Introduced Version
HOUSE BILL No. 1386
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 4-21.5-3-6; IC 12-7-2; IC 12-8; IC 12-9.1-4;
IC 12-10; IC 12-15; IC 31-37-19-29; IC 34-30-2.1-129.4.
Synopsis: Medicaid matters. Sets forth the powers and duties of the
office of the secretary of family and social services (office of the
secretary) concerning Medicaid home and community based services
waivers. Defines "home and community based services waiver".
Requires a provider of services under a home and community based
services waiver to follow any waiver requirements under federal law
and developed by the office of the secretary. Establishes requirements
for home and community based services waivers. Relocates provisions
requiring reimbursement for assisted living services for individuals
who are aged and disabled and receiving services under a Medicaid
waiver. Specifies that: (1) these provisions apply to an individual
receiving services under a home and community based services waiver;
and (2) reimbursement is required for certain services determined to be
medically necessary for the individual. Relocates provisions
establishing limitations concerning assisted living services provided in
a home and community based services program. Relocates a provision
requiring the office of the secretary to annually determine any state
savings generated by home and community based services. Removes
a provision allowing the division of aging to adopt rules concerning an
appeals process for a housing with services establishment provider's
determination that the provider is unable to meet the health needs of a
resident and allows the office of the secretary to adopt rules concerning
the appeals process. Requires an individual who provides attendant
care services for compensation from Medicaid to register with the
office of the secretary. Removes the requirement that the division of
aging administer programs established under Medicaid waivers for
(Continued next page)
Effective: July 1, 2024.
Barrett
January 11, 2024, read first time and referred to Committee on Public Health.
2024 IN 1386—LS 7038/DI 147 Digest Continued
in-home services for treatment of medical conditions. Requires certain
facilities to provide notice within a specified time to the division of
family resources (division) that a delinquent child will be released from
the facility. Requires the division to take action necessary to ensure that
the delinquent child, if eligible, participates in the Medicaid program
upon the child's release and receives services required by federal law.
Specifies that an insurer may not deny a Medicaid claim solely due to
a lack of prior authorization in accordance with federal law. Requires
an insurer to respond to a state inquiry regarding a Medicaid claim not
later than 60 days after receiving the inquiry. Specifies, for purposes of
a provision concerning Medicaid third party liability, that the state is
considered to have acquired the rights of the person to payment by any
other party for accumulated and future health care items or services.
(Current law provides that the state is considered to have acquired
these rights for the health care items or services.) Repeals a provision
providing that licensed home health agencies and licensed personal
services agencies are approved to provide certain services under a
Medicaid waiver granted to the state under federal law that provides
services for treatment of medical conditions. Repeals provisions
requiring the division of aging to submit a plan, before October 1,
2017, to the general assembly to expand the scope and availability of
home and community based services for individuals who are aged and
disabled. Makes conforming amendments.
2024 IN 1386—LS 7038/DI 1472024 IN 1386—LS 7038/DI 147 Introduced
Second Regular Session of the 123rd General Assembly (2024)
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 2023 Regular Session of the General Assembly.
HOUSE BILL No. 1386
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 4-21.5-3-6, AS AMENDED BY P.L.241-2023,
2 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 JULY 1, 2024]: Sec. 6. (a) Notice shall be given under this section
4 concerning the following:
5 (1) A safety order under IC 22-8-1.1.
6 (2) Any order that:
7 (A) imposes a sanction on a person or terminates a legal right,
8 duty, privilege, immunity, or other legal interest of a person;
9 (B) is not described in section 4 or 5 of this chapter or
10 IC 4-21.5-4; and
11 (C) by statute becomes effective without a proceeding under
12 this chapter if there is no request for a review of the order
13 within a specified period after the order is issued or served.
14 (3) A notice of program reimbursement or equivalent
15 determination or other notice regarding a hospital's
2024 IN 1386—LS 7038/DI 147 2
1 reimbursement issued by the office of Medicaid policy and
2 planning or by a contractor of the office of Medicaid policy and
3 planning regarding a hospital's year end cost settlement.
4 (4) A determination of audit findings or an equivalent
5 determination by the office of Medicaid policy and planning or by
6 a contractor of the office of Medicaid policy and planning arising
7 from a Medicaid postpayment or concurrent audit of a hospital's
8 Medicaid claims.
9 (5) A license suspension or revocation under:
10 (A) IC 24-4.4-2;
11 (B) IC 24-4.5-3;
12 (C) IC 28-1-29;
13 (D) IC 28-7-5;
14 (E) IC 28-8-4.1; or
15 (F) IC 28-8-5.
16 (6) An order issued by the secretary or the secretary's designee
17 against providers regulated by the office of the secretary, the
18 division of aging, or the bureau of disabilities services and not
19 licensed by the Indiana department of health under IC 16-27 or
20 IC 16-28.
21 (b) When an agency issues an order described by subsection (a), the
22 agency shall give notice to the following persons:
23 (1) Each person to whom the order is specifically directed.
24 (2) Each person to whom a law requires notice to be given.
25 A person who is entitled to notice under this subsection is not a party
26 to any proceeding resulting from the grant of a petition for review
27 under section 7 of this chapter unless the person is designated as a
28 party in the record of the proceeding.
