Introduced Version
HOUSE BILL No. 1393
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 12-7-2; IC 12-15; IC 16-21-10; IC 27-1-3-10.
Synopsis: Managed care and hospital assessment fee. Authorizes the
managed care assessment fee to be assessed against specified insurers
and administered by the office of the secretary of family and social
services. Establishes the managed care assessment fee committee. Sets
forth requirements of the managed care assessment fee. Establishes the
high risk pool fund. Expires the managed care assessment fee on June
30, 2025. Allows certain providers to contractually agree to a different
reimbursement rate with a managed care organization as part of a value
based services contract. Excludes hospitals and private psychiatric
hospitals. Provides for payments to hospitals out of the phase out trust
fund and expires the fund. Exempts: (1) physician owned hospitals; and
(2) hospitals that only provide respite care to certain individuals; from
the hospital assessment fee. Makes assessment of the hospital
assessment fee subject to federal approval of changes made by this act.
Requires the hospital assessment fee committee to: (1) review and
approve the quality program; and (2) be guided to ensure hospitals are
reimbursed at a rate that meets specified requirements. Specifies
components of a state directed payment program. Specifies uses of the
hospital assessment fee and that hospital assessment fees will not be
used for disproportionate share payments if the state directed payment
program is implemented. Reduces the hospital fee assessment by the
managed care assessment fee and the payment from the phase out trust
fund. Requires the commissioner of the department of insurance to
revoke or suspend the authority of a managed care organization to do
business in Indiana if the managed care organization fails to pay the
(Continued next page)
Effective: Upon passage.
Barrett
January 11, 2024, read first time and referred to Committee on Public Health.
2024 IN 1393—LS 6847/DI 104 Digest Continued
managed care assessment fee. Repeals language concerning the
hospital care for the indigent program. Repeals language specifying the
distribution of the hospital assessment fee.
2024 IN 1393—LS 6847/DI 1042024 IN 1393—LS 6847/DI 104 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. 1393
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 12-7-2-16.7 IS ADDED TO THE INDIANA CODE
2 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
3 UPON PASSAGE]: Sec. 16.7. "Assessment period", for purposes of
4 IC 12-15-29.5, has the meaning set forth in IC 12-15-29.5-1.
5 SECTION 2. IC 12-7-2-35, AS AMENDED BY P.L.184-2017,
6 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
7 UPON PASSAGE]: Sec. 35. (a) "Committee", for purposes of
8 IC 12-15-29.5, has the meaning set forth in IC 12-15-29.5-2.
9 (b) "Committee", for purposes of IC 12-15-33, has the meaning set
10 forth in IC 12-15-33-1.
11 SECTION 3. IC 12-7-2-57.5, AS AMENDED BY P.L.146-2008,
12 SECTION 378, IS AMENDED TO READ AS FOLLOWS
13 [EFFECTIVE UPON PASSAGE]: Sec. 57.5. (a) "Department", for
14 purposes of IC 12-13-14, has the meaning set forth in IC 12-13-14-1.
15 (b) "Department", for purposes of IC 12-15-29.5, has the
2024 IN 1393—LS 6847/DI 104 2
1 meaning set forth in IC 12-15-29.5-3.
2 SECTION 4. IC 12-7-2-85.7 IS ADDED TO THE INDIANA CODE
3 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
4 UPON PASSAGE]: Sec. 85.7. "Fee", for purposes of IC 12-15-29.5,
5 has the meaning set forth in IC 12-15-29.5-4.
