Reprinted
February 27, 2008
ENGROSSED
SENATE BILL No. 315
_____
DIGEST OF SB 315
(Updated February 26, 2008 4:43 pm - DI 77)
Citations Affected: IC 12-7; IC 12-9; IC 12-10; noncode.
Synopsis: Aging and long term care services. Provides that a person
who has made certain asset transfers is not eligible for residential care
assistance. Transfers the adult guardianship program from the division
of aging to the division of disability and rehabilitative services.
Requires rules to be adopted to: (1) implement a screening and
counseling program for individuals seeking long term care services; (2)
implement a process of prior approval for certain individuals seeking
admission to a nursing facility; and (3) the annual review of Medicaid
rates. Prohibits the state department of health from approving the
certification of new or converted comprehensive care beds for
participation in the Medicaid program until July 1, 2011, unless the
state comprehensive care bed occupancy rate is more than 95% in
health facilities. Allows for an exception for replacement beds if
specified requirements are met. Makes conforming and technical
changes.
Effective: March 31, 2008; July 1, 2008.
Dillon, Hume, Mrvan, Deig
(HOUSE SPONSORS _ HOY, CROUCH)
January 10, 2008, read first time and referred to Committee on Health and Provider
Services.
January 17, 2008, reported favorably _ Do Pass; reassigned to Committee on
Appropriations.
January 24, 2008, amended, reported favorably _ Do Pass.
January 28, 2008, read second time, amended, ordered engrossed.
January 29, 2008, engrossed. Read third time, passed. Yeas 48, nays 0.
HOUSE ACTION
February 4, 2008, read first time and referred to Committee on Public Health.
February 21, 2008, amended, reported _ Do Pass.
February 26, 2008, read second time, amended, ordered engrossed.
Reprinted
February 27, 2008
Second Regular Session 115th General Assembly (2008)
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 2007 Regular Session of the General Assembly.
ENGROSSED
SENATE BILL No. 315
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 12-7-2-114; (08)ES0315.2.1. -->
SECTION 1. IC 12-7-2-114 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2008]: Sec. 114. "Incapacitated
individual", for purposes of IC 12-10-7, IC 12-9-7, has the meaning set
forth in IC 12-10-7-1. IC 12-9-7-1.
SOURCE: IC 12-7-2-116; (08)ES0315.2.2. -->
SECTION 2. IC 12-7-2-116 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2008]: Sec. 116. "Indigent adult",
for purposes of IC 12-10-7, IC 12-9-7, has the meaning set forth in
IC 12-10-7-2. IC 12-9-7-2.
SOURCE: IC 12-7-2-149.1; (08)ES0315.2.3. -->
SECTION 3. IC 12-7-2-149.1, AS AMENDED BY P.L.145-2006,
SECTION 57, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2008]: Sec. 149.1. "Provider" means the following:
(1) For purposes of IC 12-10-7, IC 12-9-7, the meaning set forth
in IC 12-10-7-3. IC 12-9-7-3.
(2) For purposes of the following statutes, an individual, a
partnership, a corporation, or a governmental entity that is
enrolled in the Medicaid program under rules adopted under
IC 4-22-2 by the office of Medicaid policy and planning:
(A) IC 12-14-1 through IC 12-14-9.5.
(B) IC 12-15, except IC 12-15-32, IC 12-15-33, and
IC 12-15-34.
(C) IC 12-17.6.
(3) Except as provided in subdivision (4), for purposes of
IC 12-17.2, a person who operates a child care center or child care
home under IC 12-17.2.
(4) For purposes of IC 12-17.2-3.5, a person that:
(A) provides child care; and
(B) is directly paid for the provision of the child care under the
federal Child Care and Development Fund voucher program
administered under 45 CFR 98 and 45 CFR 99.
The term does not include an individual who provides services to
a person described in clauses (A) and (B), regardless of whether
the individual receives compensation.