29 (c) The notice must include the following:
30 (1) A brief description of the order.
31 (2) A brief explanation of the available procedures and the time
32 limit for seeking administrative review of the order under section
33 7 of this chapter.
34 (3) Any other information required by law.
35 (d) An order described in subsection (a) is effective fifteen (15) days
36 after the order is served, unless a statute other than this article specifies
37 a different date or the agency specifies a later date in its order. This
38 subsection does not preclude an agency from issuing, under
39 IC 4-21.5-4, an emergency or other temporary order concerning the
40 subject of an order described in subsection (a).
41 (e) If a petition for review of an order described in subsection (a) is
42 filed within the period set by section 7 of this chapter and a petition for
2024 IN 1386—LS 7038/DI 147 3
1 stay of effectiveness of the order is filed by a party or another person
2 who has a pending petition for intervention in the proceeding, an
3 administrative law judge shall, as soon as practicable, conduct a
4 preliminary hearing to determine whether the order should be stayed in
5 whole or in part. The burden of proof in the preliminary hearing is on
6 the person seeking the stay. The administrative law judge may stay the
7 order in whole or in part. The order concerning the stay may be issued
8 after an order described in subsection (a) becomes effective. The
9 resulting order concerning the stay shall be served on the parties and
10 any person who has a pending petition for intervention in the
11 proceeding. It must include a statement of the facts and law on which
12 it is based.
13 SECTION 2. IC 12-7-2-18.1, AS ADDED BY P.L.149-2023,
14 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
15 JULY 1, 2024]: Sec. 18.1. "Assisted living services", for purposes of
16 IC 12-10-11.5, IC 12-8-1.6, has the meaning set forth in
17 IC 12-10-11.5-8(a). IC 12-8-1.6-1.
18 SECTION 3. IC 12-7-2-107.7 IS ADDED TO THE INDIANA
19 CODE AS A NEW SECTION TO READ AS FOLLOWS
20 [EFFECTIVE JULY 1, 2024]: Sec. 107.7. "Home and community
21 based services waiver", for purposes of IC 12-8-1.6, has the
22 meaning set forth in IC 12-8-1.6-2.
23 SECTION 4. IC 12-7-2-117.1, AS AMENDED BY P.L.141-2006,
24 SECTION 20, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
25 JULY 1, 2024]: Sec. 117.1. (a) "Individual in need of self-directed
26 in-home care", for purposes of IC 12-8-1.7, has the meaning set
27 forth in IC 12-8-1.7-2.
28 (b) "Individual in need of self-directed in-home care", for purposes
29 of IC 12-10-17.1, has the meaning set forth in IC 12-10-17.1-6.
30 SECTION 5. IC 12-7-2-122.6 IS ADDED TO THE INDIANA
31 CODE AS A NEW SECTION TO READ AS FOLLOWS
32 [EFFECTIVE JULY 1, 2024]: Sec. 122.6. "Level of services", for
33 purposes of IC 12-8-1.6, has the meaning set forth in IC 12-8-1.6-3.
34 SECTION 6. IC 12-8-1.6 IS ADDED TO THE INDIANA CODE
35 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
36 JULY 1, 2024]:
37 Chapter 1.6. Medicaid Home and Community Based Services
38 Waivers
39 Sec. 1. As used in this chapter, "assisted living services" refers
40 to services covered under a home and community based services
41 waiver and provided in any of the following entities:
42 (1) A residential care facility licensed under IC 16-28.
2024 IN 1386—LS 7038/DI 147 4
1 (2) Any other housing with services establishment.
2 Sec. 2. (a) As used in this chapter, "home and community based
3 services waiver" refers to a federal Medicaid waiver granted to the
4 state under 42 U.S.C. 1396n(c) to provide home and community
5 based long term care services and supports to individuals with
6 disabilities.
7 (b) The term does not include home and community services
8 offered as part of the approved Medicaid state plan.
9 Sec. 3. As used in this chapter, "level of services" means a
10 determination of the type of services an individual may receive
11 under a Medicaid waiver based on the individual's impairment and
12 dependence and the corresponding reimbursement rate for the
13 determined level of care.
14 Sec. 4. (a) The office of the secretary has all powers necessary
15 and convenient to administer a home and community based
16 services waiver.
17 (b) The office of the secretary shall do the following:
18 (1) Administer money appropriated or allocated to the office
19 of the secretary by the state, including money appropriated or
20 allocated for a home and community based services waiver.
21 (2) Take any action necessary to implement a home and
22 community based services waiver, including applying to the
23 United States Department of Health and Human Services for
24 approval to amend or renew the waiver, implement a new
25 Medicaid waiver, or amend the Medicaid state plan.
26 (3) Ensure that a home and community based services waiver
27 is subject to funding available to the office of the secretary.
28 (4) Ensure, in coordination with the budget agency, that the
29 cost of a home and community based services waiver does not
30 exceed the total amount of funding available by the budget
31 agency, including state and federal funds, for the Medicaid
32 programs established to provide services under a home and
33 community based services waiver.
34 (5) Establish and administer a program for a home and
35 community based services waiver to provide an eligible
36 individual with care that does not cost more than services
37 provided to a similarly situated individual residing in an
38 institution.
