Citations Affected: IC 12-7; IC 12-10; IC 12-15; IC 16-18; IC 16-27;
IC 25-22.5; IC 25-23; IC 34-30; noncode.
Effective: Upon passage; July 2001; July 1, 2001.
January 9, 2001, read first time and referred to Committee on Rules and Legislative
Procedure.
January 30, 2001, amended, reported favorably _ Do Pass.
February 8, 2001, read second time, ordered engrossed.
February 9, 2001, engrossed.
February 13, 2001, read third time, passed. Yeas 44, nays 6.
licensed health professional. Requires an individual in need of in-home care and the individual's case manager to develop an authorized care plan. Amends requirements of the drug utilization review board concerning prior authorization programs and programs to reduce costs in the Medicaid outpatient prescription drug program. Amends the services that may be provided by home health agencies. Extends the prescription drug advisory committee until December 2003 and allows legislative members on the advisory committee to vote. Requires the prescription drug advisory committee to make every effort to first expand the current program design to provide an increased benefit to cover a high percentage of the out of pocket costs paid by the recipient for the recipient's prescription drugs. Establishes the governor's commission on caregivers to study issues regarding the availability and quality of caregivers in long term care health settings. Requires the commission to submit a report to the governor and legislative council by not later than October 1, 2002. Allows the commission to contract with a private individual or organization to provide the staff support necessary for the operation of the commission, including conducting research and developing the required report. Appropriates $49,000 from the state general fund for the commission to fulfill its purpose. Requires that appropriate federal Medicaid waivers be sought to permit reimbursement of these services under Medicaid. Makes conforming amendments.
A BILL FOR AN ACT to amend the Indiana Code concerning
health and to make an appropriation.
SECTION 1. IC 12-7-2-14.7 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2001]: Sec. 14.7. "Ancillary services", for purposes of
IC 12-10-17, has the meaning set forth in IC 12-10-17-2.
SECTION 2. IC 12-7-2-18.3 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2001]: Sec. 18.3. "Attendant care services", for purposes of
IC 12-10-17, has the meaning set forth in IC 12-10-17-3.
SECTION 3. IC 12-7-2-20.7 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2001]: Sec. 20.7. "Basic services", for purposes of IC 12-10-17,
has the meaning set forth in IC 12-10-17-4.
SECTION 4. IC 12-7-2-103.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 103.5. "Health related
services":
(1) for purposes of IC 12-10-15, has the meaning set forth in
IC 12-10-15-2; and
(2) for purposes of IC 12-10-17, has the meaning set forth in
IC 12-10-17-5.
SECTION 5. IC 12-7-2-117.1 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2001]: Sec. 117.1. "Individual in need of
self-directed in-home care", for purposes of IC 12-10-17, has the
meaning set forth in IC 12-10-17-6.
SECTION 6. IC 12-7-2-122.9 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2001]: Sec. 122.9. "Licensed health
professional", for purposes of IC 12-10-17, has the meaning set
forth in IC 12-10-17-7.
SECTION 7. IC 12-7-2-137.3 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2001]: Sec. 137.3. "Personal services
attendant", for purposes of IC 12-10-17, has the meaning set forth
in IC 12-10-17-8.
SECTION 8. IC 12-7-2-138 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 138. "Physician" means
the following:
(1) For purposes of IC 12-10-17 and IC 12-15-35, the meaning
set forth in IC 12-15-35-12. an individual who is licensed to
practice medicine in Indiana under IC 25-22.5.
(2) For purposes of IC 12-26, either of the following:
(A) An individual who holds a license to practice medicine
under IC 25-22.5.
(B) A medical officer of the United States government who is
in Indiana performing the officer's official duties.
SECTION 9. IC 12-7-2-174.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2001]: Sec. 174.5. "Self-directed in-home
health care", for purposes of IC 12-10-17, has the meaning set
forth in IC 12-10-17-9.
SECTION 10. IC 12-10-10-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 2. As used in this
chapter, "community and home care services" means services provided
within the limits of available funding to an eligible individual. The
term includes the following:
(1) Homemaker services and attendant care, including personal
care services.
(2) Respite care services and other support services for primary
or family caregivers.
in-home care if the individual were not physically disabled. The
term includes the following:
(1) Assistance in getting in and out of beds, wheelchairs, and
motor vehicles.