SOURCE: IC 12-7-2-159; (08)ES0315.2.4. -->
SECTION 4. IC 12-7-2-159 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2008]: Sec. 159. "Region", for
purposes of IC 12-10-7, IC 12-9-7, has the meaning set forth in
IC 12-10-7-4. IC 12-9-7-4.
SOURCE: IC 12-9-7; (08)ES0315.2.5. -->
SECTION 5. IC 12-9-7 IS ADDED TO THE INDIANA CODE AS
A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2008]:
Chapter 7. Adult Guardianship Services
Sec. 1. As used in this chapter, "incapacitated individual" means
an individual who:
(1) cannot be located upon reasonable inquiry;
(2) is unable:
(A) to manage in whole or in part the individual's
property;
(B) to provide self-care; or
(C) to do either of the functions described in clauses (A)
and (B);
because of mental illness, dementia, physical illness, infirmity,
habitual drunkenness, excessive use of drugs, confinement,
detention, duress, fraud, undue influence of others on the
individual, or other disability (as that term is used in
IC 12-10-10-3 or IC 12-14-15-1); or
(3) has a developmental disability.
Sec. 2. As used in this chapter, "indigent adult" means an
individual who:
(1) is at least eighteen (18) years of age;
(2) has no appropriate person to serve as guardian; and
(3) either:
(A) has an annual gross income of not more than one
hundred twenty-five percent (125%) of the federal income
poverty level as determined annually by the federal Office
of Management and Budget under 42 U.S.C. 9902; or
(B) demonstrates the inability to obtain privately provided
guardianship services.
Sec. 3. As used in this chapter, "provider" refers to a regional
guardianship services provider.
Sec. 4. As used in this chapter, "region" means a service
provision region established by the division by rule adopted under
IC 4-22-2.
Sec. 5. The adult guardianship services program is established
to provide services within the limits of available funding for
indigent incapacitated adults.
Sec. 6. The director shall administer the program on a statewide
basis.
Sec. 7. The director of the division shall adopt rules under
IC 4-22-2 to implement this chapter.
Sec. 8. (a) The division shall contract in writing for the provision
of the guardianship services required in each region with a
nonprofit corporation that is:
(1) qualified to receive tax deductible contributions under
Section 170 of the Internal Revenue Code; and
(2) located in the region.
(b) The division shall establish qualifications to determine
eligible providers in each region.
(c) Each contract between the division and a provider must
specify a method for the following:
(1) The establishment of a guardianship committee within the
provider, serving under the provider's board of directors.
(2) The provision of money and services by the provider in an
amount equal to at least twenty-five percent (25%) of the total
amount of the contract and the provision by the division of the
remaining amount of the contract. The division shall establish
guidelines to determine the value of services provided under
this subdivision.
(3) The establishment of procedures to avoid a conflict of
interest for the provider in providing necessary services to
each incapacitated individual.
(4) The identification and evaluation of indigent adults in need
of guardianship services.
(5) The adoption of individualized service plans to provide the
least restrictive type of guardianship or related services for
each incapacitated individual, including the following:
(A) Designation as a representative payee by:
(i) the Social Security Administration;
(ii) the United States Office of Personnel Management;
(iii) the United States Department of Veterans Affairs; or
(iv) the United States Railroad Retirement Board.
(B) Limited guardianship under IC 29-3.
(C) Guardianship of the person or estate under IC 29-3.
(D) The appointment of:
(i) a health care representative under IC 16-36-1-7; or
(ii) a power of attorney under IC 30-5.
(6) The periodic reassessment of each incapacitated
individual.
(7) The provision of legal services necessary for the
guardianship.
(8) The training and supervision of paid and volunteer staff.
(9) The establishment of other procedures and programs
required by the division.
Sec. 9. (a) Each provider is subject to periodic audit of the adult
guardianship services program by an independent certified public
accountant.
(b) The results of the audit required under subsection (a) must
be submitted to the division.