39 (6) Within the limits of available resources, provide service
40 coordination services to individuals receiving services under
41 a home and community based services waiver, including the
42 development of an individual service plan that:
2024 IN 1386—LS 7038/DI 147 5
1 (A) addresses an individual's needs;
2 (B) considers the individual's family resources and access
3 to community and natural support; and
4 (C) is consistent with the person centered care approach
5 for receiving services under a waiver.
6 (7) Monitor services provided by a provider that:
7 (A) provides services to an individual using funds provided
8 by the office of the secretary or under the authority of the
9 office of the secretary; and
10 (B) entered into one (1) or more provider agreements to
11 provide services under a home and community based
12 services waiver.
13 (8) Establish and administer a complaint process for:
14 (A) an individual receiving; or
15 (B) a provider described in subdivision 7(B) providing;
16 services under a home and community based services waiver.
17 (c) The office of the secretary may do the following:
18 (1) At the office's discretion, delegate any of its authority
19 under this chapter to any division or office within the office of
20 the secretary of family and social services.
21 (2) Issue administrative orders under IC 4-21.5-3-6 regarding
22 the provision of a home and community based services
23 waiver.
24 Sec. 5. (a) The office of the secretary shall establish:
25 (1) eligibility criteria for an individual to receive; and
26 (2) certification criteria for a provider of;
27 services under a home and community based services waiver.
28 (b) The eligibility criteria established under subsection (a) may
29 vary based on the targeted need of each home and community
30 based services waiver.
31 (c) An individual who is determined by the office of the
32 secretary to be ineligible for services under a home and community
33 based services waiver may appeal the determination under
34 IC 4-21.5.
35 Sec. 6. The office of the secretary shall serve as the placement
36 authority for individuals receiving services under a home and
37 community based services waiver and an individual service plan.
38 Sec. 7. Subject to the availability of applicable waiver slots and
39 funding, the office of the secretary shall provide access to home
40 and community based services that are appropriate and necessary
41 for an individual determined to be eligible by the office of the
42 secretary for services under a home and community based services
2024 IN 1386—LS 7038/DI 147 6
1 waiver.
2 Sec. 8. A provider of services under a home and community
3 based services waiver shall follow any waiver requirements under
4 federal law and developed by the office of the secretary, including
5 the planning process, service plan, and home and community based
6 setting requirements set forth in 42 CFR 441.301.
7 Sec. 9. A home and community based services waiver, including
8 the delivery and receipt of services provided under the home and
9 community based services waiver, must meet the following
10 requirements:
11 (1) Be provided under public supervision.
12 (2) Be individualized and designed to meet the needs of
13 individuals eligible to receive services under the home and
14 community based services waiver.
15 (3) Meet applicable state and federal standards.
16 (4) Be provided by qualified personnel.
17 (5) Be provided, to the extent appropriate, with services
18 provided under the home and community based services
19 waiver that are provided in a home and community based
20 setting where nonwaiver individuals receive services.
21 (6) Be provided in accordance with an individual's service
22 plan.
23 Sec. 10. (a) As used in this section, "office" includes the
24 following:
25 (1) The office of the secretary of family and social services.
26 (2) A managed care organization that has contracted with the
27 office of Medicaid policy and planning under IC 12-15.
28 (3) A person that has contracted with a managed care
29 organization described in subdivision (2).
30 (b) Under a home and community based services waiver that
31 provides services to an individual who is aged or disabled, the
32 office shall reimburse for the following services provided to the
33 individual by a provider of assisted living services, if determined
34 to be medically necessary for the individual:
35 (1) Assisted living services.
36 (2) Integrated health care coordination.
37 (3) Transportation.
38 (c) If the office approves an increase in the level of services for
39 a recipient of assisted living services, the office shall reimburse the
40 provider of assisted living services for the level of services for the
41 increase as of the date that the provider has documentation of
42 providing the increase in the level of services.
2024 IN 1386—LS 7038/DI 147 7
1 (d) The office may reimburse for any home and community
2 based services provided to a Medicaid recipient beginning on the
3 date of the individual's Medicaid application.
4 (e) The office may not do any of the following concerning
5 assisted living services provided in a home and community based
6 services program:
7 (1) Require the installation of a sink in the kitchenette within
8 any living unit of an entity that participated in the Medicaid
9 home and community based services program before July 1,
10 2018.
11 (2) Require all living units within a setting that provides
12 assisted living services to comply with physical plant
13 requirements that are applicable to individual units occupied
14 by a Medicaid recipient.
15 (3) Require a provider to offer only private rooms.
16 (4) Require a housing with services establishment provider to
17 provide housing when:
18 (A) the provider is unable to meet the health needs of a
19 resident without:
20 (i) undue financial or administrative burden; or
21 (ii) fundamentally altering the nature of the provider's
22 operations; and
23 (B) the resident is unable to arrange for services to meet
24 the resident's health needs.
25 (5) Require a housing with services establishment provider to
26 separate an agreement for housing from an agreement for
27 services.
28 (6) Prohibit a housing with services establishment provider
29 from offering studio apartments with only a single sink in the
30 unit.