6 SECTION 5. IC 12-7-2-91, AS AMENDED BY P.L.246-2023,
7 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
8 UPON PASSAGE]: Sec. 91. "Fund" means the following:
9 (1) For purposes of IC 12-12-1-9, the fund described in
10 IC 12-12-1-9.
11 (2) For purposes of IC 12-15-20, the meaning set forth in
12 IC 12-15-20-1.
13 (3) For purposes of IC 12-15-29.5, the meaning set forth in
14 IC 12-15-29.5-5.
15 (3) (4) For purposes of IC 12-17-12, the meaning set forth in
16 IC 12-17-12-4.
17 (4) (5) For purposes of IC 12-17.2-7.2, the meaning set forth in
18 IC 12-17.2-7.2-4.7.
19 (5) (6) For purposes of IC 12-17.6, the meaning set forth in
20 IC 12-17.6-1-3.
21 (6) (7) For purposes of IC 12-23-2, the meaning set forth in
22 IC 12-23-2-1.
23 (7) (8) For purposes of IC 12-23-18, the meaning set forth in
24 IC 12-23-18-4.
25 (8) (9) For purposes of IC 12-24-6, the meaning set forth in
26 IC 12-24-6-1.
27 (9) (10) For purposes of IC 12-24-14, the meaning set forth in
28 IC 12-24-14-1.
29 (10) (11) For purposes of IC 12-30-7, the meaning set forth in
30 IC 12-30-7-3.
31 SECTION 6. IC 12-7-2-126.9, AS ADDED BY P.L.152-2017,
32 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
33 UPON PASSAGE]: Sec. 126.9. (a) "Managed care organization",
34 except as provided in subsection (b), means a person that has a
35 comprehensive risk contract with the office of Medicaid policy and
36 planning under IC 12-15.
37 (b) "Managed care organization", for purposes of
38 IC 12-15-29.5, has the meaning set forth in IC 12-15-29.5-6.
39 SECTION 7. IC 12-7-2-143.3 IS ADDED TO THE INDIANA
40 CODE AS A NEW SECTION TO READ AS FOLLOWS
41 [EFFECTIVE UPON PASSAGE]: Sec. 143.3. "Premium revenue",
42 for purposes of IC 12-15-29.5, has the meaning set forth in
2024 IN 1393—LS 6847/DI 104 3
1 IC 12-15-29.5-8.
2 SECTION 8. IC 12-7-2-186.3 IS ADDED TO THE INDIANA
3 CODE AS A NEW SECTION TO READ AS FOLLOWS
4 [EFFECTIVE UPON PASSAGE]: Sec. 186.3. "State share", for
5 purposes of IC 12-15-29.5, has the meaning set forth in
6 IC 12-15-29.5-9.
7 SECTION 9. IC 12-15-29.5 IS ADDED TO THE INDIANA CODE
8 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
9 UPON PASSAGE]:
10 Chapter 29.5. Managed Care Assessment Fee
11 Sec. 1. As used in this chapter, "assessment period" refers to the
12 state fiscal years for which a fee may be assessed under this
13 chapter.
14 Sec. 2. As used in this chapter, "committee" means the managed
15 care assessment fee committee established by section 11 of this
16 chapter.
17 Sec. 3. As used in this chapter, "department" refers to the
18 department of insurance created by IC 27-1-1-1.
19 Sec. 4. As used in this chapter, "fee" means the managed care
20 assessment fee authorized under this chapter.
21 Sec. 5. As used in this chapter, "fund" means the high risk pool
22 fund established by section 15 of this chapter.
23 Sec. 6. As used in this chapter, "managed care organization"
24 means the following:
25 (1) A health maintenance organization, as defined in
26 IC 27-13-1-19.
27 (2) A Medicaid managed care organization, as defined in
28 IC 12-7-2-126.9.
29 (3) A preferred provider organization that is subject to the
30 requirements of IC 27-8-11-5.
31 (4) Any other type of organization recognized as a managed
32 care organization under Indiana law, as determined by the
33 commissioner of the department in accordance with 42 U.S.C.
34 1396b(w)(7)(A)(viii).
35 Sec. 7. As used in this chapter, "office of the secretary" refers
36 to the office of the secretary of family and social services.
37 Sec. 8. As used in this chapter, "premium revenue" means
38 money or any other item of value given in consideration to a
39 managed care organization for coverage of individuals, including
40 policy fees, admission fees, or membership fees.
41 Sec. 9. As used in this chapter, "state share" means the portion
42 of allowable Medicaid expenses funded by the state or other local
2024 IN 1393—LS 6847/DI 104 4
1 units of government, or as permitted by federal Medicaid laws by
2 other entities other than the federal government.
3 Sec. 10. For purposes of this chapter, each managed care
4 organization described in section 6(1) through 6(4) of this chapter
5 is considered to be a separate class of a managed care organization.
6 Sec. 11. (a) The managed care assessment fee committee is
7 established. The committee consists of the following eight (8) voting
8 members:
9 (1) The secretary of family and social services appointed
10 under IC 12-8-1.5-2, or the secretary's designee, who shall
11 serve as chairperson of the committee.
12 (2) The commissioner of the department, or the
13 commissioner's designee.
14 (3) The state budget director, or the state budget director's
15 designee.
