
            (vii) (G) Economic self-sufficiency.
SOURCE: IC 12-7-2-69; (11)IN0218.1.4. -->     SECTION 4. IC 12-7-2-69, AS AMENDED BY P.L.1-2007, SECTION 108, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 69. (a) "Division", except as provided in subsections (b) and (c), refers to any of the following:
        (1) The division of disability and rehabilitative services established by IC 12-9-1-1.
        (2) The division of aging established by IC 12-9.1-1-1.
        (3) The division of family resources established by IC 12-13-1-1.
        (4) The division of mental health and addiction established by IC 12-21-1-1.
    (b) The term refers to the following:
        (1) For purposes of the following statutes, the division of disability and rehabilitative services established by IC 12-9-1-1:
            (A) IC 12-9.
            (B) IC 12-11.
            (C) IC 12-12.
            (D) IC 12-12.5.
            (E) IC 12-12.7.
             (F) IC 12-28-5.
        (2) For purposes of the following statutes, the division of aging established by IC 12-9.1-1-1:
            (A) IC 12-9.1.
            (B) IC 12-10.
        (3) For purposes of the following statutes, the division of family resources established by IC 12-13-1-1:
            (A) IC 12-13.
            (B) IC 12-14.
            (C) IC 12-15.
            (D) IC 12-16.
            (E) IC 12-17.2.
            (F) IC 12-18.
            (G) IC 12-19.
            (H) IC 12-20.
        (4) For purposes of the following statutes, the division of mental health and addiction established by IC 12-21-1-1:
            (A) IC 12-21.
            (B) IC 12-22.
            (C) IC 12-23.
            (D) IC 12-25.
    (c) With respect to a particular state institution, the term refers to the division whose director has administrative control of and responsibility for the state institution.
    (d) For purposes of IC 12-24, IC 12-26, and IC 12-27, the term refers to the division whose director has administrative control of and responsibility for the appropriate state institution.
SOURCE: IC 12-12.7-2-17; (11)IN0218.1.5. -->     SECTION 5. IC 12-12.7-2-17, AS ADDED BY P.L.93-2006, SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 17. (a) A family shall participate in the cost of programs and services provided under this chapter to the extent allowed by federal law according to the following cost participation schedule:
    Percentage of        Copayment            Maximum
    Federal Income        Per        Monthly
    Poverty Level        Treatment    Cost Share
    At     But Not
    Least     More Than
    0%     250%     $     0     $     0
    251%     350%     $     3     $ 24
    351%     450%     $     6     $ 48
    451%     550%     $     15     $ 120
    551%     650%     $    25     $ 200
    651%     750%     $    50     $ 400
    751%     850%     $    75     $ 600
    851%     1000%     $    100     $ 800
    1001%          $ 120    $ 960
    (b) A cost participation plan used by the division for families to participate in the cost of the programs and services provided under this chapter:
        (1) must:
            (A) be based on income and ability to pay;
            (B) provide for a review of a family's cost participation amount:
                (i) annually; and
                (ii) within thirty (30) days after the family reports a

reduction in income; and
            (C) allow the division to waive a required copayment if other medical expenses or personal care needs expenses for any member of the family reduce the level of income the family has available to pay copayments under this section;
        (2) may allow a family to voluntarily contribute payments that exceed the family's required cost participation amount;
        (3) must require the family to allow the division access to all health care coverage information that the family has concerning the infant or toddler who is to receive services;
        (4) must require families to consent to the division billing third party payors for early intervention services provided; and
        (5) may allow the division to waive the billing to third party payors if the family is able to demonstrate financial or personal hardship on the part of the family member. and
        (6) must require the division to waive the family's monthly copayments in any month for those services for which it receives payment from the family's health insurance coverage.
    (c) Funds received through a cost participation plan under this section must be used to fund programs described in section 18 of this chapter.