31 (7) Preclude the use of a shared bathroom between adjoining
32 or shared units if the participants consent to the use of a
33 shared bathroom.
34 (8) Reduce the scope of services that may be provided by a
35 provider of assisted living services under the aged and
36 disabled Medicaid waiver in effect on July 1, 2021.
37 (f) The office of the secretary may adopt rules under IC 4-22-2
38 that establish the right, and an appeals process, for a resident to
39 appeal a provider's determination that the provider is unable to
40 meet the health needs of the resident as described in subsection
41 (e)(4). The process:
42 (1) must require an objective third party to review the
2024 IN 1386—LS 7038/DI 147 8
1 provider's determination in a timely manner; and
2 (2) may not be required if the provider is licensed by the
3 Indiana department of health and the licensure requirements
4 include an appellate procedure for such a determination.
5 Sec. 11. (a) The office of the secretary shall annually determine
6 any state savings generated by home and community based services
7 under this chapter by reducing the use of institutional care.
8 (b) The office of the secretary shall annually report to the
9 governor, the budget agency, the budget committee, the interim
10 study committee on public health, behavioral health, and human
11 services established by IC 2-5-1.3-4, and the executive director of
12 the legislative services agency the savings determined under
13 subsection (a). A report under this subsection to the executive
14 director of the legislative services agency must be in an electronic
15 format under IC 5-14-6.
16 (c) Savings determined under subsection (a) may be used to fund
17 the state's share of additional home and community based
18 Medicaid waiver slots.
19 Sec. 12. The office of the secretary may adopt rules under
20 IC 4-22-2 to implement this chapter.
21 SECTION 7. IC 12-8-1.7 IS ADDED TO THE INDIANA CODE
22 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
23 JULY 1, 2024]:
24 Chapter 1.7. Individuals in Need of Self-Directed In-Home Care
25 Sec. 1. As used in this chapter, "attendant care services" means
26 the basic and ancillary services that the individual chooses to direct
27 and supervise a personal services attendant to perform and that
28 enable an individual in need of self-directed in-home care to live in
29 the individual's home and community rather than in an institution
30 and to carry out functions of daily living, self-care, and mobility.
31 Sec. 2. As used in this chapter, "individual in need of
32 self-directed in-home care" means an individual with a disability,
33 or person responsible for making health related decisions for the
34 individual with a disability, who:
35 (1) is approved to receive Medicaid waiver services under 42
36 U.S.C. 1396n(c);
37 (2) is in need of attendant care services because of
38 impairment;
39 (3) requires assistance to complete functions of daily living,
40 self-care, and mobility, including those functions included in
41 attendant care services;
42 (4) chooses to self-direct a paid personal services attendant to
2024 IN 1386—LS 7038/DI 147 9
1 perform attendant care services; and
2 (5) assumes the responsibility to initiate self-directed in-home
3 care and exercise judgment regarding the manner in which
4 those services are delivered, including the decision to employ,
5 train, and dismiss a personal services attendant.
6 Sec. 3. As used in this chapter, "personal services attendant"
7 means an individual who is registered to provide attendant care
8 services under this chapter and who has entered into a contract
9 with an individual and acts under the individual's direction to
10 provide attendant care services that could be performed by the
11 individual if the individual were physically capable.
12 Sec. 4. The office of the secretary shall have self-directed care
13 options and services available for an eligible individual who:
14 (1) receives services under a home and community based
15 services waiver (as defined in IC 12-8-1.6-2); and
16 (2) chooses self-directed care services.
17 Sec. 5. (a) An individual may not provide attendant care services
18 for compensation from Medicaid for an individual in need of
19 self-directed in-home care services unless the individual is
20 registered under this chapter.
21 (b) Except in instances of extraordinary care, an individual who
22 is a legally responsible relative of an individual in need of
23 self-directed in-home care, including a parent of a minor individual
24 and a spouse, is precluded from providing attendant care services
25 for compensation under this chapter.
26 Sec. 6. (a) The office of the secretary shall register an individual
27 to provide services under this chapter who provides the following:
28 (1) A personal resume containing information concerning the
29 individual's qualifications, work experience, and any
30 credentials the individual may hold. The individual must
31 certify that the information contained in the resume is true
32 and accurate.
33 (2) The individual's:
34 (A) limited criminal history check from the Indiana central
35 repository for criminal history information under
36 IC 10-13-3;
37 (B) expanded criminal history check (as defined in
38 IC 20-26-2-1.5); or
39 (C) criminal history check from another source allowed by
40 law.
41 (3) If applicable, the individual's state nurse aide registry
42 report from the Indiana department of health. This
2024 IN 1386—LS 7038/DI 147 10
1 subdivision does not require an individual to be a nurse aide.
2 (4) Three (3) letters of reference.
3 (5) A registration fee. The office of the secretary shall
4 establish the amount of the registration fee.
5 (6) Proof that the individual is at least eighteen (18) years of
6 age.
7 (7) Any other information required by the office of the
8 secretary.
9 (b) A registration is valid for two (2) years. A personal services
10 attendant may renew the personal services attendant's registration
11 by updating any information in the file that has changed and by
12 paying the fee required under subsection (a)(5). The limited
13 criminal history check and state nurse aid registry report required
14 under subsection (a)(2) and (a)(3) must be updated every two (2)
15 years.
