HB 1727-1_ Filed 04/05/2001, 11:55

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MR. PRESIDENT:

    The Senate Committee on Finance, to which was referred House Bill No. 1727, has had the same under consideration and begs leave to report the same back to the Senate with the recommendation that said bill be AMENDED as follows:

    Delete the title and insert the following:
    A BILL FOR AN ACT concerning health and human services.
    Delete everything after the enacting clause and insert the following:

SOURCE: IC 4-6-10.5; (01)AM172704.1. -->     SECTION 1. IC 4-6-10.5 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]:
     Chapter 10.5. Public Assistance Programs Investigative Unit
    Sec. 1. The attorney general shall establish, within the office of the attorney general, a unit for the investigation of abusive and improper or fraudulent practices in the public assistance programs administered by the office of the secretary of family and social services established by IC 12-8-1-1 , including:
        (1) the federal food stamp program administered under 7 CFR 277.15;
        (2) the Medicaid program administered under IC 12-15; and
        (3) cash assistance provided under the temporary assistance for needy families program administered under 45 CFR 260 et seq.
    Sec. 2. The investigative unit established by section 1 of this chapter shall investigate:
        (1) fraud and abuse on the part of recipients of public

assistance under the programs described in section 1 of this chapter; and
        (2) potential criminal misconduct by others involved in the administration of the programs.
    Sec. 3. If the attorney general determines, following an investigation under this chapter, that a criminal violation may have been committed by any person or entity, the attorney general shall refer the matter to the appropriate prosecuting authority for further action. If invited to do so by the prosecuting authority, the attorney general may participate in the prosecution of a case referred under this subsection.
    Sec. 4. If the attorney general determines, following an investigation under this chapter, that misconduct may have occurred on the part of an employee of the state of Indiana, the attorney general may refer the matter to the appropriate agency of the state for potential disciplinary action.

SOURCE: IC 12-10-10-12; (01)AM172704.2. -->     SECTION 2. IC 12-10-10-12 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 12. Reimbursement rates for services provided under this chapter may not exceed reimbursement rates for similar services provided under the Medicaid:
        (1) aged and disabled waiver; or
        (2) intermediate care facilities for the mentally retarded (ICF/MR) waiver.

SOURCE: IC 12-15-12-13; (01)AM172704.3. -->     SECTION 3. IC 12-15-12-13 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 13. (a) This section applies to a Medicaid recipient who:
        (1) is determined by the office to be eligible for enrollment in a Medicaid managed care program; and
        (2) resides in a county having:
            (A) a population of more than one hundred thousand (100,000), according to the most recently available census information; and
            (B) at least two (2) managed care organizations that:
                (i) are contracted with the office;
                (ii) have an adequate provider network in place, including, at a minimum, a sufficient number of contracted primary medical providers of the appropriate specialty types, as determined by the office; and
                (iii) have maintained at least one-third (1/3) of the

eligible member enrollment for a continuous period of six (6) months.
    (b) The office shall require a recipient described in subsection (a) to enroll in the risk-based managed care program.
    (c) The office may adopt rules under IC 4-22-2 to implement this section.

SOURCE: IC 12-15-32-11; (01)AM172704.4. -->     SECTION 4. IC 12-15-32-11 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 11. (a) The office may assess community residential facilities for the developmentally disabled (as defined in IC 12-7-2-61 ) and intermediate care facilities for the mentally retarded (as defined in IC 16-29-4-2 ) that are not operated by the state in an amount not to exceed five six percent (5%) (6%) of the annual gross residential services revenue of the facility for the facility's preceding fiscal year.
    (b) The assessments shall be paid to the office of Medicaid policy and planning in equal monthly amounts on or before the tenth day of each calendar month. The office may withhold Medicaid payments to a provider described in subsection (a) that fails to pay an assessment within thirty (30) days after the due date. The amount withheld may not exceed the amount of the assessments due.
    (c) Revenue from the assessments shall be credited to a special account within the state general fund to be called the Medicaid assessment account. Money in the account may be used only for services for which federal financial participation under Medicaid is available to match state funds. An amount equivalent to the federal financial participation estimated to be received for services financed from assessments under subsection (a) shall be used to finance Medicaid services provided by facilities described in subsection (a).
    (d) If federal financial participation to match the assessments in subsection (a) becomes unavailable under federal law, the authority to impose the assessments terminates on the date that the federal statutory, regulatory, or interpretive change takes effect.