SOURCE: IC 12-28-5-10; (11)IN0218.1.6. -->     SECTION 6. IC 12-28-5-10, AS AMENDED BY P.L.99-2007, SECTION 147, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 10. In conjunction with the The division of disability and rehabilitative services, the council shall do the following:
        (1) Determine the current and projected needs of each geographic area of Indiana for residential services for individuals with a developmental disability.
        (2) Determine how the provision of developmental or vocational services for residents in these geographic areas affects the availability of developmental or vocational services to individuals with a developmental disability living in their own homes.
        (3) Develop standards for licensure of supervised group living facilities regarding the following:
            (A) A sanitary and safe environment for residents and employees.
            (B) Classification of supervised group living facilities.
            (C) Any other matters that will ensure that the residents will receive a residential environment.
        (4) Develop standards for the approval of entities providing supported living services.
        (5) Recommend social and habilitation programs to the Indiana health facilities council for individuals with a developmental disability who reside in health facilities licensed under IC 16-28.
        (6) Develop and update semiannually a report that identifies the numbers of individuals with a developmental disability who live in health facilities licensed under IC 16-28. The Indiana health facilities council shall assist in developing and updating this report.
SOURCE: IC 12-28-5-11; (11)IN0218.1.7. -->     SECTION 7. IC 12-28-5-11 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 11. (a) A supervised group living facility must have a license or provisional license issued under this chapter to operate.
    (b) An entity that provides supported living services must be approved by the council division under this chapter to operate.
SOURCE: IC 12-28-5-12; (11)IN0218.1.8. -->     SECTION 8. IC 12-28-5-12, AS AMENDED BY P.L.99-2007, SECTION 148, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 12. (a) The council division may license only those supervised group living facilities that:
        (1) meet the standards established under section 10 of this chapter; and
        (2) are necessary to provide adequate services to individuals with a developmental disability in that geographic area.
    (b) A supervised group living facility described in subsection (c) may locate in only one (1) of the following counties:
        (1) A county having a population of more than twenty-seven thousand (27,000) but less than twenty-seven thousand two hundred (27,200).
        (2) A county having a population of more than one hundred seventy thousand (170,000) but less than one hundred eighty thousand (180,000).
        (3) A county having a population of more than fifty thousand (50,000) but less than fifty-five thousand (55,000).
    (c) (b) Notwithstanding 431 IAC 1.1-3-7(c) and 431 IAC 1.1-3-7(d), the council division shall license one (1) supervised group living facility that is located less than one thousand (1,000) feet from another supervised group living facility or a sheltered workshop under the following conditions:
        (1) Both of the supervised group living facilities meet all standards for licensure as provided in section 10(3) of this chapter.
        (2) Both of the supervised group living facilities are built on land that is owned by one (1) private entity.
        (3) The community formed by the supervised group living facilities provides job opportunities for residents of the supervised group living facilities, as appropriate.
    (d) (c) The council division may approve an entity to provide supported living services only if the entity meets the standards established under section 10 of this chapter.
SOURCE: IC 12-28-5-13; (11)IN0218.1.9. -->     SECTION 9. IC 12-28-5-13 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 13. The council division may revoke:
        (1) the license of a supervised group living facility; or
        (2) the approval of an entity that provides supported living services;
that no longer meets the standards established under section 10 of this chapter after following the procedures prescribed by IC 4-21.5-3. If a hearing is provided for or authorized to be held by the council, division, the council division may designate a person as its agent or representative to conduct a hearing. The agent or representative shall conduct the hearing under IC 4-21.5-3.
SOURCE: IC 12-28-5-14; (11)IN0218.1.10. -->     SECTION 10. IC 12-28-5-14 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 14. (a) The council division may issue a provisional license to a facility that does not qualify for a license under section 12 of this chapter but that provides satisfactory evidence that the facility will qualify within a period prescribed by the council. division. The period may not exceed six (6) months.
    (b) The council division may issue provisional approval to an entity providing supported living services that does not qualify for approval under section 12 of this chapter but that provides satisfactory evidence that the entity will qualify within a period prescribed by the council. division. The period may not exceed six (6) months.
SOURCE: IC 12-28-5-19; (11)IN0218.1.11. -->     SECTION 11. IC 12-28-5-19 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 19. (a) The council division may adopt rules under IC 4-22-2 to implement this chapter.
     (b) After June 30, 2011, rules of the former community residential council (repealed) are considered rules of the division.
SOURCE: IC 21-38-6-1; (11)IN0218.1.12. -->     SECTION 12. IC 21-38-6-1, AS ADDED BY P.L.2-2007, SECTION 279, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 1. An employee health plan that provides coverage for early intervention services shall reimburse the first steps program for payments made by the program for early intervention services that are covered under the employee health plan. a monthly fee established by the division of disability and

rehabilitative services. The monthly fee shall be provided instead of claims processing of individual claims.

SOURCE: IC 21-38-6-3; (11)IN0218.1.13. -->     SECTION 13. IC 21-38-6-3, AS ADDED BY P.L.2-2007, SECTION 279, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 3. The first steps program may pay required deductibles, copayments, or other out-of-pocket expenses for a first steps child directly to a provider. An employee health plan shall apply any payments made by the first steps program to the employee health plan's deductibles, copayments, or other out-of-pocket expenses according to the terms and conditions of the employee health plan. The reimbursement required under IC 28-31-6-1 may not be reduced or denied as a result of:
        (1) a required deductible;
        (2) copayments;
        (3) coinsurance; or
        (4) other out-of-pocket expenses.