(2) Assistance with routine bodily functions, including:
(A) health related services (as defined in section 5 of this
chapter);
(B) bathing and personal hygiene;
(C) dressing and grooming; and
(D) feeding, including preparation and cleanup.
Sec. 5. As used in this chapter, "health related services" means
those medical activities that:
(1) in the opinion of the attending physician, could be
performed by the individual if the individual were physically
capable, and if the medical activity can be safely performed in
the home; and
(2) the person who performs the medical activity has received
training or instruction from a licensed health professional in
how to properly perform the medical activity.
Sec. 6. As used in this chapter, "individual in need of
self-directed in-home care" means a disabled individual who:
(1) is approved to receive Medicaid waiver services under 42
U.S.C. 1396n(c), or is a participant in the community and
home options to institutional care for the elderly and disabled
program under IC 12-10-10;
(2) is in need of attendant care services because of
impairment;
(3) requires assistance to complete functions of daily living,
self-care, and mobility, including those functions included in
attendant care services;
(4) chooses to self-direct a paid personal services attendant to
perform attendant care services; and
(5) assumes the responsibility to initiate self-directed in-home
care and exercise judgment regarding the manner in which
those services are delivered, including the decision to employ,
train, and dismiss a personal services attendant.
Sec. 7. As used in this chapter, "licensed health professional"
means the following:
(1) A registered nurse.
(2) A licensed practical nurse.
(3) A physician with an unlimited license to practice medicine
or osteopathic medicine.
based services waiver program under the state Medicaid plan to
provide for the payment for attendant care services provided by a
personal services attendant for an individual in need of
self-directed in-home care under this chapter, including any
related record keeping and employment expenses.
(b) The office shall not, to the extent permitted by federal law,
consider as income money paid under this chapter to or on behalf
of an individual in need of self-directed in-home care to enable the
individual to employ registered personal services attendants, for
purposes of determining the individual's income eligibility for
services under this chapter.
Sec. 18. The division may:
(1) initiate demonstration projects to test new ways of
providing attendant care services; and
(2) research ways to best provide attendant care services in
urban and rural areas.
Sec. 19. (a) The division may adopt rules under IC 4-22-2 that
are necessary to implement this chapter.
(b) The office shall apply for any federal waivers necessary to
implement this chapter.
SECTION 12. IC 12-15-35-9 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 9. As used in this
chapter, "intervention" means an action taken by the board, the office,
or the office's contractor with a prescriber or pharmacist to inform
about or to influence prescribing or dispensing practices or utilization
of drugs.
SECTION 13. IC 12-15-35-19 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 19. (a) The drug
utilization review board is established.
(b) The board may meet monthly.
SECTION 14. IC 12-15-35-35, AS AMENDED BY P.L.231-1999,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 35. (a) As used in this section, "single source
drug" means a covered outpatient drug that is produced or distributed
under an original new drug application approved by the federal Food
and Drug Administration, including a drug product marketed by any
cross-licensed producers or distributors operating under the new drug
application.
(b) Before the office or board develops or initiates a program to
place a single source drug on prior approval, restrict the drug in its use,
or establish a drug monitoring process or program to measure or restrict
utilization of single source drugs other than in the SURS program, the
board must meet the following conditions:
(1) Make a determination, after considering evidence and credible
information provided to the board by the office and the public,
that placing a single source drug on prior approval or restricting
the drug's use will not:
(A) impede the quality of patient care in the Medicaid
program; or
(B) increase costs in other parts of the Medicaid program,
including hospital costs and physician costs.
(2) Meet to review a formulary or a restriction on a single source
drug after the office provides at least thirty (30) days notification
to the public that the board will review the formulary or
restriction on a single source drug at a particular board meeting.
The notification shall contain the following information:
(A) A statement of the date, time, and place at which the board
meeting will be convened.
(B) A general description of the subject matter of the board
meeting.
(C) An explanation of how a copy of the formulary to be
discussed at the meeting may be obtained.
The board shall meet to review the formulary or the restriction on
a single source drug at least thirty (30) days but not more than
sixty (60) days after the notification.
