Indiana 2023 Regular Session

Indiana Senate Bill SB0196 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	Introduced Version
3	3	SENATE BILL No. 196
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 12-15-44.5.
7	7	Synopsis: Healthy Indiana plan health care accounts. Repeals the
8	8	health care account and cost sharing requirements of an individual for
9	9	the healthy Indiana plan.
10	10	Effective: July 1, 2023.
11	11	Ford J.D.
12	12	January 10, 2023, read first time and referred to Committee on Health and Provider
13	13	Services.
14	14	2023 IN 196—LS 6633/DI 104 Introduced
15	15	First Regular Session of the 123rd General Assembly (2023)
16	16	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
17	17	Constitution) is being amended, the text of the existing provision will appear in this style type,
18	18	additions will appear in this style type, and deletions will appear in this style type.
19	19	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
20	20	provision adopted), the text of the new provision will appear in this style type. Also, the
21	21	word NEW will appear in that style type in the introductory clause of each SECTION that adds
22	22	a new provision to the Indiana Code or the Indiana Constitution.
23	23	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
24	24	between statutes enacted by the 2022 Regular Session of the General Assembly.
25	25	SENATE BILL No. 196
26	26	A BILL FOR AN ACT to amend the Indiana Code concerning
27	27	Medicaid.
28	28	Be it enacted by the General Assembly of the State of Indiana:
29	29	1 SECTION 1. IC 12-15-44.5-3.5, AS AMENDED BY
30	30	2 P.L.180-2022(ss), SECTION 16, IS AMENDED TO READ AS
31	31	3 FOLLOWS [EFFECTIVE JULY 1, 2023]: Sec. 3.5. (a) The plan must
32	32	4 include the following in a manner and to the extent determined by the
33	33	5 office:
34	34	6 (1) Mental health care services.
35	35	7 (2) Inpatient hospital services.
36	36	8 (3) Prescription drug coverage, including coverage of a long
37	37	9 acting, nonaddictive medication assistance treatment drug if the
38	38	10 drug is being prescribed for the treatment of substance abuse.
39	39	11 (4) Emergency room services.
40	40	12 (5) Physician office services.
41	41	13 (6) Diagnostic services.
42	42	14 (7) Outpatient services, including therapy services.
43	43	15 (8) Comprehensive disease management.
44	44	16 (9) Home health services, including case management.
45	45	17 (10) Urgent care center services.
46	46	2023 IN 196—LS 6633/DI 104 2
47	47	1 (11) Preventative care services.
48	48	2 (12) Family planning services:
49	49	3 (A) including contraceptives and sexually transmitted disease
50	50	4 testing, as described in federal Medicaid law (42 U.S.C. 1396
51	51	5 et seq.); and
52	52	6 (B) not including abortion or abortifacients.
53	53	7 (13) Hospice services.
54	54	8 (14) Substance abuse services.
55	55	9 (15) Donated breast milk that meets requirements developed by
56	56	10 the office of Medicaid policy and planning.
57	57	11 (16) A service determined by the secretary to be required by
58	58	12 federal law as a benchmark service under the federal Patient
59	59	13 Protection and Affordable Care Act.
60	60	14 (b) The plan may not permit treatment limitations or financial
61	61	15 requirements on the coverage of mental health care services or
62	62	16 substance abuse services if similar limitations or requirements are not
63	63	17 imposed on the coverage of services for other medical or surgical
64	64	18 conditions.
65	65	19 (c) The plan may provide vision services and dental services. only
66	66	20 to individuals who regularly make the required monthly contributions
67	67	21 for the plan as set forth in section 4.7(c) of this chapter.
68	68	22 (d) The benefit package offered in the plan:
69	69	23 (1) must be benchmarked to a commercial health plan described
70	70	24 in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
71	71	25 (2) may not include a benefit that is not present in at least one (1)
72	72	26 of these commercial benchmark options.
73	73	27 (e) The office shall provide to an individual who participates in the
74	74	28 plan a list of health care services that qualify as preventative care
75	75	29 services for the age, gender, and preexisting conditions of the
76	76	30 individual. The office shall consult with the federal Centers for Disease
77	77	31 Control and Prevention for a list of recommended preventative care
78	78	32 services.
79	79	33 (f) The plan shall, at no cost to the individual, provide payment of
80	80	34 preventative care services described in 42 U.S.C. 300gg-13 for an
81	81	35 individual who participates in the plan.