16 (c) The office of the secretary shall maintain a file for each
17 personal services attendant that contains:
18 (1) comments related to the provision of attendant care
19 services submitted by an individual in need of self-directed
20 in-home care who has employed the personal services
21 attendant; and
22 (2) the items described in subsection (a)(1) through (a)(4).
23 (d) Upon request, the office of the secretary shall provide to an
24 individual in need of self-directed in-home care the following:
25 (1) Without charge, a list of personal services attendants who
26 are registered with the office of the secretary and available
27 within the requested geographic area.
28 (2) A copy of the information of a specified personal services
29 attendant who is on file with the office of the secretary under
30 subsection (c). The office of the secretary may charge a fee for
31 shipping, handling, and copying expenses.
32 (e) The limited criminal history check requirement described in
33 subsection (a)(2) may be satisfied by fulfilling the components of an
34 expanded criminal history check under IC 20-26-2-1.5 and is
35 subject to the conditions described in IC 16-27-2-4(c).
36 Sec. 7. The case manager of an individual in need of
37 self-directed in-home care shall maintain an attending physician's
38 written opinion in a case file that is maintained for the individual
39 by the case manager.
40 Sec. 8. (a) A personal services attendant who is hired by the
41 individual in need of self-directed in-home care is an employee of
42 the individual in need of self-directed in-home care.
2024 IN 1386—LS 7038/DI 147 11
1 (b) The office of the secretary is not liable for any actions of a
2 personal services attendant or an individual in need of self-directed
3 in-home care.
4 (c) A personal services attendant and an individual in need of
5 self-directed in-home care are each liable for any negligent or
6 wrongful act or omission in which the person personally
7 participates.
8 Sec. 9. (a) Except as provided in subsection (b), an individual in
9 need of self-directed in-home care is responsible for recruiting,
10 hiring, training, paying, certifying any employment related
11 documents, dismissing, and supervising in the individual's home
12 during service hours a personal services attendant who provides
13 attendant care services for the individual.
14 (b) If an individual in need of self-directed in-home care is:
15 (1) less than twenty-one (21) years of age; or
16 (2) unable to direct in-home care because of a brain injury or
17 mental deficiency;
18 the individual's parent, spouse, legal guardian, or a person
19 possessing a valid power of attorney for the individual may make
20 employment, care, and training decisions and certify any
21 employment related documents on behalf of the individual.
22 (c) An individual in need of self-directed in-home care or an
23 individual under subsection (b) and the individual's case manager
24 shall develop an authorized care plan. The authorized care plan
25 must include a list of weekly services or tasks that must be
26 performed to comply with the authorized care plan.
27 Sec. 10. The individual in need of self-directed in-home care and
28 the personal services attendant must each sign a contract, in a form
29 approved by the office of the secretary, that includes, at a
30 minimum, the following provisions:
31 (1) The responsibilities of the personal services attendant.
32 (2) The frequency the personal services attendant will provide
33 attendant care services.
34 (3) The duration of the contract.
35 (4) The hourly wage of the personal services attendant. The
36 wage may not be less than the federal minimum wage or more
37 than the rate that the recipient is eligible to receive under a
38 Medicaid home and community based services waiver.
39 (5) Reasons and notice agreements for early termination of
40 the contract.
41 Sec. 11. (a) The office of the secretary shall amend the home and
42 community based services waiver program under the Medicaid
2024 IN 1386—LS 7038/DI 147 12
1 state plan to provide for the payment for attendant care services
2 provided by a personal services attendant for an individual in need
3 of self-directed in-home care under this chapter, including any
4 related record keeping and employment expenses.
5 (b) The office of the secretary shall not, to the extent permitted
6 by federal law, consider as income money paid under this chapter
7 to or on behalf of an individual in need of self-directed in-home
8 care to enable the individual to employ registered personal services
9 attendants for purposes of determining the individual's income
10 eligibility for services under this chapter or IC 12-8-1.6.
11 Sec. 12. The office of the secretary shall adopt rules under
12 IC 4-22-2 concerning the following:
13 (1) The method of payment to a personal services attendant
14 who provides authorized services under this chapter.
15 (2) Record keeping requirements for personal attendant
16 services.
17 (3) The receipt, review, and investigation of complaints
18 concerning the:
19 (A) neglect;
20 (B) abuse;
21 (C) mistreatment; or
22 (D) misappropriation of property;
23 of an individual in need of self-directed in-home care by a
24 personal services attendant.
25 (4) Establishing notice and administrative hearing procedures
26 in accordance with IC 4-21.5.
27 (5) Appeal procedures, including judicial review of
28 administrative hearings.
29 (6) Procedures to place a personal services attendant who has
30 been determined to have been guilty of:
31 (A) neglect;
32 (B) abuse;
33 (C) mistreatment; or
34 (D) misappropriation of property;
35 of an individual in need of self-directed in-home care on the
36 state nurse aide registry.
37 (7) Any rules necessary to implement this chapter.