(3). Ensure that:
(A) there is access to at least two (2) alternative drugs within
each therapeutic classification, if available, on the formulary;
and
(B) a process is in place through which a Medicaid recipient
has access to medically necessary drugs.
(4) Reconsider the drug's removal from its restricted status or
from prior approval not later than six (6) months after the single
source drug is placed on prior approval or restricted in its use.
(5) Ensure that the program provides either telephone or FAX
approval or denial Monday through Friday, twenty-four (24) hours
a day. The office must provide the approval or denial within
twenty-four (24) hours after receipt of a prior approval request.
The program must provide for the dispensing of at least a
seventy-two (72) hour supply of the drug in an emergency
situation or on weekends.
(6) Ensure that any prior approval program or restriction on the
use of a single source drug is not applied to prevent acceptable
medical use for appropriate off-label indications.
in the Medicaid program.
SECTION 16. IC 16-18-2-28.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2001]: Sec. 28.5. "Attendant care services",
for purposes of IC 16-27-1, has the meaning set forth in
IC 16-27-1-0.5.
SECTION 17. IC 16-27-1-0.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2001]: Sec. 0.5. As used in this chapter,
"attendant care services" means those services that could be
performed by an impaired individual for whom the services are
provided if the individual were not impaired, that enable the
impaired individual to live in the individual's home and
community, rather than an in an institution, and to carry out
functions of daily living, self-care, and mobility. The term includes
the following:
(1) Assistance in getting in and out of beds, wheelchairs, and
motor vehicles.
(2) Assistance with routine bodily functions, including:
(A) bathing and personal hygiene;
(B) using the toilet and maintaining continence;
(C) dressing and grooming; and
(D) feeding, including preparation and cleanup.
(3) The provision of medical assistance:
(A) through providing reminders or cues to take
medication, the opening of pre-set medication containers,
and providing assistance in the handling or ingesting of
non-controlled substance medications, including eye drops,
herbs, supplements, and over-the-counter medications; and
(B) to an individual who is unable to accomplish the task
due to an impairment and who is:
(i) competent and has directed the services; or
(ii) incompetent and has the services directed by a
competent individual who may consent to health care for
the impaired individual.
SECTION 18. IC 16-27-1-5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 2001]: Sec]. 5. (a) As used in this
chapter, "home health services" means services that are:
(1) provided to a patient by:
(A) a home health agency; or
(B) another person under an arrangement with a home health
agency;
Nurse Anesthetists or a course approved by the board.
(13) An optometrist practicing the optometrist's profession under
IC 25-24.
(14) A pharmacist practicing the pharmacist's profession under
IC 25-26.
(15) A physical therapist practicing the physical therapist's
profession under IC 25-27.
(16) A podiatrist practicing the podiatrist's profession under
IC 25-29.
(17) A psychologist practicing the psychologist's profession under
IC 25-33.
(18) A speech-language pathologist or audiologist practicing the
pathologist's or audiologist's profession under IC 25-35.6.
(19) An employee of a physician or group of physicians who
performs an act, a duty, or a function that is customarily within
the specific area of practice of the employing physician or group
of physicians, if the act, duty, or function is performed under the
direction and supervision of the employing physician or a
physician of the employing group within whose area of practice
the act, duty, or function falls. An employee may not make a
diagnosis or prescribe a treatment and must report the results of
an examination of a patient conducted by the employee to the
employing physician or the physician of the employing group
under whose supervision the employee is working. An employee
may not administer medication without the specific order of the
employing physician or a physician of the employing group.
Unless an employee is licensed or registered to independently
practice in a profession described in subdivisions (8) through
(17), nothing in this subsection grants the employee independent
practitioner status or the authority to perform patient services in
an independent practice in a profession.
(20) A hospital licensed under IC 16-21 or IC 12-25.
(21) A health care organization whose members, shareholders, or
partners are individuals, partnerships, corporations, facilities, or
institutions licensed or legally authorized by this state to provide
health care or professional services as:
(A) a physician;
(B) a psychiatric hospital;
(C) a hospital;
(D) a health maintenance organization or limited service
health maintenance organization;
(E) a health facility;
section, "licensed health professional" means:
(1) a registered nurse;
(2) a licensed practical nurse;
(3) a physician with an unlimited license to practice medicine or
osteopathic medicine;
(4) a licensed dentist;
(5) a licensed chiropractor;
(6) a licensed optometrist;
(7) a licensed pharmacist;
(8) a licensed physical therapist;
(9) a certified psychologist;
(10) a licensed podiatrist; or
(11) a licensed speech-language pathologist or audiologist.