82	82	36 (g) The plan shall, at no cost to the individual, provide payments of
83	83	37 not more than five hundred dollars ($500) per year for preventative
84	84	38 care services not described in subsection (f). Any additional
85	85	39 preventative care services covered under the plan and received by the
86	86	40 individual during the year are subject to the deductible and payment
87	87	41 requirements of the plan.
88	88	42 (h) The office shall apply to the United States Department of Health
89	89	2023 IN 196—LS 6633/DI 104 3
90	90	1 and Human Services for any amendment to the waiver necessary to
91	91	2 implement the providing of the services or supplies described in
92	92	3 subsection (a)(15). This subsection expires July 1, 2024.
93	93	4 SECTION 2. IC 12-15-44.5-4.5 IS REPEALED [EFFECTIVE JULY
94	94	5 1, 2023]. Sec. 4.5. (a) An individual who participates in the plan must
95	95	6 have a health care account to which payments may be made for the
96	96	7 individual's participation in the plan.
97	97	8 (b) An individual's health care account must be used to pay the
98	98	9 individual's deductible for health care services under the plan.
99	99	10 (c) An individual's deductible must be at least two thousand five
100	100	11 hundred dollars ($2,500) per year.
101	101	12 (d) An individual may make payments to the individual's health care
102	102	13 account as follows:
103	103	14 (1) An employer withholding or causing to be withheld from an
104	104	15 employee's wages or salary, after taxes are deducted from the
105	105	16 wages or salary, the individual's contribution under this chapter
106	106	17 and distributed equally throughout the calendar year.
107	107	18 (2) Submission of the individual's contribution under this chapter
108	108	19 to the office to deposit in the individual's health care account in
109	109	20 a manner prescribed by the office.
110	110	21 (3) Another method determined by the office.
111	111	22 SECTION 3. IC 12-15-44.5-4.7, AS AMENDED BY P.L.152-2017,
112	112	23 SECTION 33, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
113	113	24 JULY 1, 2023]: Sec. 4.7. (a) To participate in the plan, an individual
114	114	25 must apply for the plan on a form prescribed by the office. The office
115	115	26 may develop and allow a joint application for a household.
116	116	27 (b) A pregnant woman is not subject to the cost sharing provisions
117	117	28 of the plan. Subsections (c) through (g) do not apply to a pregnant
118	118	29 woman participating in the plan.
119	119	30 (c) An applicant who is approved to participate in the plan does not
120	120	31 begin benefits under the plan until a payment of at least:
121	121	32 (1) one-twelfth (1/12) of the annual income contribution amount;
122	122	33 or
123	123	34 (2) ten dollars ($10);
124	124	35 is made to the individual's health care account established under
125	125	36 section 4.5 of this chapter for the individual's participation in the plan.
126	126	37 To continue to participate in the plan, an individual must contribute to
127	127	38 the individual's health care account at least two percent (2%) of the
128	128	39 individual's annual household income per year or an amount
129	129	40 determined by the secretary that is based on the individual's annual
130	130	41 household income per year, but not less than one dollar ($1) per month.
131	131	42 The amount determined by the secretary under this subsection must be
132	132	2023 IN 196—LS 6633/DI 104 4
133	133	1 approved by the United States Department of Health and Human
134	134	2 Services and must be budget neutral to the state as determined by the
135	135	3 state budget agency.
136	136	4 (d) If an applicant who is approved to participate in the plan fails to
137	137	5 make the initial payment into the individual's health care account, at
138	138	6 least the following must occur:
139	139	7 (1) If the individual has an annual income that is at or below one
140	140	8 hundred percent (100%) of the federal poverty income level, the
141	141	9 individual's benefits are reduced as specified in subsection (e)(1).
142	142	10 (2) If the individual has an annual income of more than one
143	143	11 hundred percent (100%) of the federal poverty income level, the
144	144	12 individual is not enrolled in the plan.
145	145	13 (e) If an enrolled individual's required monthly payment to the plan
146	146	14 is not made within sixty (60) days after the required payment date, the
147	147	15 following, at a minimum, occur:
148	148	16 (1) For an individual who has an annual income that is at or below
149	149	17 one hundred percent (100%) of the federal income poverty level,
150	150	18 the individual is:
151	151	19 (A) transferred to a plan that has a material reduction in
152	152	20 benefits, including the elimination of benefits for vision and
153	153	21 dental services; and
154	154	22 (B) required to make copayments for the provision of services
155	155	23 that may not be paid from the individual's health care account.