SOURCE: IC 12-10-6-2.1; (08)ES0315.2.6. -->
SECTION 6. IC 12-10-6-2.1, AS AMENDED BY P.L.99-2007,
SECTION 61, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2008]: Sec. 2.1. (a) An individual who is incapable of residing
in the individual's own home may apply for residential care assistance
under this section. The determination of eligibility for residential care
assistance is the responsibility of the division. Except as provided in
subsections (g) and (i), an individual is eligible for residential care
assistance if the division determines that the individual:
(1) is a recipient of Medicaid or the federal Supplemental Security
Income program;
(2) is incapable of residing in the individual's own home because
of dementia, mental illness, or a physical disability;
(3) requires a degree of care less than that provided by a health
care facility licensed under IC 16-28;
and
(4) can be adequately cared for in a residential care setting;
and
(5) has not made any asset transfer prohibited under the state
plan or in 42 U.S.C. 1396p(c) in order to be eligible for
Medicaid.
(b) Individuals with mental retardation may not be admitted to a
home or facility that provides residential care under this section.
(c) A service coordinator employed by the division may:
(1) evaluate a person seeking admission to a home or facility
under subsection (a); or
(2) evaluate a person who has been admitted to a home or facility
under subsection (a), including a review of the existing
evaluations in the person's record at the home or facility.
If the service coordinator determines the person evaluated under this
subsection has mental retardation, the service coordinator may
recommend an alternative placement for the person.
(d) Except as provided in section 5 of this chapter, residential care
consists of only room, board, and laundry, along with minimal
administrative direction. State financial assistance may be provided for
such care in a boarding or residential home of the applicant's choosing
that is licensed under IC 16-28 or a Christian Science facility listed and
certified by the Commission for Accreditation of Christian Science
Nursing Organizations/Facilities, Inc., that meets certain life safety
standards considered necessary by the state fire marshal. Payment for
such care shall be made to the provider of the care according to
division directives and supervision. The amount of nonmedical
assistance to be paid on behalf of a recipient living in a boarding home,
residential home, or Christian Science facility shall be based on the
daily rate established by the division. The rate for facilities that are
referred to in this section and licensed under IC 16-28 may not exceed
an upper rate limit established by a rule adopted by the division. The
recipient may retain from the recipient's income a monthly personal
allowance of fifty-two dollars ($52). This amount is exempt from
income eligibility consideration by the division and may be exclusively
used by the recipient for the recipient's personal needs. However, if the
recipient's income is less than the amount of the personal allowance,
the division shall pay to the recipient the difference between the
amount of the personal allowance and the recipient's income. A reserve
or an accumulated balance from such a source, together with other
sources, may not be allowed to exceed the state's resource allowance
allowed for adults eligible for state supplemental assistance or
Medicaid as established by the rules of the office of Medicaid policy
and planning.
(e) In addition to the amount that may be retained as a personal
allowance under this section, an individual shall be allowed to retain
an amount equal to the individual's state and local income tax liability.
The amount that may be retained during a month may not exceed
one-third (1/3) of the individual's state and local income tax liability for
the calendar quarter in which that month occurs. This amount is
exempt from income eligibility consideration by the division. The
amount retained shall be used by the individual to pay any state or local
income taxes owed.
(f) In addition to the amounts that may be retained under
subsections (d) and (e), an eligible individual may retain a Holocaust
victim's settlement payment. The payment is exempt from income
eligibility consideration by the division.
(g) The rate of payment to the provider shall be determined in
accordance with a prospective prenegotiated payment rate predicated
on a reasonable cost related basis, with a growth of profit factor, as
determined in accordance with generally accepted accounting
principles and methods, and written standards and criteria, as
established by the division. The division shall establish an
administrative appeal procedure to be followed if rate disagreement
occurs if the provider can demonstrate to the division the necessity of
costs in excess of the allowed or authorized fee for the specific
boarding or residential home. The amount may not exceed the
maximum established under subsection (d).