(b) This chapter does not prohibit:
(1) furnishing nursing assistance in an emergency;
(2) the practice of nursing by any student enrolled in a board
approved nursing education program where such practice is
incidental to the student's program of study;
(3) the practice of any nurse who is employed by the government
of the United States or any of its bureaus, divisions, or agencies
while in the discharge of the nurse's official duties;
(4) the gratuitous care of sick, injured, or infirm individuals by
friends or the family of that individual;
(5) the care of the sick, injured, or infirm in the home for
compensation if the person assists only:
(A) with personal care;
(B) in the administration of a domestic or family remedy; or
(C) in the administration of a remedy that is ordered by a
licensed health professional and that is within the scope of
practice of the licensed health professional under Indiana law;
(6) performance of tasks by persons who provide health care
services which are delegated or ordered by licensed health
professionals, if the delegated or ordered tasks do not exceed the
scope of practice of the licensed health professionals under
Indiana law;
(7) a physician with an unlimited license to practice medicine or
osteopathic medicine in Indiana, a licensed dentist, chiropractor,
dental hygienist, optometrist, pharmacist, physical therapist,
podiatrist, psychologist, speech-language pathologist, or
audiologist from practicing the person's profession; or
(8) a school corporation or school employee from acting under
IC 34-4-16.5-3.5. IC 34-30-14;
connection with the member's duties. The expenses of the committee
shall be paid from the Indiana pharmaceutical assistance fund created
by IC 4-12-8. The office of the secretary of family and social services
shall provide staff for the committee. The committee is a public agency
for purposes of IC 5-14-1.5 and IC 5-14-3. The advisory council is a
governing body for purposes of IC 5-14-1.5.
(d) Not later than September 1, 2000, The board shall make
periodic program design recommendations to the governor and the
family and social services administration concerning the following:
(1) Eligibility criteria, including the desirability of incorporating
an income factor based on the federal poverty level.
(2) Benefit structure.
(3) Cost-sharing requirements, including whether the program
should include a requirement for copayments or premium
payments.
(4) Marketing and outreach strategies.
(5) Administrative structure and delivery systems.
(6) Evaluation.
(e) The recommendations shall address the following:
(1) Cost-effectiveness of program design.
(2) Coordination with existing pharmaceutical assistance
programs.
(3) Strategies to minimize crowd-out of private insurance.
(4) Reasonable balance between maximum eligibility levels and
maximum benefit levels.
(5) Feasibility of a health care subsidy program where the amount
of the subsidy is based on income.
(6) Advisability of entering into contracts with health insurance
companies to administer the program.
(f) The committee may not recommend the use of funds from the
Indiana pharmaceutical assistance fund for a state prescription drug
benefit for low-income senior citizens if there is a federal statute or
program providing a similar prescription drug benefit for the benefit of
low-income senior citizens.
(g) When the committee considers possible program design
modifications, the committee shall make every effort to first
expand the current program design to provide an increased benefit
to cover a high percentage of the out of pocket costs paid by the
recipient for the recipient's prescription drugs.
(h) This SECTION expires December 31, 2001. 2003.
SECTION 24. [EFFECTIVE JULY 1, 2001] (a) As used in this
SECTION, "commission" refers to the governor's commission on
caregivers established by subsection (d).
(b) As used in this SECTION, "health facility" has the meaning
set forth in IC 16-18-2-167.
(c) As used in this SECTION, "long term care caregivers"
means certified nurse aides, licensed practical nurses, and
registered nurses employed in health facilities, home health care,
and other community based settings.
(d) The governor's commission on caregivers is established.
(e) The commission consists of the following members:
(1) The governor or the governor's designee, who shall serve
as the chairperson.
(2) The state health commissioner (IC 16-19-4-2) or the
commissioner's designee.
(3) The president of the Indiana state board of nursing
(IC 25-23-1-5) or the president's designee.
