LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6713 NOTE PREPARED: Mar 11, 2024
BILL NUMBER: HB 1067 BILL AMENDED: Mar 8, 2024
SUBJECT: Human Services Matters.
FIRST AUTHOR: Rep. Clere BILL STATUS: Enrolled
FIRST SPONSOR: Sen. Bohacek
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
DEDICATED
XFEDERAL
Summary of Legislation: Special Service Review: This bill establishes the Special Service Review Team
to review denied applications and applications for which a determination has not been made for the
Community Integration and Habilitation waiver. It limits the geographical area of review. It establishes
reporting requirements. It requires the Division of Disability and Rehabilitative Services (DDRS) to obtain
consent from a waiver applicant in order to share the application and information accompanying the
application with the review team. It provides immunity for an employee who obtains consent and provides
the information in good faith. It also provides that the review team expires December 31, 2026.
Emergency Placement Priority: This bill makes changes to the situations in which an emergency placement
priority may be provided for individuals under a Medicaid waiver.
Commission on Aging and CHOICE Board: This bill amends the membership of and provisions concerning:
(1) the Indiana State Commission on Aging; and (2) the Community and Home Options to Institutional Care
for the Elderly and Disabled Board (CHOICE Board).
IDD Task Force: This bill requires the Services for Individuals with Intellectual and Other Developmental
Disabilities Task Force (IDD Task Force) to establish, not later than May 1, 2024, a subcommittee to make
recommendations to the IDD Task Force regarding the Medicaid buy-in program and benefit related barriers
to employment for individuals with intellectual and developmental disabilities. It requires the subcommittee
to prepare and submit recommendations to the IDD Task Force. It changes the expiration date of the IDD
Task Force. It also requires the DDRS to provide quarterly updates to the DDRS Advisory Council regarding
the implementation of recommendations made by the IDD Task Force.
HB 1067 1 Risk-Based Managed Care Program: This bill authorizes the Office of the Secretary of Family and Social
Services (FSSA) to implement a risk based managed care program for certain Medicaid recipients. It requires
the Office of Medicaid Policy and Planning to convene a workgroup and, with managed care organizations,
to conduct a claims submission testing period before the risk based managed care program is established. It
also provides that, during the first 210 days after the risk based managed care program is implemented, a
provider that experiences a financial emergency due to claims payment issues shall receive temporary
emergency assistance from the managed care organizations with which the provider is contracted.
Community Mental Health Centers: This bill requires the FSSA and the Division of Mental Health and
Addiction (DMHA) to include each Community Mental Health Center that meets certain requirements in the
Community Mental Health Services Demonstration Program, if Indiana is approved to participate in the
program and as a state plan amendment for specified reimbursement after the program. It also allows the
FSSA and the DMHA to apply for a Medicaid state plan amendment or waiver to allow for Medicaid
reimbursement for eligible Certified Community Behavioral Health Clinic services by certain Medicaid
providers, if Indiana is not approved to participate in the program.
Effective Date: Upon passage; July 1, 2024; January 1, 2025.
Explanation of State Expenditures: Community Mental Health Centers: The bill requires that a Medicaid
provider, including a Community Mental Health Center (CMHC), be reimbursed by Medicaid for all of the
services for which a Certified Community Behavioral Health Clinic (CCBHC) would receive Medicaid
reimbursement. The magnitude of increased Medicaid costs is indeterminate but would be based on the
services offered by a Medicaid provider that would not otherwise have been reimbursed.
Applying for the Medicaid state plan amendment or waiver to include CCBHC services in other Medicaid
provider reimbursement is a routine administrative functions of the FSSA.
Risk-Based Managed Care Program: The bill's provisions requiring testing of the claims submission process
could increase costs for managed care organizations which may be passed on to the Medicaid program. The
bill requires the Office of Medicaid Policy and Planning, with federal approval of prepayments for providers
in financial emergency, to oversee the financial emergency process, including making determinations that
a provider is in a financial emergency and to convene a workgroup, as prescribed in the bill. The FSSA
reports that the bill’s requirements are within the agency’s routine administrative functions.
Emergency Placement Priority: The bill will have an indeterminate impact on the number of emergency
placement applications by removing alternative living arrangements as a consideration, although this is not
the primary criterion used by the FSSA in choosing emergency placement. The cost of services provided to
an individual is based on placement. The waiver services provided for an individual may cost more than
institutional care for that specific individual, but overall waiver services are cost neutral compared to
institutional care based on the terms of the entire waiver.
Special Service Review: The bill will increase workload and expenditures by a minimal amount for the
DDRS for the Special Service Review Team. The review team sunsets on December 31, 2026.
IDD Task Force: Between January 1, 2025, and December 31, 2027, the bill requires the DDRS to provide
quarterly updates to the DDRS Advisory Council regarding implementation of the recommendations made
by the IDD Task Force. This requirement is within the routine administrative functions of the DDRS and
should be able to be implemented with no additional appropriations, assuming near customary agency
HB 1067 2 staffing and resource levels.
