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 6959 NOTE PREPARED: Jan 3, 2024
BILL NUMBER: HB 1191 BILL AMENDED:
SUBJECT: Medicaid Matters.
FIRST AUTHOR: Rep. Clere BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State
DEDICATED
XFEDERAL
Summary of Legislation: Independent Review: The bill allows a provider that has entered into a contract
with a managed care organization (MCO), after exhausting any internal procedures of the MCO for provider
grievances and appeals, to request an independent review of the MCO's action with an independent third
party provider selected by the Office of Medicaid Policy and Planning (OMPP). It establishes a procedure
for an independent third party provider to review an action of an MCO.
Contract Prohibitions: It prohibits a provision in a contract between a provider and an MCO that would
negate or restrict the right of a provider to an independent review and provides that such a contract provision
is void and unenforceable.
Clean Claims: The bill provides that if the Office of the Secretary of Family and Social Services (FSSA) or
a contractor of the FSSA fails to pay or denies a clean claim for any eligible Medicaid service within certain
time limits due to the FSSA or contractor incorrectly processing the clean claim because of errors attributable
to the internal system of an insurer or MCO, the FSSA or contractor may not assert that the provider failed
to meet the timely filing requirements for the claim.
Medicaid Advisory Committee: This bill changes the membership of the Medicaid Advisory Committee
(committee). It allows a member of the committee whose position was eliminated to continue to serve until
the member's term expires. It establishes co-chairs for the committee and provides that the elected co-chair
of the committee serves for a two-year term.
Reporting: It requires the FSSA to prepare a report that describes every type of report that must be prepared
by a Medicaid contractor or MCE and submitted to the FSSA or the OMPP. It specifies the information that
HB 1191 1 must be contained in the report. The bill requires the FSSA to submit the report to the committee and the
General Assembly, and it requires the committee to hold public hearings on the report.
The bill makes technical changes.
Effective Date: July 1, 2024.
Explanation of State Expenditures: Family and Social Services Administration (FSSA): The bill could
increase the number of Medicaid claims that are paid by establishing an independent review process for
denied or reduced reimbursement claims. The FSSA will establish a fee schedule to pay the independent
third-party reviewer upon completing the review and issuing a final ruling. The total compensation to the
reviewer is indeterminate, but will have increased cost for the state General Fund starting in FY 2026.
Additional interest payments may result for providers who submit clean claims that were incorrectly
processed either by FSSA or its claims processing contractor.
Also, FSSA’s workload will be increase to establish and operate a third-party independent review of claims
by December 31, 2025. The compiled reports will have a minor impact on the FSSA’s workload. If a meeting
to publicly review the report prepared by the FSSA occurs outside of the committee’s regular quarterly
meetings, administrative expenditures will have a minor increase.
Medicaid Advisory Committee: Nonlegislative members of the Medicaid Advisory Committee are entitled
to a travel allowance for regular or special meetings in accordance with the amounts set by the Budget
Committee for state employees. Members of the General Assembly who serve on the committee are entitled
to a per diem of $196 and mileage reimbursement of $0.67 per mile (mileage rate is effective starting January
2024).
Additional Information - The state Medicaid plan and waivers are an agreement with the federal Centers for
Medicare and Medicaid Services regarding the reimbursement of services. Claims paid outside of the
Medicaid plan and waivers may be reimbursed from state only funds or federal penalties may apply.
[Medicaid is jointly funded between the state and federal governments. The standard state share of costs for
most Medicaid medical services for FFY 2024 is 34%, or 10% for the age 19 to 64 expansion population
within the Healthy Indiana Plan. The CHIP state share is 24%. The state share of administrative costs is
50%.]
Explanation of State Revenues:
Explanation of Local Expenditures:
Explanation of Local Revenues:
State Agencies Affected: Office Medicaid Policy and Planning; Family and Social Services Administration;
Medicaid Advisory Committee.
Local Agencies Affected:
Information Sources:
Fiscal Analyst: Karen Rossen, 317-234-2106.
HB 1191 2