SOURCE: IC 12-17.6-4-7; (01)AM172704.5. -->     SECTION 5. IC 12-17.6-4-7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2001]: Sec. 7. (a) This section applies to a child who:
        (1) is determined by the office to be eligible for enrollment in a Medicaid managed care program; and
        (2) resides in a county having:
            (A) a population of more than one hundred thousand (100,000), according to the most recently available census information; and
            (B) at least two (2) managed care organizations that:

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                (i) are contracted with the office;
                (ii) have an adequate provider network in place, including, at a minimum, a sufficient number of contracted primary medical providers of the appropriate specialty types, as determined by the office; and
                (iii) have maintained at least one-third (1/3) of the eligible member enrollment for a continuous period of six (6) months.
    (b) The office shall require a child described in subsection (a) to enroll in the risk-based managed care program.
    (c) The office may adopt rules under IC 4-22-2 to implement this section.

SOURCE: ; (01)AM172704.6. -->     SECTION 6. [EFFECTIVE UPON PASSAGE] (a) As used in this SECTION, "office" refers to the office of the secretary of family and social services established by IC 12-8-1-1.
    (b) As used in this SECTION, "waiver" means a Section 1915(b) freedom of choice waiver under the federal Social Security Act (42 U.S.C. 1315).
    (c) Before July 1, 2001, the office shall apply to the United States Department of Health and Human Services for approval of an amendment to the state Medicaid plan or waiver to implement IC 12-15-12-13 and IC 12-17.6-4-7 , both as added by this act.
    (d) If a provision of this SECTION differs from the requirements of a state plan or waiver amendment, the office shall submit the amendment request in a manner that complies with the requirements of the amendment. However, after the amendment is approved, the office shall apply within one hundred twenty (120) days for an amendment to the approved amendment that contains the provisions of this SECTION that were not included in the approved amendment.
    (e) The office may not implement the amended state plan or waiver until the office files an affidavit with the governor attesting that the federal amendment 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 amendment is approved.
    (f) If the office receives approval of an amendment under this SECTION from the United States Department of Health and Human Services and the governor receives the affidavit filed under subsection (e), the office shall implement the amendment not more than sixty (60) days after the governor receives the affidavit.

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    (g) The office may adopt rules under IC 4-22-2 that are necessary to implement this SECTION.
    (h) Notwithstanding IC 12-15-12-13 and IC 12-17.6-4-7 , both as added by this act, if an amendment submitted under this SECTION is not approved, the office is not required to implement IC 12-15-12-13 and IC 12-17.6-4-7 , both as added by this act.
    (i) This SECTION expires July 1, 2005.

SOURCE: ; (01)AM172704.7. -->     SECTION 7. [EFFECTIVE UPON PASSAGE] (a) As used in this SECTION, "office" refers to the office of Medicaid policy and planning established by IC 12-8-6-1.
    (b) The office shall develop a disease management program to study the provision of health care services to Medicaid recipients with chronic diseases, the cost of those services, and alternative methods of service delivery to provide the necessary services at a reduced cost.
    (c) The office may contract with an outside individual or entity to assist in developing the programs required under subsection (b).
    (d) The office shall report to the health finance commission (IC 2-5-23) and the budget committee not later than December 31, 2002, regarding the programs developed under this SECTION.
    (e) This SECTION expires January 1, 2003.

SOURCE: ; (01)AM172704.8. -->     SECTION 8. [EFFECTIVE UPON PASSAGE] (a) As used in this SECTION, "office" refers to the office of Medicaid policy and planning established by IC 12-8-6-1.
    (b) The office shall develop a program to control Medicaid expenditures for prescription drugs for recipients.
    (c) The office shall report to the health finance commission (IC 2-5-23) and the budget committee not later than September 1, 2001, regarding the program developed under this SECTION.
    (d) This SECTION expires December 31, 2001.

SOURCE: ; (01)AM172704.9. -->     SECTION 9. [EFFECTIVE JULY 1, 2001] (a) The definitions in 405 IAC 1-14.6, as in effect on January 1, 2001, apply throughout this SECTION.
    (b) The state's rate setting contractor shall calculate the median for each rate component each quarter using all cost reports received by the state or the state's rate setting contractor within one hundred fifty (150) days after each provider's fiscal year end. If an audit report has been issued for a provider within one hundred fifty days (150) of the provider's fiscal year end, the rate setting contractor may request additional information relative to that audit report. If the audit report is issued later than one hundred fifty (150) days after the provider's fiscal year end, the

rate setting contractor may not request additional information relative to that audit report for that rate review.

SOURCE: ; (01)AM172704.10. -->     SECTION 10. An emergency is declared for this act.
    (Reference is to HB 1727 as reprinted February 20, 2001.)

and when so amended that said bill do pass .

Committee Vote: Yeas 12, Nays 2.

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