Indiana 2024 Regular Session

Indiana House Bill HB1374 Compare Versions

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

Old	New	Differences
1	1
2	2	Introduced Version
3	3	HOUSE BILL No. 1374
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 12-15.
7	7	Synopsis: Medicaid claim payments for nursing facilities. Beginning
8	8	July 1, 2024, and ending December 31, 2024, requires the office of the
9	9	secretary of family and social services (office) and a managed care
10	10	organization to pay 87.5% of a claim to a nursing facility if the claim
11	11	is not paid within a specified time. Requires the office to assess a
12	12	managed care organization a fine of $4,800 per claim for failure to pay
13	13	a nursing facility claim within the required time. Repeals a provision
14	14	concerning reporting that has expired.
15	15	Effective: July 1, 2024.
16	16	Karickhoff
17	17	January 10, 2024, read first time and referred to Committee on Public Health.
18	18	2024 IN 1374—LS 7005/DI 104 Introduced
19	19	Second Regular Session of the 123rd General Assembly (2024)
20	20	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
21	21	Constitution) is being amended, the text of the existing provision will appear in this style type,
22	22	additions will appear in this style type, and deletions will appear in this style type.
23	23	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
24	24	provision adopted), the text of the new provision will appear in this style type. Also, the
25	25	word NEW will appear in that style type in the introductory clause of each SECTION that adds
26	26	a new provision to the Indiana Code or the Indiana Constitution.
27	27	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
28	28	between statutes enacted by the 2023 Regular Session of the General Assembly.
29	29	HOUSE BILL No. 1374
30	30	A BILL FOR AN ACT to amend the Indiana Code concerning
31	31	Medicaid.
32	32	Be it enacted by the General Assembly of the State of Indiana:
33	33	1 SECTION 1. IC 12-15-5-17.5 IS REPEALED [EFFECTIVE JULY
34	34	2 1, 2024]. Sec. 17.5. (a) The office shall report on its progress on the
35	35	3 development of a risk based managed care program or capitated
36	36	4 managed care program for Medicaid recipients who are eligible to
37	37	5 participate in the Medicare program (42 U.S.C. 1395 et seq.) and
38	38	6 receive nursing facility services to the interim study committee on
39	39	7 public health, behavioral health, and human services before November
40	40	8 1, 2021.
41	41	9 (b) Not later than February 1, 2022, the office shall report the
42	42	10 following information and analysis to the legislative council and budget
43	43	11 committee (in an electronic format under IC 5-14-6) regarding the
44	44	12 implementation of a risk based managed care program or capitated
45	45	13 managed care program for Medicaid recipients who are eligible to
46	46	14 participate in the Medicare program (42 U.S.C. 1395 et seq.) and
47	47	15 receive nursing facility services, as follows:
48	48	16 (1) The projected utilization of home and community based
49	49	17 services and institutional services for the four (4) years following
50	50	2024 IN 1374—LS 7005/DI 104 2
51	51	1 implementation, and including, but not limited to, information on:
52	52	2 (A) provider network adequacy;
53	53	3 (B) family caregiver programming; and
54	54	4 (C) costs and funding sources associated with creating and
55	55	5 maintaining adequate provider networks and family caregiving
56	56	6 programming.
57	57	7 (2) How administrative processes, including service approval and
58	58	8 billing processes, between managed care entities and providers of
59	59	9 services will be addressed or streamlined in a risk based managed
60	60	10 care program or capitated managed care program, with specific
61	61	11 discussion of uniform provider credentialing, the potential of a
62	62	12 single claims processing portal, and prior authorization processes.
63	63	13 (3) Projected total spending for a risk based managed care
64	64	14 program or capitated managed care program for the four (4) years
65	65	15 following implementation. Such information shall include the
66	66	16 identification of and impact on each source of state matching
67	67	17 funds and overall impact on the state general fund.
68	68	18 (4) The expected financial impacts of a risk based managed care
69	69	19 program or capitated managed care program on the available
70	70	20 amounts and use of the nursing facility quality assessment fee and