156	156	24 (2) For an individual who has an annual income of more than one
157	157	25 hundred percent (100%) of the federal poverty income level, the
158	158	26 individual shall be terminated from the plan and may not reenroll
159	159	27 in the plan for at least six (6) months.
160	160	28 (f) The state shall contribute to the individual's health care account
161	161	29 the difference between the individual's payment required under this
162	162	30 section and the plan deductible set forth in section 4.5(c) of this
163	163	31 chapter.
164	164	32 (g) (b) A member shall remain enrolled with the same managed care
165	165	33 organization during the member's benefit period. A member may
166	166	34 change managed care organizations as follows:
167	167	35 (1) Without cause:
168	168	36 (A) before making a contribution or before finalizing
169	169	37 enrollment; in accordance with subsection (d)(1); or
170	170	38 (B) during the annual plan renewal process.
171	171	39 (2) For cause, as determined by the office.
172	172	40 SECTION 4. IC 12-15-44.5-4.9, AS AMENDED BY P.L.114-2018,
173	173	41 SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
174	174	42 JULY 1, 2023]: Sec. 4.9. (a) An individual who is approved to
175	175	2023 IN 196—LS 6633/DI 104 5
176	176	1 participate in the plan is eligible for a twelve (12) month plan period if
177	177	2 the individual continues to meet the plan requirements specified in this
178	178	3 chapter.
179	179	4 (b) If an individual chooses to renew participation in the plan, the
180	180	5 individual is subject to an annual renewal process at the end of the
181	181	6 benefit period to determine continued eligibility for participating in the
182	182	7 plan. If the individual does not complete the renewal process, the
183	183	8 individual may not reenroll in the plan for at least six (6) months.
184	184	9 (c) This subsection applies to participants who consistently made
185	185	10 the required payments in the individual's health care account. If the
186	186	11 individual receives the qualified preventative services recommended
187	187	12 to the individual during the year, the individual is eligible to have the
188	188	13 individual's unused share of the individual's health care account at the
189	189	14 end of the plan period, determined by the office, matched by the state
190	190	15 and carried over to the subsequent plan period to reduce the
191	191	16 individual's required payments. If the individual did not, during the
192	192	17 plan period, receive all qualified preventative services recommended
193	193	18 to the individual, only the nonstate contribution to the health care
194	194	19 account may be used to reduce the individual's payments for the
195	195	20 subsequent plan period.
196	196	21 (d) For individuals participating in the plan who, in the past, did not
197	197	22 make consistent payments into the individual's health care account
198	198	23 while participating in the plan, but:
199	199	24 (1) had a balance remaining in the individual's health care
200	200	25 account; and
201	201	26 (2) received all of the required preventative care services;
202	202	27 the office may elect to offer a discount on the individual's required
203	203	28 payments to the individual's health care account for the subsequent
204	204	29 benefit year. The amount of the discount under this subsection must be
205	205	30 related to the percentage of the health care account balance at the end
206	206	31 of the plan year but not to exceed a fifty percent (50%) discount of the
207	207	32 required contribution.
208	208	33 (e) If an individual is no longer eligible for the plan, does not renew
209	209	34 participation in the plan at the end of the plan period, or is terminated
210	210	35 from the plan for nonpayment of a required payment, the office shall,
211	211	36 not more than one hundred twenty (120) days after the last date of the
212	212	37 plan benefit period, refund to the individual the amount determined
213	213	38 under subsection (f) of any funds remaining in the individual's health
214	214	39 care account as follows:
215	215	40 (1) An individual who is no longer eligible for the plan or does
216	216	41 not renew participation in the plan at the end of the plan period
217	217	42 shall receive the amount determined under STEP FOUR of
218	218	2023 IN 196—LS 6633/DI 104 6
219	219	1 subsection (f).
220	220	2 (2) An individual who is terminated from the plan due to
221	221	3 nonpayment of a required payment shall receive the amount
222	222	4 determined under STEP SIX of subsection (f).
223	223	5 The office may charge a penalty for any voluntary withdrawals from the
224	224	6 health care account by the individual before the end of the plan benefit
225	225	7 year. The individual may receive the amount determined under STEP
226	226	8 SIX of subsection (f).
227	227	9 (f) The office shall determine the amount payable to an individual
228	228	10 described in subsection (e) as follows:
229	229	11 STEP ONE: Determine the total amount paid into the individual's
230	230	12 health care account under this chapter.
231	231	13 STEP TWO: Determine the total amount paid into the individual's
232	232	14 health care account from all sources.