No later than May 1, 2024, the bill requires the IDD Task Force to establish a subcommittee. This
requirement could result in additional per diem and travel expenses depending on the number of members
appointed to the subcommittee and the number of subcommittee meetings held. The bill also moves the
sunset date for the IDD Task Force from December 31, 2025, to December 31, 2024. Any change in total
expenditures of the IDD Task Force will depend on the increased cost for the new subcommittee and the
reduced cost of holding fewer meetings of the IDD Task Force.
Commission on Aging and CHOICE Board: This bill modifies the makeup of the Commission on Aging and
requires that the Executive Director of the Indiana Housing and Community Development Authority
(IHCDA) be a Commission member.
This bill expands the CHOICE Board from 15 to 17 members, including a lay member and the Executive
Director of the IHCDA. Each board members who is not a state employee is entitled to $100 per diem and
travel reimbursement for each meeting. Each member who is a state employee is entitled to travel
reimbursement. These membership provisions should be able to be implemented with no additional
appropriations, assuming near customary agency staffing and resource levels for the IHCDA.
The bill requires the Governor to appoint new members to the Commission on Aging and to appoint a
member to the CHOICE Board. This is within the Governor’s routine administrative functions and should
be able to be implemented with no additional appropriations, assuming near customary staffing and resource
levels.
Additional Information:
Medicaid: Medicaid and the Children’s Health Insurance Program (CHIP) are jointly funded between the
state and federal governments. The state share of costs for most Medicaid medical services for FFY 2024
is 34%, 10% for the age 19 to 64 expansion population within the Healthy Indiana Plan (HIP), and 24% for
CHIP. The state share of administrative costs is 50%. The state share of most Medicaid and CHIP
expenditures is paid from General Fund appropriations, and state dedicated funds primarily cover HIP costs.
Community Mental Health Centers: CCBHCs and CMHCs treat similar populations and provide similar
services, but CCBHCs provide some additional services to additional populations. The CCBHCs are
reimbursed by a perspective payment system (PPS) which provides a daily rate for all services provided to
a qualified Medicaid recipient during a single day. CMHCs receive a majority of their patient services
reimbursement through the Medicaid Rehabilitative Option (MRO), which provides reimbursement based
on a level of service determined by the client’s condition. Currently, Indiana has 24 certified CMHCs.
CCBHCs are clinics that provide a range of mental health and substance use services and are required to
provide assistance to anyone who requests care regardless of their diagnosis, age, place of residence, or
ability to pay. CCBHCs are also required to have crisis services available 24 hours a day, 7 days a week. No
CCBHCs are currently certified by Indiana.
In order to be considered a CCBHC, a CCBHC must serve all consumers who seek help regardless of ability
to pay, therefore a higher percentage of CCBHCs than CMHC’s offer treatment at no charge or minimal
payment in Demonstration Program states, of which Indiana currently is not.
HB 1067 3 Emergency Placement Priority: In CY 2022, there were 556 emergency placement applications filed and 531
decisions rendered on applications. Of the decisions rendered, 237 (45%) were approved.
IDD Task Force: The IDD Task Force was established in 2017 and generally meets twice per year. It consists
of 21 members–4 legislators, 8 lay members, and 9 state employees. As of March 2024, legislator per diem
is $196, and lay member per diem is $100 Legislative members receive travel reimbursement of $0.67 per
mile, while lay members and state employee members receive $0.49 per mile.
Explanation of State Revenues:
Explanation of Local Expenditures: Community Mental Health Centers: If Indiana receives a
demonstration grant, CMHCs that can meet federal requirements will be appointed as CCBHCs. This may
increase the cost of care provided by CMHCs based on the services offered.
Explanation of Local Revenues: Community Mental Health Centers: CMHCs may receive additional
reimbursement for additional services, if FSSA has an approved state plan amendment or waiver. If Indiana
becomes a demonstration state, the method of reimbursement for certain services may change.
State Agencies Affected: Division of Disability and Rehabilitative Services, Office of Medicaid Policy and
Planning, Family and Social Services Administration; Indiana Housing and Community Development
Authority; Governor’s Office.
Local Agencies Affected: Community Mental Health Centers.
Information Sources:
HEA 1001-2023 SECTION 8; State Research Data Brief: Variation In Services Offered by Certified
Community Behavioral Health Clinics & Community Mental Health Centers, Mathmatica, published June
2021; https://www.samhsa.gov/certified-community-behavioral-health-clinics;
https://www.in.gov/fssa/dmha/state-psychiatric-hospitals/community-mental-health-center-resources;
https://www.in.gov/fssa/dmha/certified-community-behavioral-health-clinic;
https://cdn.arcind.org/wp-content/uploads/2023/05/DDRS-Advisory-Council-BDDS-Slides-May-2023.pdf.
Fiscal Analyst: Jason Barrett, 317-232-9809; Karen Rossen, 317-234-2106.
HB 1067 4