16 (4) One (1) member representing a health maintenance
17 organization, appointed by the governor from a list of at least
18 three (3) individuals submitted by the Insurance Institute of
19 Indiana.
20 (5) One (1) member representing a Medicaid managed care
21 organization, appointed by the governor from a list of at least
22 three (3) individuals submitted by the Insurance Institute of
23 Indiana.
24 (6) One (1) member representing a preferred provider
25 organization, appointed by the governor.
26 (7) One (1) member who represents either:
27 (A) an organization described in section 6(4) of this
28 chapter identified by the commissioner of the department
29 to be included under this chapter; or
30 (B) if the commissioner of the department does not identify
31 an organization described in section 6(4) of this chapter, a
32 preferred provider organization;
33 appointed by the governor.
34 (8) One (1) member with expertise in managed care and
35 managed care organizations, appointed by the governor.
36 (b) The committee shall perform the actions specified for the
37 committee in this chapter concerning the fee established under this
38 chapter.
39 (c) The committee shall meet at the call of the chairperson. The
40 members shall serve without compensation.
41 (d) A quorum consists of at least five (5) members. An
42 affirmative vote of at least five (5) members of the committee is
2024 IN 1393—LS 6847/DI 104 5
1 necessary to approve any matter before the committee.
2 Sec. 12. (a) Beginning July 1, 2024, except as provided in
3 subsection (b), the office shall assess a managed care assessment fee
4 to a managed care organization at a rate equal to six percent (6%)
5 of the managed care organization's premium revenue for each
6 state fiscal year during the assessment period. However, the office
7 may not use an assessment methodology that would result in a
8 collection from a managed care organization that would exceed the
9 maximum federal indirect threshold of six percent (6%) set forth
10 in 42 CFR 433.68(f)(3)(i). Any state plan amendment or waiver
11 that the office submits to the United States Department of Health
12 and Human Services must request that the fee be implemented on
13 July 1, 2024, even if that requires the assessment to be
14 implemented retroactively.
15 (b) The office may assess a fee under this section only if the
16 following conditions are met:
17 (1) The fee is used only for the purposes set forth in section 16
18 of this chapter.
19 (2) The committee approves the assessment fee methodology
20 described in subsection (a) or (c).
21 (3) The United States Department of Health and Human
22 Services approves the assessment fee methodology described
23 in subsection (a) or (c).
24 (4) The hospital assessment fee committee approves the state
25 directed payment program described in IC 16-21-10-8(a)(2).
26 (5) The United States Department of Health and Human
27 Services approves the Medicaid state plan amendments and
28 waiver requests, including revisions, that are necessary to
29 implement or maintain the state directed payment program
30 described in IC 16-21-10-8(a)(2).
31 (6) The money generated from the fee does not revert to the
32 state general fund.
33 (c) The office shall assess a fee to a managed care organization
34 in an alternative methodology if the following occur:
35 (1) Before May 1 of any year, the committee proposes and
36 approves use of any or both of the following alternative fee
37 assessment methodologies:
38 (A) A percentage of premium revenue received by a
39 managed care organization during a state fiscal year.
40 (B) A per member per month amount on a state fiscal year
41 basis, which may include the use of a tiered system
42 concerning individual enrollment of a managed care
2024 IN 1393—LS 6847/DI 104 6
1 organization.
2 The alternative methodology under this subdivision may be
3 applied in a uniform manner within each classification of
4 managed care organization and may exempt a managed care
5 organization from the fee.
6 (2) The hospital assessment fee committee established by
7 IC 16-21-10-7 approves the alternative methodology proposed
8 by the committee under subdivision (1), determining that the
9 alternative approach:
10 (A) will not impose an excessive administrative burden on
11 the office; and
12 (B) is reasonably likely to generate sufficient state share
13 dollars to meet the funding levels specified in section
14 16(a)(1) through 16(a)(3) of this chapter for each state
15 fiscal year during the assessment period.
16 An alternative methodology under this subsection may not result
17 in a collection from a managed care organization that would
18 exceed the maximum federal indirect threshold of six percent (6%)
19 set forth in 42 CFR 433.68(f)(3)(i).
20 (d) Both the committee and the hospital assessment fee
21 committee shall consult with and make available to each other data
22 and other relevant information necessary to make the
23 determinations required in subsection (c).
24 (e) Before May 31, 2024, the office shall submit the approved fee
25 assessment methodology to the United States Department of Health
26 and Human Services.
27 (f) If the United States Department of Health and Human
28 Services does not approve the fee assessment methodology or
29 proposes modifications or an alternative methodology to the fee
30 assessment methodology submitted by the office under subsection
31 (e), the office may not submit an alternative methodology or agree
32 to the United States Department of Health and Human Services'
33 modifications or alternative methodology unless the following
34 requirements are met:
35 (1) The alternative or modified methodology from the United
36 States Department of Health and Human Services complies
37 with the requirements of this chapter.