38 SECTION 8. IC 12-9.1-4-1, AS ADDED BY P.L.141-2006,
39 SECTION 38, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
40 JULY 1, 2024]: Sec. 1. The division shall administer money
41 appropriated or allocated to the division by the state, including money
42 appropriated or allocated from the following:
2024 IN 1386—LS 7038/DI 147 13
1 (1) The federal Older Americans Act (42 U.S.C. 3001 et seq.).
2 (2) The United States Department of Agriculture (7 U.S.C. 612C
3 et seq.).
4 (3) Medicaid waiver in-home services for the elderly and disabled
5 (42 U.S.C. 1396 et seq.) for treatment of medical conditions.
6 (4) (3) Money appropriated or allocated to the division to
7 administer a program under this title.
8 (5) (4) Other funding sources that are designated by the general
9 assembly or available from the federal government under grants
10 that are consistent with the duties of the division.
11 SECTION 9. IC 12-9.1-4-2, AS ADDED BY P.L.141-2006,
12 SECTION 38, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
13 JULY 1, 2024]: Sec. 2. The division shall administer the following
14 programs:
15 (1) Programs established under any of the following statutes:
16 (A) This article.
17 (B) IC 12-10.
18 (2) Programs under IC 12-30, to the extent the division has
19 responsibilities for programs under IC 12-30.
20 (3) Medicaid waivers for in-home services for treatment of
21 medical conditions.
22 SECTION 10. IC 12-9.1-4-3 IS REPEALED [EFFECTIVE JULY
23 1, 2024]. Sec. 3. Notwithstanding any other law:
24 (1) home health agencies licensed under IC 16-27-1 are approved
25 to provide home health services; and
26 (2) personal services agencies licensed under IC 16-27-4 are
27 approved to provide personal services;
28 under any federal waiver granted to the state under 42 U.S.C. 1315 or
29 42 U.S.C. 1396n that provides services for treatment of medical
30 conditions.
31 SECTION 11. IC 12-10-11.5-6 IS REPEALED [EFFECTIVE JULY
32 1, 2024]. Sec. 6. (a) The office of the secretary of family and social
33 services shall annually determine any state savings generated by home
34 and community based services under this chapter by reducing the use
35 of institutional care.
36 (b) The secretary shall annually report to the governor, the budget
37 agency, the budget committee, the interim study committee on public
38 health, behavioral health, and human services established by
39 IC 2-5-1.3-4, and the executive director of the legislative services
40 agency the savings determined under subsection (a). A report under
41 this subsection to the executive director of the legislative services
42 agency must be in an electronic format under IC 5-14-6.
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1 (c) Savings determined under subsection (a) may be used to fund the
2 state's share of additional home and community based Medicaid waiver
3 slots.
4 SECTION 12. IC 12-10-11.5-8 IS REPEALED [EFFECTIVE JULY
5 1, 2024]. Sec. 8. (a) As used in this chapter, "assisted living services"
6 refers to services covered under a waiver and provided in any of the
7 following entities:
8 (1) A residential care facility licensed under IC 16-28.
9 (2) Any other housing with services establishment.
10 (b) As used in this section, "level of services" means a
11 determination of the type of services an individual may receive under
12 a Medicaid waiver based on the individual's impairment and
13 dependence and the corresponding reimbursement rate for the
14 determined level of care.
15 (c) As used in this section, "office" includes the following:
16 (1) The office of the secretary of family and social services.
17 (2) A managed care organization that has contracted with the
18 office of Medicaid policy and planning under IC 12-15.
19 (3) A person that has contracted with a managed care organization
20 described in subdivision (2).
21 (d) Under a Medicaid waiver that provides services to an individual
22 who is aged or disabled, the office shall reimburse for the following
23 services provided to the individual by a provider of assisted living
24 services:
25 (1) Assisted living services.
26 (2) Integrated health care coordination.
27 (3) Transportation.
28 (e) If the office approves an increase in the level of services for a
29 recipient of assisted living services, the office shall reimburse the
30 provider of assisted living services for the level of services for the
31 increase as of the date that the provider has documentation of providing
32 the increase in the level of services.
33 (f) The office may reimburse for any home and community based
34 services provided to a Medicaid recipient beginning on the date of the
35 individual's Medicaid application.
36 (g) The office may not do any of the following concerning assisted
37 living services provided in a home and community based services
38 program:
39 (1) Require the installation of a sink in the kitchenette within any
40 living unit of an entity that participated in the Medicaid home and
41 community based service program before July 1, 2018.
42 (2) Require all living units within a setting that provides assisted
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1 living services to comply with physical plant requirements that
2 are applicable to individual units occupied by a Medicaid
3 recipient.
4 (3) Require a provider to offer only private rooms.
5 (4) Require a housing with services establishment provider to
6 provide housing when:
7 (A) the provider is unable to meet the health needs of a
8 resident without:
9 (i) undue financial or administrative burden; or
10 (ii) fundamentally altering the nature of the provider's
11 operations; and
12 (B) the resident is unable to arrange for services to meet the
13 resident's health needs.
14 (5) Require a housing with services establishment provider to
15 separate an agreement for housing from an agreement for
16 services.
17 (6) Prohibit a housing with services establishment provider from
18 offering studio apartments with only a single sink in the unit.
