HB 1749-1_ Filed 04/09/2003, 09:13 Miller
SENATE MOTION
MR. PRESIDENT:
I move
that Engrossed House Bill 1749 be amended to read as follows:
SOURCE: Page 14, line 11; (03)MO174905.14. -->
Page 14, line 11, strike "one" and insert " two".
Page 14, line 11, strike "fifty".
Page 14, line 12, strike "(150%)" and insert " (200%)".
Page 15, between lines 41 and 42, begin a new line blocked left and
insert:
" The maximum credit that may be taken under this subsection is
equal to ninety percent (90%) of assessments paid.".
Page 16, between lines 11 and 12, begin a new paragraph and
insert:
SOURCE: IC 27-8-10-3; (03)MO174905.7. -->
"SECTION 7.
IC 27-8-10-3
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 3. (a) An association
policy issued under this chapter may pay usual and customary charges
or use other reimbursement systems that are consistent with managed
care plans, including fixed fee schedules and capitated reimbursement,
for medically necessary eligible health care services rendered or
furnished for the diagnosis or treatment of illness or injury that exceed
the deductible and coinsurance amounts applicable under section 4 of
this chapter.
However, the amount of reimbursement for a health
care service covered under an association policy may not exceed
the amount of reimbursement for the same health care service
under Medicare plus ten percent (10%).
(b) Eligible expenses are the charges for the following health care
services and articles to the extent furnished by a health care provider
in an emergency situation or furnished or prescribed by a physician:
(1) Hospital services, including charges for the institution's most
common semiprivate room, and for private room only when
medically necessary, but limited to a total of one hundred eighty
(180) days in a year.
(2) Professional services for the diagnosis or treatment of
injuries, illnesses, or conditions, other than mental or dental, that
are rendered by a physician or, at the physician's direction, by the
physician's staff of registered or licensed nurses, and allied health
professionals.
(3) The first twenty (20) professional visits for the diagnosis or
treatment of one (1) or more mental conditions rendered during
the year by one (1) or more physicians or, at their direction, by
their staff of registered or licensed nurses, and allied health
professionals.
(4) Drugs and contraceptive devices requiring a physician's
prescription.
(5) Services of a skilled nursing facility for not more than one
hundred eighty (180) days in a year.
(6) Services of a home health agency up to two hundred seventy
(270) days of service a year.
(7) Use of radium or other radioactive materials.
(8) Oxygen.
(9) Anesthetics.
(10) Prostheses, other than dental.
(11) Rental of durable medical equipment which has no personal
use in the absence of the condition for which prescribed.
(12) Diagnostic X-rays and laboratory tests.
(13) Oral surgery for:
(A) excision of partially or completely erupted impacted
teeth;
(B) excision of a tooth root without the extraction of the entire
tooth; or
(C) the gums and tissues of the mouth when not performed in
connection with the extraction or repair of teeth.
(14) Services of a physical therapist and services of a speech
therapist.
(15) Professional ambulance services to the nearest health care
facility qualified to treat the illness or injury.
(16) Other medical supplies required by a physician's orders.
An association policy may also include comparable benefits for those
who rely upon spiritual means through prayer alone for healing upon
such conditions, limitations, and requirements as may be determined
by the board of directors.
(b) (c) A managed care organization that issues an association
policy may not refuse to enter into an agreement with a hospital solely
because the hospital has not obtained accreditation from an
accreditation organization that:
(1) establishes standards for the organization and operation of
hospitals;
(2) requires the hospital to undergo a survey process for a fee
paid by the hospital; and
(3) was organized and formed in 1951.
(c) (d) This section does not prohibit a managed care organization
from using performance indicators or quality standards that:
(1) are developed by private organizations; and
(2) do not rely upon a survey process for a fee charged to the
hospital to evaluate performance.
(d) (e) For purposes of this section, if benefits are provided in the
form of services rather than cash payments, their value shall be
determined on the basis of their monetary equivalency.
(e) (f) The following are not eligible expenses in any association
policy within the scope of this chapter:
(1) Services for which a charge is not made in the absence of
insurance or for which there is no legal obligation on the part of
the patient to pay.
(2) Services and charges made for benefits provided under the
laws of the United States, including Medicare and Medicaid,
military service connected disabilities, medical services provided
for members of the armed forces and their dependents or for
employees of the armed forces of the United States, medical
services financed in the future on behalf of all citizens by the
United States.