(4) The secretary of family and social services (IC 12-8-1-2) or
the secretary's designee.
(5) The chairman of the commission for higher education
(IC 20-12-0.5-7) or the chairman's designee.
(6) The state superintendent of public instruction or the
superintendent's designee.
(7) The commissioner of the department of workforce
development (IC 22-4.1-3-1) or the commissioner's designee.
(8) The director of the department of commerce (IC 4-4-3-2)
or the director's designee.
(9) The commissioner of the department of labor (IC 22-1-1-2)
or the commissioner's designee.
(10) One (1) member appointed by the governor to represent
each of the following organizations:
(A) The Indiana Association of Homes and Services for the
Aging.
(B) The Indiana Health Care Association.
(C) The Indiana Association for Home and Hospice Care.
(D) The Indiana State Nurses Association.
(E) The Indiana Health and Hospital Association.
(F) The Indiana Home Care Task Force.
(G) The Indiana Association of Area Agencies on Aging.
(H) United Senior Action.
(I) The Indiana University School of Nursing.
(J) Ivy Tech State College.
(11) One (1) member appointed by the governor to represent
a private postsecondary educational institution that offers
nursing degrees.
(f) The commission shall do the following:
(1) Review data and information on the availability of and
need for long term care caregivers.
(2) Evaluate barriers to increasing the supply of long term
care caregivers.
(3) Evaluate the adequacy of existing training programs in the
state for long term care caregivers.
(4) Develop recommendations to increase the supply of long
term care caregivers, including the following:
(A) Welfare to work programs.
(B) Worker recruitment and incentive programs.
(C) Immigration.
(D) Linkages between training programs and the long term
care and senior services industries.
(E) Cross-training of nurse aides across the continuum of
long term care services.
(F) Potential roles for various state agencies and
educational institutions represented on the commission.
(g) Eleven (11) members of the commission constitute a quorum.
(h) The affirmative votes of at least eleven (11) members of the
commission are required for the commission to take any action,
including the approval of a final report.
(i) 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).
(j) The commission may contract with a private individual or
organization to provide the staff support necessary for the
operation of the commission, including conducting research and
developing the report required under subsection (l).
(k) The commission shall submit a report to the governor and
the legislative council by not later than October 1, 2002.
(l) There is appropriated to the commission forty-nine thousand
dollars ($49,000) from the state general fund to implement this
SECTION, beginning July 1, 2001, and ending October 1, 2002.
(m) Funds appropriated under subsection (l) do not revert to the
state general fund at the close of a state fiscal year but remain
available to the commission through October 1, 2002.
(n) This SECTION expires October 2, 2002.
SECTION 25. [EFFECTIVE UPON PASSAGE] (a) As used in
this SECTION, "office" refers to the office of Medicaid policy and
planning.
(b) The office shall apply for any necessary federal waivers to
provide Medicaid reimbursement of attendant care services
provided by registered personal services attendants to Medicaid
recipients under IC 12-10-17, as added by this act.
(c) Notwithstanding IC 12-10-17, as added by this act, the office
may not implement IC 12-10-17, as added by this act, for Medicaid
waiver recipients until:
(1) any necessary waiver is approved; and
(2) the office has filed an affidavit with the governor attesting
that the appropriate 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 is
approved.
(d) If the office receives a waiver under this SECTION from the
United States Department of Health and Human Services, and the
governor receives the affidavit filed under subsection (c), the office
shall implement the waiver not later than sixty (60) days after the
governor receives the affidavit.
(e) This SECTION expires July 1, 2006.
SECTION 26. [EFFECTIVE JULY 1, 2001] (a) Notwithstanding
IC 12-10-17-12(a)(5), as added by this act, the division of disability,
aging, and rehabilitative services may not establish a registration
fee that exceeds thirty dollars ($30).
(b) Notwithstanding IC 12-10-17-12(d)(2), as added by this act,
the division of disability, aging, and rehabilitative services may not
charge a fee for shipping, handling, and copying expenses that
exceeds five dollars ($5) per file.
(c) The office of Medicaid policy and planning may adopt rules
under IC 4-22-2 that are necessary to implement this SECTION.
(d) This SECTION expires July 1, 2003.
SECTION 27. An emergency is declared for this act.