(h) The personal allowance for one (1) month for an individual
described in subsection (a) is the amount that an individual would be
entitled to retain under subsection (d) plus an amount equal to one-half
(1/2) of the remainder of:
(1) gross earned income for that month; minus
(2) the sum of:
(A) sixteen dollars ($16); plus
(B) the amount withheld from the person's paycheck for that
month for payment of state income tax, federal income tax,
and the tax prescribed by the federal Insurance Contribution
Act (26 U.S.C. 3101 et seq.); plus
(C) transportation expenses for that month; plus
(D) any mandatory expenses required by the employer as a
condition of employment.
(i) An individual who, before September 1, 1983, has been admitted
to a home or facility that provides residential care under this section is
eligible for residential care in the home or facility.
(j) The director of the division may contract with the division of
mental health and addiction or the division of disability and
rehabilitative services to purchase services for individuals with a
mental illness or a developmental disability by providing money to
supplement the appropriation for community residential care programs
established under IC 12-22-2 or community residential programs
established under IC 12-11-1.1-1.
(k) A person with a mental illness may not be placed in a Christian
Science facility listed and certified by the Commission for
Accreditation of Christian Science Nursing Organizations/Facilities,
Inc., unless the facility is licensed under IC 16-28.
SOURCE: IC 12-10-6-3; (08)ES0315.2.7. -->
SECTION 7. IC 12-10-6-3, AS AMENDED BY P.L.1-2007,
SECTION 117, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2008]: Sec. 3. (a) The division, in cooperation
with the state department of health, taking into account licensure
requirements under IC 16-28, shall adopt rules under IC 4-22-2
governing the reimbursement to facilities under section 2.1 of this
chapter. The rules must be designed to determine the costs that must be
incurred by efficiently and economically operated facilities in order to
provide room, board, laundry, and other services, along with minimal
administrative direction to individuals who receive residential care in
the facilities under section 2.1 of this chapter.
(b) A rule adopted under this subsection (a) by:
(1) the division; or
(2) the state department of health;
must conform to the rules for residential care facilities that are licensed
under IC 16-28.
(b) (c) Any rate established under section 2.1 of this chapter may be
appealed according to the procedures under IC 4-21.5.
(c) (d) The division shall annually review each facility's rate using
the following:
(1) Generally accepted accounting principles.
(2) The costs incurred by efficiently and economically operated
facilities in order to provide care and services in conformity with
quality and safety standards and applicable laws and rules.
SOURCE: IC 12-10-12-6; (08)ES0315.2.8. -->
SECTION 8. IC 12-10-12-6, AS AMENDED BY P.L.50-2007,
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2008]: Sec. 6. (a) This subsection does not apply after
June
30, 2008. December 30, 2008. If an individual who is discharged from
a hospital licensed under IC 16-21:
(1) is admitted to a nursing facility after the individual has been
screened under the nursing facility preadmission program
described in this chapter; and
(2) is eligible for participation in the federal Medicaid program;
prior approval of the individual's admission to the nursing facility may
not be required by the office under IC 12-15-21-1 through
IC 12-15-21-3.
(b) This subsection applies beginning July 1, 2008. December 31,
2008. If an individual:
(1) is admitted to a nursing facility after the individual has been
screened under the nursing facility preadmission program
described in this chapter; and
(2) is eligible for participation in the federal Medicaid program;
prior approval of the individual's admission to the nursing facility may
be required by the office under IC 12-15-21-1 through IC 12-15-21-3.
(c) The office may shall adopt rules under IC 4-22-2 to implement:
(1) subsection (b);
(2) a screening and counseling program for individuals
seeking long term care services; and
(3) a biennial review of Medicaid waiver reimbursement
rates.
However, the adopted rules may not take effect before July 1, 2008.
SOURCE: IC 12-10-12-16; (08)ES0315.2.9. -->
SECTION 9. IC 12-10-12-16 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2008]: Sec. 16. (a) A screening
team shall conduct a nursing facility preadmission screening program
for each individual within the time permitted under this chapter. The
program must consist of an assessment of the following:
(1) The individual's medical needs.
