Introduced Version
SENATE BILL No. 196
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 12-15-44.5.
Synopsis: Healthy Indiana plan health care accounts. Repeals the
health care account and cost sharing requirements of an individual for
the healthy Indiana plan.
Effective: July 1, 2023.
Ford J.D.
January 10, 2023, read first time and referred to Committee on Health and Provider
Services.
2023 IN 196—LS 6633/DI 104 Introduced
First Regular Session of the 123rd General Assembly (2023)
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 2022 Regular Session of the General Assembly.
SENATE BILL No. 196
A BILL FOR AN ACT to amend the Indiana Code concerning
Medicaid.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 12-15-44.5-3.5, AS AMENDED BY
2 P.L.180-2022(ss), SECTION 16, IS AMENDED TO READ AS
3 FOLLOWS [EFFECTIVE JULY 1, 2023]: Sec. 3.5. (a) The plan must
4 include the following in a manner and to the extent determined by the
5 office:
6 (1) Mental health care services.
7 (2) Inpatient hospital services.
8 (3) Prescription drug coverage, including coverage of a long
9 acting, nonaddictive medication assistance treatment drug if the
10 drug is being prescribed for the treatment of substance abuse.
11 (4) Emergency room services.
12 (5) Physician office services.
13 (6) Diagnostic services.
14 (7) Outpatient services, including therapy services.
15 (8) Comprehensive disease management.
16 (9) Home health services, including case management.
17 (10) Urgent care center services.
2023 IN 196—LS 6633/DI 104 2
1 (11) Preventative care services.
2 (12) Family planning services:
3 (A) including contraceptives and sexually transmitted disease
4 testing, as described in federal Medicaid law (42 U.S.C. 1396
5 et seq.); and
6 (B) not including abortion or abortifacients.
7 (13) Hospice services.
8 (14) Substance abuse services.
9 (15) Donated breast milk that meets requirements developed by
10 the office of Medicaid policy and planning.
11 (16) A service determined by the secretary to be required by
12 federal law as a benchmark service under the federal Patient
13 Protection and Affordable Care Act.
14 (b) The plan may not permit treatment limitations or financial
15 requirements on the coverage of mental health care services or
16 substance abuse services if similar limitations or requirements are not
17 imposed on the coverage of services for other medical or surgical
18 conditions.
19 (c) The plan may provide vision services and dental services. only
20 to individuals who regularly make the required monthly contributions
21 for the plan as set forth in section 4.7(c) of this chapter.
22 (d) The benefit package offered in the plan:
23 (1) must be benchmarked to a commercial health plan described
24 in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
25 (2) may not include a benefit that is not present in at least one (1)
26 of these commercial benchmark options.
27 (e) The office shall provide to an individual who participates in the
28 plan a list of health care services that qualify as preventative care
29 services for the age, gender, and preexisting conditions of the
30 individual. The office shall consult with the federal Centers for Disease
31 Control and Prevention for a list of recommended preventative care
32 services.
33 (f) The plan shall, at no cost to the individual, provide payment of
34 preventative care services described in 42 U.S.C. 300gg-13 for an
35 individual who participates in the plan.
36 (g) The plan shall, at no cost to the individual, provide payments of
37 not more than five hundred dollars ($500) per year for preventative
38 care services not described in subsection (f). Any additional
39 preventative care services covered under the plan and received by the
40 individual during the year are subject to the deductible and payment
41 requirements of the plan.
42 (h) The office shall apply to the United States Department of Health
2023 IN 196—LS 6633/DI 104 3
1 and Human Services for any amendment to the waiver necessary to
2 implement the providing of the services or supplies described in
3 subsection (a)(15). This subsection expires July 1, 2024.
4 SECTION 2. IC 12-15-44.5-4.5 IS REPEALED [EFFECTIVE JULY
5 1, 2023]. Sec. 4.5. (a) An individual who participates in the plan must
6 have a health care account to which payments may be made for the
7 individual's participation in the plan.
8 (b) An individual's health care account must be used to pay the
9 individual's deductible for health care services under the plan.
10 (c) An individual's deductible must be at least two thousand five
11 hundred dollars ($2,500) per year.
12 (d) An individual may make payments to the individual's health care
13 account as follows:
14 (1) An employer withholding or causing to be withheld from an
15 employee's wages or salary, after taxes are deducted from the
16 wages or salary, the individual's contribution under this chapter
17 and distributed equally throughout the calendar year.
18 (2) Submission of the individual's contribution under this chapter
19 to the office to deposit in the individual's health care account in
20 a manner prescribed by the office.
21 (3) Another method determined by the office.
22 SECTION 3. IC 12-15-44.5-4.7, AS AMENDED BY P.L.152-2017,
23 SECTION 33, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
24 JULY 1, 2023]: Sec. 4.7. (a) To participate in the plan, an individual
25 must apply for the plan on a form prescribed by the office. The office
26 may develop and allow a joint application for a household.