SOURCE: IC 27-8-27-6; (11)IN0218.1.14. -->     SECTION 14. IC 27-8-27-6 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 6. A health insurance plan that provides coverage for early intervention services shall reimburse the first steps program for payments made by the program for early intervention services that are covered under the health insurance plan. a monthly fee established by the division of disability and rehabilitative services. The monthly fee shall be provided instead of claims processing of individual claims.
SOURCE: IC 27-8-27-9; (11)IN0218.1.15. -->     SECTION 15. IC 27-8-27-9 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 9. The first steps program may pay required deductibles, copayments, or other out-of-pocket expenses for a first steps child directly to a provider. An insurer (as defined in IC 27-8-14.5-3) shall apply any payments made by the first steps program to the health insurance plan's deductibles, copayments, or other out-of-pocket expenses according to the terms and conditions of the health insurance plan. Reimbursement required under section 6 of this chapter may not be reduced or denied as a result of:
        (1) a required deductible;
        (2) copayments;
        (3) coinsurance; or
        (4) other out-of-pocket expenses.

SOURCE: IC 12-28-5-1; IC 12-28-5-2; IC 12-28-5-3; IC 12-28-5-4; IC 12-28-5-5; IC 12-28-5-6; IC 12-28-5-7; IC 12-28-5-8; IC 12-28-5- 9; IC 12-28-5-15. ; (11)IN0218.1.16. -->     SECTION 16. THE FOLLOWING ARE REPEALED [EFFECTIVE JULY 1, 2011]: IC 12-28-5-1; IC 12-28-5-2; IC 12-28-5-3; IC 12-28-5-4; IC 12-28-5-5; IC 12-28-5-6; IC 12-28-5-7; IC 12-28-5-8; IC 12-28-5-9; IC 12-28-5-15.
SOURCE: ; (11)IN0218.1.17. -->     SECTION 17. P.L.73-2008, SECTION 1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: SECTION 1. (a) As used in this SECTION, "division" refers to the division of disability and rehabilitative services established by IC 12-9-1-1.
    (b) As used in this SECTION, "office" refers to the office of Medicaid policy and planning established by IC 12-8-6-1.
    (c) As used in this SECTION, "waiver" refers to any waiver administered by the office and the division under section 1915(c) of the federal Social Security Act.
    (d) Before July 1, 2008, the office shall apply to the United States Department of Health and Human Services for approval to amend a waiver to set priorities as described in subsection (e) in providing services under the waiver.
    (e) The waiver amendment must provide for the following individuals to be given priority in receiving services under the waiver:
(1) An individual who is determined by the state department of health to no longer need or receive active treatment provided in a supervised group living setting.
(2) An individual who is receiving service under the direction of the division in a supervised group living setting, nursing facility, or large private intermediate care facility and has a history of unexplained injuries or documented abuse that is substantiated by the division and that threatens the health and welfare of the individual.
(3) A current resident, or the guardian of a resident who is incapacitated, of a large, private intermediate care facility for the mentally retarded who requests to leave the facility.
(4) An individual who will be attaining the maximum age for a residential or group home setting funded by the department of education, the division of family resources, or the office.
(5) An individual for whom the primary caregiver of the individual is no longer able to care for the individual due to:
(A) the death of the primary caregiver;
(B) the long term institutionalization of the primary caregiver;
(C) the long term incapacitation of the primary caregiver; or
(D) the long term incarceration of the primary caregiver.
        (6) An individual who is on the waiver waiting list and has
        been determined to have a shortened life span as defined by
        the division.
(7) Any other priority as determined by the division.
    (f) The office may not implement the amendment to the waiver until the office files an affidavit with the governor attesting that the amendment to the federal waiver applied for under this SECTION is in

effect. The office shall file the affidavit under this subsection not later than five (5) days after the office is notified that the waiver amendment is approved.
    (g) If the office receives approval for the amendment to the waiver under this SECTION from the United States Department of Health and Human Services and the governor receives the affidavit filed under subsection (f), the office shall implement the amendment to the waiver not more than sixty (60) days after the governor receives the affidavit.
    (d) Before October 1, 2011, the office shall apply to the United States Department of Health and Human Services for approval to amend a waiver to set an emergency placement priority for individuals in the following situations:
        (1) Death of a primary caregiver where alternative placement in a supervised group living setting:
            (A) is not available; or
            (B) is determined by the division to be an inappropriate option.
        (2) A situation in which:
            (A) the primary caregiver is at least eighty (80) years of age and is no longer able to care for the individual; and
            (B) alternate placement in a supervised group living setting is not available or is determined by the division to be an inappropriate option.
        (3) There is evidence of abuse or neglect in the current institutional or home placement, and alternate placement in a supervised group living setting is not available or is determined by the division to be an inappropriate option.
        (4) There are other health and safety risks, as determined by the division director, and alternate placement in a supervised group living setting is not available or is determined by the division to be an inappropriate option.

    (h) (e)The office may adopt rules under IC 4-22-2 necessary to implement this SECTION.
    (i) (f) This SECTION expires July 1, 2016.