233	233	15 STEP THREE: Divide STEP ONE by STEP TWO.
234	234	16 STEP FOUR: Multiply the ratio determined in STEP THREE by
235	235	17 the total amount remaining in the individual's health care account.
236	236	18 STEP FIVE: Subtract any nonpayments of a required payment.
237	237	19 STEP SIX: Multiply the amount determined under STEP FIVE by
238	238	20 at least seventy-five hundredths (0.75).
239	239	21 SECTION 5. IC 12-15-44.5-5.7, AS AMENDED BY P.L.114-2018,
240	240	22 SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
241	241	23 JULY 1, 2023]: Sec. 5.7. Subject to appeal to the office, an individual
242	242	24 may be held responsible under the plan for receiving nonemergency
243	243	25 services in an emergency room setting, including prohibiting the
244	244	26 individual from using funds in the individual's health care account to
245	245	27 pay for the nonemergency services and paying a copayment for the
246	246	28 services of at least eight dollars ($8) for the nonemergency use of a
247	247	29 hospital emergency department. However, an individual may not be
248	248	30 prohibited from using funds in the individual's health care account to
249	249	31 pay for nonemergency services provided in an emergency room setting
250	250	32 for a medical condition that arises suddenly and unexpectedly and
251	251	33 manifests itself by acute symptoms of such severity, including severe
252	252	34 pain, that the absence of immediate medical attention could reasonably
253	253	35 be expected by a prudent layperson who possesses an average
254	254	36 knowledge of health and medicine to:
255	255	37 (1) place an individual's health in serious jeopardy;
256	256	38 (2) result in serious impairment to the individual's bodily
257	257	39 functions; or
258	258	40 (3) result in serious dysfunction of a bodily organ or part of the
259	259	41 individual.
260	260	42 SECTION 6. IC 12-15-44.5-10, AS AMENDED BY P.L.30-2016,
261	261	2023 IN 196—LS 6633/DI 104 7
262	262	1 SECTION 35, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
263	263	2 JULY 1, 2023]: Sec. 10. (a) The secretary has the authority to provide
264	264	3 benefits to individuals eligible under the adult group described in 42
265	265	4 CFR 435.119 only in accordance with this chapter.
266	266	5 (b) The secretary may negotiate and make changes to the plan,
267	267	6 except that the secretary may not negotiate or change the plan in a way
268	268	7 that would do the following:
269	269	8 (1) Reduce the following:
270	270	9 (A) Contribution amounts below the minimum levels set forth
271	271	10 in section 4.7 of this chapter.
272	272	11 (B) Deductible amounts below the minimum amount
273	273	12 established in section 4.5(c) of this chapter.
274	274	13 (2) Remove or reduce the penalties for nonpayment set forth in
275	275	14 section 4.7 of this chapter.
276	276	15 (3) Revise the use of the health care account requirement set forth
277	277	16 in section 4.5 of this chapter.
278	278	17 (4) (1) Include noncommercial benefits or add additional plan
279	279	18 benefits in a manner inconsistent with section 3.5 of this chapter.
280	280	19 (5) Allow services to begin:
281	281	20 (A) without the payment established or required by; or
282	282	21 (B) earlier than the time frames otherwise established by;
283	283	22 section 4.7 of this chapter.
284	284	23 (6) (2) Reduce financial penalties for the inappropriate use of the
285	285	24 emergency room below the minimum levels set forth in section
286	286	25 5.7 of this chapter.
287	287	26 (7) (3) Permit members to change health plans without cause in
288	288	27 a manner inconsistent with section 4.7(g) 4.7(b) of this chapter.
289	289	28 (8) (4) Operate the plan in a manner that would obligate the state
290	290	29 to financial participation beyond the level of state appropriations
291	291	30 or funding otherwise authorized for the plan.
292	292	31 (c) The secretary may make changes to the plan under this chapter
293	293	32 if the changes are required by federal law or regulation.
294	294	33 SECTION 7. [EFFECTIVE JULY 1, 2023] (a) Before September
295	295	34 1, 2023, the office of the secretary of family and social services shall
296	296	35 apply to the United States Department of Health and Human
297	297	36 Services for any amendment to the healthy Indiana plan Medicaid
298	298	37 waiver necessary to remove the health care account and cost
299	299	38 sharing requirements of participants in the healthy Indiana plan,
300	300	39 as required by this act.
301	301	40 (b) This SECTION expires December 31, 2023.
302	302	2023 IN 196—LS 6633/DI 104