(2) The availability of services, other than services provided in a
nursing facility, that are appropriate to the individual's needs.
(3) The cost effectiveness of providing services appropriate to the
individual's needs that are provided outside of, rather than within,
a nursing facility.
(b) The assessment must be conducted in accordance with rules
adopted under IC 4-22-2 by the director of the division in cooperation
with the office.
(c) Communication among members of a screening team or between
a screening team and the division, or the office, or the agency during
the prescreening process may be conducted using by means including
any of the following:
(1) Standard mail.
(2) Express mail.
(3) Facsimile machine.
(4) Secured electronic communication.
SOURCE: IC 12-10-7; (08)ES0315.2.10. -->
SECTION 10. IC 12-10-7 IS REPEALED [EFFECTIVE JULY 1,
2008].
SOURCE: ; (08)ES0315.2.11. -->
SECTION 11. [EFFECTIVE JULY 1, 2008]
(a) On July 1, 2008,
all rules, contracts, assets, and liabilities of the division of aging's
guardianship program under IC 12-10-7 (before its repeal by this
act) are transferred to the division of disability and rehabilitative
services under IC 12-9-7 (as added by this act) and are considered
rules, contracts, assets, and liabilities of the division of disability
and rehabilitative services.
(b) This SECTION expires July 1, 2013.
SOURCE: ; (08)ES0315.2.12. -->
SECTION 12. [EFFECTIVE MARCH 31, 2008] (a) This
SECTION does not apply to the conversion of acute care beds to
comprehensive care beds pursuant to IC 16-29-3.
(b) As used in this SECTION, "comprehensive care bed" means
a bed that:
(1) is licensed or is to be licensed under IC 16-28-2;
(2) functions as a bed licensed under IC 16-28-2; or
(3) is subject to IC 16-28.
The term does not include a comprehensive care bed that will be
used solely to provide specialized services and that is subject to
IC 16-29.
(c) As used in this SECTION, "replacement bed" means a
comprehensive care bed that is relocated to a health facility that is
licensed or is to be licensed under IC 16-28. This term includes
comprehensive care beds that are certified for participation in:
(1) the state Medicaid program; or
(2) both the state Medicaid program and federal Medicare
program.
(d) Except as provided in subsection (e), the Indiana health
facilities council may not recommend and the state department of
health may not approve the certification of new or converted
comprehensive care beds for participation in the state Medicaid
program unless the statewide comprehensive care bed occupancy
rate is more than ninety-five percent (95%), as calculated annually
on January 1 by the state department of health.
(e) This SECTION does not apply to a health facility that:
(1) seeks a replacement bed exception under subsection (d);
(2) is licensed or is to be licensed under IC 16-28;
(3) applies to the state department of health to certify a
comprehensive care bed for participation in the Medicaid
program if the comprehensive care bed for which the health
facility is seeking certification is a replacement bed for an
existing comprehensive care bed;
(4) applies to the division of aging in the manner:
(A) described in subsection (e); and
(B) prescribed by the division; and
(5) meets the licensure, survey, and certification requirements
of IC 16-28.
(f) An application described in subsection (e)(4) for a
replacement bed exception must include the following:
(1) The total number and identification of the existing
comprehensive care beds that the applicant requests be
replaced by health facility location and by provider.
(2) If the replacement bed is being transferred to a different
health facility, a verification from the health facility holding
the comprehensive care bed certification that the health
facility has agreed to transfer the beds to the applicant health
facility.
(3) If the replacement bed is being transferred to a different
health facility under different ownership, a copy of the
complete agreement between the health facility transferring
the beds and the applicant health facility.
(4) Any other information requested by the division of aging
that is necessary to evaluate the transaction.
(g) This SECTION expires June 30, 2011.
SOURCE: ; (08)ES0315.2.13. -->
SECTION 13.
An emergency is declared for this act.