27 (b) A pregnant woman is not subject to the cost sharing provisions
28 of the plan. Subsections (c) through (g) do not apply to a pregnant
29 woman participating in the plan.
30 (c) An applicant who is approved to participate in the plan does not
31 begin benefits under the plan until a payment of at least:
32 (1) one-twelfth (1/12) of the annual income contribution amount;
33 or
34 (2) ten dollars ($10);
35 is made to the individual's health care account established under
36 section 4.5 of this chapter for the individual's participation in the plan.
37 To continue to participate in the plan, an individual must contribute to
38 the individual's health care account at least two percent (2%) of the
39 individual's annual household income per year or an amount
40 determined by the secretary that is based on the individual's annual
41 household income per year, but not less than one dollar ($1) per month.
42 The amount determined by the secretary under this subsection must be
2023 IN 196—LS 6633/DI 104 4
1 approved by the United States Department of Health and Human
2 Services and must be budget neutral to the state as determined by the
3 state budget agency.
4 (d) If an applicant who is approved to participate in the plan fails to
5 make the initial payment into the individual's health care account, at
6 least the following must occur:
7 (1) If the individual has an annual income that is at or below one
8 hundred percent (100%) of the federal poverty income level, the
9 individual's benefits are reduced as specified in subsection (e)(1).
10 (2) If the individual has an annual income of more than one
11 hundred percent (100%) of the federal poverty income level, the
12 individual is not enrolled in the plan.
13 (e) If an enrolled individual's required monthly payment to the plan
14 is not made within sixty (60) days after the required payment date, the
15 following, at a minimum, occur:
16 (1) For an individual who has an annual income that is at or below
17 one hundred percent (100%) of the federal income poverty level,
18 the individual is:
19 (A) transferred to a plan that has a material reduction in
20 benefits, including the elimination of benefits for vision and
21 dental services; and
22 (B) required to make copayments for the provision of services
23 that may not be paid from the individual's health care account.
24 (2) For an individual who has an annual income of more than one
25 hundred percent (100%) of the federal poverty income level, the
26 individual shall be terminated from the plan and may not reenroll
27 in the plan for at least six (6) months.
28 (f) The state shall contribute to the individual's health care account
29 the difference between the individual's payment required under this
30 section and the plan deductible set forth in section 4.5(c) of this
31 chapter.
32 (g) (b) A member shall remain enrolled with the same managed care
33 organization during the member's benefit period. A member may
34 change managed care organizations as follows:
35 (1) Without cause:
36 (A) before making a contribution or before finalizing
37 enrollment; in accordance with subsection (d)(1); or
38 (B) during the annual plan renewal process.
39 (2) For cause, as determined by the office.
40 SECTION 4. IC 12-15-44.5-4.9, AS AMENDED BY P.L.114-2018,
41 SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
42 JULY 1, 2023]: Sec. 4.9. (a) An individual who is approved to
2023 IN 196—LS 6633/DI 104 5
1 participate in the plan is eligible for a twelve (12) month plan period if
2 the individual continues to meet the plan requirements specified in this
3 chapter.
4 (b) If an individual chooses to renew participation in the plan, the
5 individual is subject to an annual renewal process at the end of the
6 benefit period to determine continued eligibility for participating in the
7 plan. If the individual does not complete the renewal process, the
8 individual may not reenroll in the plan for at least six (6) months.
9 (c) This subsection applies to participants who consistently made
10 the required payments in the individual's health care account. If the
11 individual receives the qualified preventative services recommended
12 to the individual during the year, the individual is eligible to have the
13 individual's unused share of the individual's health care account at the
14 end of the plan period, determined by the office, matched by the state
15 and carried over to the subsequent plan period to reduce the
16 individual's required payments. If the individual did not, during the
17 plan period, receive all qualified preventative services recommended
18 to the individual, only the nonstate contribution to the health care
19 account may be used to reduce the individual's payments for the
20 subsequent plan period.
21 (d) For individuals participating in the plan who, in the past, did not
22 make consistent payments into the individual's health care account
23 while participating in the plan, but:
24 (1) had a balance remaining in the individual's health care
25 account; and
26 (2) received all of the required preventative care services;
27 the office may elect to offer a discount on the individual's required
28 payments to the individual's health care account for the subsequent
29 benefit year. The amount of the discount under this subsection must be
30 related to the percentage of the health care account balance at the end
31 of the plan year but not to exceed a fifty percent (50%) discount of the
32 required contribution.