19 (7) Preclude the use of a shared bathroom between adjoining or
20 shared units if the participants consent to the use of a shared
21 bathroom.
22 (8) Reduce the scope of services that may be provided by a
23 provider of assisted living services under the aged and disabled
24 Medicaid waiver in effect on July 1, 2021.
25 (h) The division may adopt rules under IC 4-22-2 that establish the
26 right, and an appeals process, for a resident to appeal a provider's
27 determination that the provider is unable to meet the health needs of
28 the resident as described in subsection (g)(4). The process:
29 (1) must require an objective third party to review the provider's
30 determination in a timely manner; and
31 (2) may not be required if the provider is licensed by the Indiana
32 department of health and the licensure requirements include an
33 appellate procedure for such a determination.
34 SECTION 13. IC 12-10-17.1-6, AS AMENDED BY P.L.99-2007,
35 SECTION 68, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
36 JULY 1, 2024]: Sec. 6. As used in this chapter, "individual in need of
37 self-directed in-home care" means an individual with a disability, or
38 person responsible for making health related decisions for the
39 individual with a disability, who:
40 (1) is approved to receive Medicaid waiver services under 42
41 U.S.C. 1396n(c), or is a participant in the community and home
42 options to institutional care for the elderly and disabled program
2024 IN 1386—LS 7038/DI 147 16
1 under IC 12-10-10;
2 (2) is in need of attendant care services because of impairment;
3 (3) requires assistance to complete functions of daily living,
4 self-care, and mobility, including those functions included in
5 attendant care services;
6 (4) chooses to self-direct a paid personal services attendant to
7 perform attendant care services; and
8 (5) assumes the responsibility to initiate self-directed in-home
9 care and exercise judgment regarding the manner in which those
10 services are delivered, including the decision to employ, train, and
11 dismiss a personal services attendant.
12 SECTION 14. IC 12-10-17.1-10, AS ADDED BY P.L.141-2006,
13 SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
14 JULY 1, 2024]: Sec. 10. (a) An individual may not provide attendant
15 care services for compensation from Medicaid or the community and
16 home options to institutional care for the elderly and disabled program
17 for an individual in need of self-directed in-home care services unless
18 the individual is registered under section 12 of this chapter.
19 (b) An individual who is a legally responsible relative of an
20 individual in need of self-directed in-home care, including a parent of
21 a minor individual and a spouse, is precluded from providing attendant
22 care services for compensation under this chapter.
23 SECTION 15. IC 12-10-17.1-17, AS ADDED BY P.L.141-2006,
24 SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
25 JULY 1, 2024]: Sec. 17. The individual in need of self-directed
26 in-home care and the personal services attendant must each sign a
27 contract, in a form approved by the division, that includes, at a
28 minimum, the following provisions:
29 (1) The responsibilities of the personal services attendant.
30 (2) The frequency the personal services attendant will provide
31 attendant care services.
32 (3) The duration of the contract.
33 (4) The hourly wage of the personal services attendant. The wage
34 may not be less than the federal minimum wage or more than the
35 rate that the recipient is eligible to receive under a Medicaid
36 home and community based services waiver or the community
37 and home options to institutional care for the elderly and disabled
38 program for attendant care services.
39 (5) Reasons and notice agreements for early termination of the
40 contract.
41 SECTION 16. IC 12-10-17.1-18, AS ADDED BY P.L.141-2006,
42 SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
2024 IN 1386—LS 7038/DI 147 17
1 JULY 1, 2024]: Sec. 18. (a) The office shall amend the home and
2 community based services waiver program under the state Medicaid
3 plan to provide for the payment for attendant care services provided by
4 a personal services attendant for an individual in need of self-directed
5 in-home care under this chapter, including any related record keeping
6 and employment expenses.
7 (b) The office shall not, to the extent permitted by federal law,
8 consider as income money paid under this chapter to or on behalf of an
9 individual in need of self-directed in-home care to enable the
10 individual to employ registered personal services attendants, for
11 purposes of determining the individual's income eligibility for services
12 under this chapter.
13 SECTION 17. IC 12-10-17.1-20, AS ADDED BY P.L.141-2006,
14 SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
15 JULY 1, 2024]: Sec. 20. (a) The division and office may adopt rules
16 under IC 4-22-2 that are necessary to implement this chapter.
17 (b) The office shall apply for any federal waivers necessary to
18 implement this chapter.
19 SECTION 18. IC 12-10-19 IS REPEALED [EFFECTIVE JULY 1,
20 2024]. (Home and Community Based Services).
21 SECTION 19. IC 12-15-1-20.4, AS AMENDED BY P.L.57-2021,
22 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
23 JULY 1, 2024]: Sec. 20.4. (a) If a Medicaid recipient is:
24 (1) adjudicated to be a delinquent child and placed in:
25 (A) a community based correctional facility for children;
26 (B) a juvenile detention facility; or
27 (C) a secure facility, not including a facility licensed as a child
28 caring institution under IC 31-27; or
29 (2) incarcerated in a prison or jail; and
30 ineligible to participate in the Medicaid program during the placement
31 described in subdivision (1) or (2) because of federal Medicaid law, the
32 division of family resources, upon notice that a child has been
33 adjudicated to be a delinquent child and placed in a facility described
34 in subdivision (1) or upon notice that a person is incarcerated in a
35 prison or jail and placed in a facility described in subdivision (2), shall
36 suspend the person's participation in the Medicaid program.