71	71	21 supplemental payments to nursing facilities that are owned and
72	72	22 operated by a governmental entity. Such information shall include
73	73	23 an analysis on whether either of these funding streams will be
74	74	24 diverted for uses other than the uses prior to implementation of a
75	75	25 risk based managed care program or capitated managed care
76	76	26 program and the effects on access to acute and post-acute care
77	77	27 services due to the expected financial impacts.
78	78	28 (c) A request for proposal for the procurement of a Medicaid
79	79	29 program to enroll a Medicaid recipient who is eligible to participate in
80	80	30 the Medicare program (42 U.S.C. 1395 et seq.) and receives nursing
81	81	31 facility services in a risk based managed care program or capitated
82	82	32 managed care program may not be issued until the request for proposal
83	83	33 has been reviewed by the budget committee.
84	84	34 (d) After the review of a request for proposal by the budget
85	85	35 committee under subsection (c), the office may not enter into a final
86	86	36 contract that would implement a program described in subsection (c)
87	87	37 before January 31, 2023.
88	88	38 SECTION 2. IC 12-15-13-1.5, AS AMENDED BY P.L.42-2011,
89	89	39 SECTION 29, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
90	90	40 JULY 1, 2024]: Sec. 1.5. (a) This section:
91	91	41 (1) applies only to claims submitted for payment by nursing
92	92	42 facilities; and
93	93	2024 IN 1374—LS 7005/DI 104 3
94	94	1 (2) does not apply when section 1.8 of this chapter is in effect.
95	95	2 (b) If the office:
96	96	3 (1) fails to pay a clean claim in the time required under section
97	97	4 1(b) of this chapter; or
98	98	5 (2) denies or suspends a claim that is subsequently determined to
99	99	6 have been a clean claim when the claim was filed;
100	100	7 the office shall pay the provider interest on the Medicaid allowable
101	101	8 amount of the claim.
102	102	9 (c) Interest paid under subsection (b):
103	103	10 (1) accrues beginning:
104	104	11 (A) twenty-two (22) days after the date the claim is filed under
105	105	12 section 1(b)(1) of this chapter; or
106	106	13 (B) thirty-one (31) days after the date the claim is filed under
107	107	14 section 1(b)(2) of this chapter; and
108	108	15 (2) stops accruing on the date the office pays the claim.
109	109	16 (d) The office shall pay interest under subsection (b) at the same
110	110	17 rate as determined under IC 12-15-21-3(7)(A).
111	111	18 SECTION 3. IC 12-15-13-1.8 IS ADDED TO THE INDIANA
112	112	19 CODE AS A NEW SECTION TO READ AS FOLLOWS
113	113	20 [EFFECTIVE JULY 1, 2024]: Sec. 1.8. (a) This section applies:
114	114	21 (1) beginning July 1, 2024, and ending December 31, 2024;
115	115	22 and
116	116	23 (2) to claims submitted for payment by nursing facilities.
117	117	24 A claim under this section is not required to meet the requirements
118	118	25 of a clean claim.
119	119	26 (b) If the office fails to pay a claim in the time required under
120	120	27 section 1(b) of this chapter, the office shall reimburse the nursing
121	121	28 facility at least eighty-seven and one-half percent (87.5%) of the
122	122	29 claim:
123	123	30 (1) twenty-two (22) days after the date the claim is filed under
124	124	31 section 1(b)(1) of this chapter; or
125	125	32 (2) thirty-one (31) days after the date the claim is filed under
126	126	33 section 1(b)(2) of this chapter.
127	127	34 (c) The office of the secretary shall fine a managed care
128	128	35 organization that fails to pay a claim in the time required under
129	129	36 section 1(b) of this chapter four thousand eight hundred dollars
130	130	37 ($4,800) per claim. If the managed care organization continuously
131	131	38 fails to pay claims to a nursing facility in accordance with this
132	132	39 chapter, the office of the secretary may stop assigning Medicaid
133	133	40 recipients to the managed care organization for the provision of
134	134	41 services.
135	135	42 (d) If a claim for which a payment was made under subsection
136	136	2024 IN 1374—LS 7005/DI 104 4
137	137	1 (b) is ultimately denied for a reason other than an administrative
138	138	2 issue with the submission of the claim, the office and the nursing
139	139	3 facility shall agree to the manner in which the payment under
140	140	4 subsection (b) is to be recouped from the nursing facility.
141	141	5 (e) This section expires January 1, 2025.
142	142	2024 IN 1374—LS 7005/DI 104