(3) Benefits which would duplicate the provision of services or
payment of charges for any care for injury or disease either:
(A) arising out of and in the course of an employment subject
to a worker's compensation or similar law; or
(B) for which benefits are payable without regard to fault
under a coverage statutorily required to be contained in any
motor vehicle or other liability insurance policy or equivalent
self-insurance.
However, this subdivision does not authorize exclusion of charges
that exceed the benefits payable under the applicable worker's
compensation or no-fault coverage.
(4) Care which is primarily for a custodial or domiciliary purpose.
(5) Cosmetic surgery unless provided as a result of an injury or
medically necessary surgical procedure.
(6) Any charge for services or articles the provision of which is
not within the scope of the license or certificate of the institution
or individual rendering the services.
(f) (g) The coverage and benefit requirements of this section for
association policies may not be altered by any other inconsistent state
law without specific reference to this chapter indicating a legislative
intent to add or delete from the coverage requirements of this chapter.
(g) (h) This chapter does not prohibit the association from issuing
additional types of health insurance policies with different types of
benefits that, in the opinion of the board of directors, may be of benefit
to the citizens of Indiana.
(h) (i) This chapter does not prohibit the association or its
administrator from implementing uniform procedures to review the
medical necessity and cost effectiveness of proposed treatment,
confinement, tests, or other medical procedures. Those procedures may
take the form of preadmission review for nonemergency
hospitalization, case management review to verify that covered
individuals are aware of treatment alternatives, or other forms of
utilization review. Any cost containment techniques of this type must
be adopted by the board of directors and approved by the
commissioner.".
SOURCE: Page 18, line 25; (03)MO174905.18. -->
Page 18, line 25, after "(a)" insert " A person is not eligible for an
association policy if the person is eligible for Medicaid. A person
other than a federally eligible individual may not apply for an
association policy unless the person has applied for Medicaid not
more than sixty (60) days before applying for the association
policy.
(b)".
Page 18, line 26, strike "(b),".
Page 18, line 26, reset in roman "(c),".
Page 18, line 33, strike "(b)" and insert " (c)".
Page 18, line 33, delete "," and insert " and subsection (a),".
Page 19, line 15, delete "(c)" and insert " (d)".
Page 19, line 25, strike "(d)" and insert " (e)".
Page 19, line 41, strike "(e)" and insert " (f)".
Page 20, line 12, strike "(f)" and insert " (g)".
Page 20, line 12, strike "(g)," and insert " (h),".
Page 20, line 14, strike "three (3)" and insert " six (6)".
Page 20, line 17, strike "three (3)" and insert " six (6)".
Page 20, line 20, strike "(g)" and insert " (h)".
Page 20, line 23, strike "(b)," and insert " (c),".
Page 20, line 31, strike "(h)" and insert " (i)".
Page 21, between lines 23 and 24, begin a new paragraph and insert:
SOURCE: ; (03)MO174905.14. -->
"SECTION 14. [EFFECTIVE JULY 1, 2003] (a) The Indiana
comprehensive health insurance association established by
IC 27-8-10-2.1
and the office of Medicaid policy and planning
established by
IC 12-8-6-1
shall jointly consider the use of all or a
part of:
(1) assessments made under
IC 27-8-10
; and
(2) funds, if any, realized by the state due to a reduction in tax
credits taken under
IC 27-8-10
;
as the nonfederal share of payments under a payment program
described in subsection (b).
(b) In conjunction with the joint efforts described in subsection
(a), the association and the office shall consider and, if feasible,
develop Medicaid payment programs that, using funding described
in subsection (a):
(1) provide Medicaid add-on payments to providers (as
defined in
IC 12-7-2-149
(2)) or affiliated entities of providers
on the basis of the provider's provision of care to individuals
covered under an association policy (as defined in
IC 27-8-10-1
); or
(2) to the extent permitted by applicable federal Medicaid
law, condition a provider's Medicaid payment on the
provider's tender of funds to the association or another
nongovernmental entity established to fund care to
individuals covered under an association policy.
(c) If mutually agreed, the association and the office may
implement a payment program developed under subsection (b).
SOURCE: ; (03)MO174905.15. -->
SECTION 15. [EFFECTIVE JULY 1, 2003]
If the amount of
reimbursement for health care services covered under an Indiana
comprehensive health insurance association policy is specified
under a contract with a health care provider,
IC 27-8-10-3
, as
amended by this act, applies to a contract specifying the amount of
reimbursement for health care services that is entered into,
delivered, amended, or renewed after June 30, 2003.".
Renumber all SECTIONS consecutively.
(Reference is to EHB 1749 as printed March 28, 2003.)
________________________________________
MO174905/DI 97 2003