37 (b) If the division of family resources receives:
38 (1) a dispositional decree under IC 31-37-19-28; or
39 (2) a modified disposition order under IC 31-37-22-9;
40 and the department of correction gives the division at least forty (40)
41 days notice that a person will be released from a facility described in
42 subsection (a)(1)(C) or (a)(2), the division of family resources shall
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1 take action necessary to ensure that a person described in subsection
2 (a) is eligible to participate in the Medicaid program upon the person's
3 release, if the person is eligible to participate.
4 (c) A facility described in subsection (a)(1) shall provide the
5 division of family resources:
6 (1) at least forty-five (45) days notice; or
7 (2) under extenuating circumstances approved by the division,
8 notice as soon as possible;
9 that a delinquent child will be released from the facility. The
10 division of family services shall take action necessary to ensure that
11 the delinquent child, if eligible, participates in the Medicaid
12 program upon the child's release and receives services required
13 under federal law thirty (30) days before the child's release and
14 thirty (30) days after the child's release.
15 SECTION 20. IC 12-15-29-4.5, AS AMENDED BY P.L.265-2019,
16 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
17 JULY 1, 2024]: Sec. 4.5. (a) An insurer shall accept a Medicaid claim
18 for a Medicaid recipient for three (3) years from the date the service
19 was provided.
20 (b) An insurer may not deny a Medicaid claim submitted by the
21 office solely on the basis of:
22 (1) the date of submission of the claim;
23 (2) the type or format of the claim form;
24 (3) the method of submission of the claim; or
25 (4) a failure to provide proper documentation at the point of sale
26 that is the basis of the claim;
27 if the claim is submitted by the office within three (3) years from the
28 date the service was provided as required in subsection (a) and the
29 office commences action to enforce the office's rights regarding the
30 claim within six (6) years of the office's submission of the claim.
31 (c) This subsection does not apply to coverage under the
32 Medicare program, Medicare Advantage, or Medicare Part D. An
33 insurer may not deny a Medicaid claim submitted by the office solely
34 due to a lack of prior authorization in accordance with 42 U.S.C.
35 1396a(a)(25). An insurer shall:
36 (1) after December 31, 2020, meet the requirements set forth in
37 IC 27-1-37.5;
38 (2) conduct the prior authorization on a retrospective basis for
39 claims where prior authorization is necessary; and
40 (3) adjudicate any claim authorized in this manner as if the claim
41 received prior authorization; and
42 (4) respond to a state inquiry regarding a claim under
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1 subsection (a) not later than sixty (60) days after receiving the
2 inquiry.
3 SECTION 21. IC 12-15-29-9, AS AMENDED BY P.L.187-2007,
4 SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
5 JULY 1, 2024]: Sec. 9. (a) IC 27-8-23 applies to this section.
6 (b) To the extent that payment for covered medical expenses has
7 been made under the state Medicaid program for health care items or
8 services furnished to a person, in a case where a third party has a legal
9 liability to make payments, the state is considered to have acquired the
10 rights of the person to payment by any other party for the accumulated
11 and future health care items or services.
12 (c) As required under 42 U.S.C. 1396a(a)(25), an insurer shall
13 accept the state's right of recovery and the assignment to the state of
14 any right of the individual or entity to payment for a health care item
15 or service for which payment has been made under the state Medicaid
16 plan.
17 SECTION 22. IC 31-37-19-29 IS ADDED TO THE INDIANA
18 CODE AS A NEW SECTION TO READ AS FOLLOWS
19 [EFFECTIVE JULY 1, 2024]: Sec. 29. (a) As used in this section,
20 "facility" means the following:
21 (1) A community based correctional facility for children.
22 (2) A juvenile detention facility.
23 (3) A secure facility, not including a facility licensed as a child
24 caring institution under IC 31-27.
25 (b) A facility shall provide the division of family resources:
26 (1) at least forty-five (45) days notice; or
27 (2) under extenuating circumstances approved by the division,
28 notice as soon as possible;
29 that a delinquent child will be released from the facility. The
30 division of family services shall take action necessary to ensure that
31 the delinquent child, if eligible, participates in the Medicaid
32 program upon the child's release and receives services required
33 under federal law thirty (30) days before the child's release and
34 thirty (30) days after the child's release.
35 SECTION 23. IC 34-30-2.1-129.4 IS ADDED TO THE INDIANA
36 CODE AS A NEW SECTION TO READ AS FOLLOWS
37 [EFFECTIVE JULY 1, 2024]: Sec. 129.4. IC 12-8-1.7-8(b)
38 (Concerning actions of a personal services attendant).
39 SECTION 24. [EFFECTIVE JULY 1, 2024] (a) An individual
40 who:
41 (1) is registered under IC 12-10-17.1, as amended by this act,
42 before July 1, 2024; and
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1 (2) provides services under a home and community based
2 services waiver;
3 is deemed registered under IC 12-8-1.7, as added by this act.
4 (b) This SECTION expires July 1, 2026.
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