33 (e) If an individual is no longer eligible for the plan, does not renew
34 participation in the plan at the end of the plan period, or is terminated
35 from the plan for nonpayment of a required payment, the office shall,
36 not more than one hundred twenty (120) days after the last date of the
37 plan benefit period, refund to the individual the amount determined
38 under subsection (f) of any funds remaining in the individual's health
39 care account as follows:
40 (1) An individual who is no longer eligible for the plan or does
41 not renew participation in the plan at the end of the plan period
42 shall receive the amount determined under STEP FOUR of
2023 IN 196—LS 6633/DI 104 6
1 subsection (f).
2 (2) An individual who is terminated from the plan due to
3 nonpayment of a required payment shall receive the amount
4 determined under STEP SIX of subsection (f).
5 The office may charge a penalty for any voluntary withdrawals from the
6 health care account by the individual before the end of the plan benefit
7 year. The individual may receive the amount determined under STEP
8 SIX of subsection (f).
9 (f) The office shall determine the amount payable to an individual
10 described in subsection (e) as follows:
11 STEP ONE: Determine the total amount paid into the individual's
12 health care account under this chapter.
13 STEP TWO: Determine the total amount paid into the individual's
14 health care account from all sources.
15 STEP THREE: Divide STEP ONE by STEP TWO.
16 STEP FOUR: Multiply the ratio determined in STEP THREE by
17 the total amount remaining in the individual's health care account.
18 STEP FIVE: Subtract any nonpayments of a required payment.
19 STEP SIX: Multiply the amount determined under STEP FIVE by
20 at least seventy-five hundredths (0.75).
21 SECTION 5. IC 12-15-44.5-5.7, AS AMENDED BY P.L.114-2018,
22 SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
23 JULY 1, 2023]: Sec. 5.7. Subject to appeal to the office, an individual
24 may be held responsible under the plan for receiving nonemergency
25 services in an emergency room setting, including prohibiting the
26 individual from using funds in the individual's health care account to
27 pay for the nonemergency services and paying a copayment for the
28 services of at least eight dollars ($8) for the nonemergency use of a
29 hospital emergency department. However, an individual may not be
30 prohibited from using funds in the individual's health care account to
31 pay for nonemergency services provided in an emergency room setting
32 for a medical condition that arises suddenly and unexpectedly and
33 manifests itself by acute symptoms of such severity, including severe
34 pain, that the absence of immediate medical attention could reasonably
35 be expected by a prudent layperson who possesses an average
36 knowledge of health and medicine to:
37 (1) place an individual's health in serious jeopardy;
38 (2) result in serious impairment to the individual's bodily
39 functions; or
40 (3) result in serious dysfunction of a bodily organ or part of the
41 individual.
42 SECTION 6. IC 12-15-44.5-10, AS AMENDED BY P.L.30-2016,
2023 IN 196—LS 6633/DI 104 7
1 SECTION 35, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
2 JULY 1, 2023]: Sec. 10. (a) The secretary has the authority to provide
3 benefits to individuals eligible under the adult group described in 42
4 CFR 435.119 only in accordance with this chapter.
5 (b) The secretary may negotiate and make changes to the plan,
6 except that the secretary may not negotiate or change the plan in a way
7 that would do the following:
8 (1) Reduce the following:
9 (A) Contribution amounts below the minimum levels set forth
10 in section 4.7 of this chapter.
11 (B) Deductible amounts below the minimum amount
12 established in section 4.5(c) of this chapter.
13 (2) Remove or reduce the penalties for nonpayment set forth in
14 section 4.7 of this chapter.
15 (3) Revise the use of the health care account requirement set forth
16 in section 4.5 of this chapter.
17 (4) (1) Include noncommercial benefits or add additional plan
18 benefits in a manner inconsistent with section 3.5 of this chapter.
19 (5) Allow services to begin:
20 (A) without the payment established or required by; or
21 (B) earlier than the time frames otherwise established by;
22 section 4.7 of this chapter.
23 (6) (2) Reduce financial penalties for the inappropriate use of the
24 emergency room below the minimum levels set forth in section
25 5.7 of this chapter.
26 (7) (3) Permit members to change health plans without cause in
27 a manner inconsistent with section 4.7(g) 4.7(b) of this chapter.
28 (8) (4) Operate the plan in a manner that would obligate the state
29 to financial participation beyond the level of state appropriations
30 or funding otherwise authorized for the plan.
31 (c) The secretary may make changes to the plan under this chapter
32 if the changes are required by federal law or regulation.
33 SECTION 7. [EFFECTIVE JULY 1, 2023] (a) Before September
34 1, 2023, the office of the secretary of family and social services shall
35 apply to the United States Department of Health and Human
36 Services for any amendment to the healthy Indiana plan Medicaid
37 waiver necessary to remove the health care account and cost
38 sharing requirements of participants in the healthy Indiana plan,
39 as required by this act.
40 (b) This SECTION expires December 31, 2023.
2023 IN 196—LS 6633/DI 104