38 (2) The committee approves the alternative or modified
39 methodology.
40 (3) The hospital assessment fee committee determines by an
41 affirmative vote of a quorum that the alternative or modified
42 methodology proposed:
2024 IN 1393—LS 6847/DI 104 7
1 (A) will not impose excessive administrative burdens on the
2 office; and
3 (B) is reasonably likely to generate sufficient state share
4 dollars to meet the funding levels specified by section
5 16(a)(1) through 16(a)(3) of this chapter for each state
6 fiscal year during the assessment period.
7 (g) The office shall keep records of the fees collected under this
8 chapter and report the amount of fees collected to the
9 commissioner of the department.
10 Sec. 13. The office may seek a waiver under 42 CFR 433.68(e)
11 of any of the following federal requirements in the implementation
12 of an assessment fee methodology under section 12 of this chapter:
13 (1) The broad based requirement under 42 CFR 433.68(c).
14 (2) The uniformly imposed requirement under 42 CFR
15 433.68(d).
16 Sec. 14. The office shall cease to collect a fee under this chapter
17 if any of the following occur:
18 (1) An appellate court issues a final order that either:
19 (A) the fee described in this chapter; or
20 (B) the hospital assessment fee under IC 16-21-10;
21 cannot be implemented or continued.
22 (2) The United States Department of Health and Human
23 Services denies approval of collecting the fee under this
24 chapter.
25 (3) The hospital assessment fee under IC 16-21-10 ceases to be
26 collected for circumstances set forth under IC 16-21-10-8.
27 (4) The hospital assessment fee completes a phase out period
28 (as defined in IC 16-21-10-5.3).
29 Sec. 15. (a) The high risk pool fund is established for the
30 purpose of holding a portion of the fees collected under this
31 chapter.
32 (b) The department shall administer the fund and keep records
33 of the fees deposited into the fund. The expenses of administering
34 the fund shall be paid from money in the fund.
35 (c) Money in the fund at the end of a state fiscal year does not
36 revert to the state general fund.
37 (d) The treasurer of state shall invest the money in the fund not
38 currently needed to meet the obligations of the fund in the same
39 manner as other public money may be invested. Interest that
40 accrues from these investments shall be deposited in the fund.
41 Sec. 16. (a) Beginning July 1, 2024, and for each state fiscal year
42 during the assessment period, the fees collected under this chapter
2024 IN 1393—LS 6847/DI 104 8
1 shall be distributed as follows:
2 (1) An amount equal to twenty-eight and five-tenths percent
3 (28.5%) of the total fees collected under this IC 16-21-10-8 for
4 state fiscal year 2023, to be used to contribute to the funding
5 of the office's Medicaid expenses.
6 (2) Twenty percent (20%) of the state share dollars for the
7 state fiscal year for the programs described in
8 IC 16-21-10-8(a).
9 (3) Twenty percent (20%) of the state share dollars for the
10 state fiscal year for the expenses described in
11 IC 16-21-10-13.3(b)(1).
12 (4) Ten percent (10%) to be used to create a high risk pool for
13 high cost medical conditions, as determined by the
14 department, to help lower premiums for managed care
15 organizations.
16 (b) The fees described in subsection (a)(2) shall be deposited into
17 the hospital Medicaid fee fund established by IC 16-21-10-9.
18 (c) The fees described in subsection (a)(3) shall be deposited into
19 the incremental hospital fee fund established by IC 16-21-10-13.5.
20 (d) The funds described in subsection (a)(4) shall be deposited
21 into the fund established by section 15 of this chapter.
22 (e) If the fees collected for a state fiscal year are not sufficient to
23 fulfill the funding levels specified in subsection (a)(1) through
24 (a)(4), the fees must be applied in the following order of priority:
25 (1) First, to fund the amount described in subsection (a)(1).
26 (2) Second, to fund the amount specified in subsection (a)(3).
27 (3) Third, to fund the amount specified in subsection (a)(2).
28 (4) Fourth, to fund the amount specified in subsection (a)(4).
29 Sec. 17. (a) For fees due from a managed care organization
30 under this chapter for the state fiscal year beginning July 1, 2024:
31 (1) the office shall, before December 21, 2024, notify each
32 managed care organization of the fee amount owed by the
33 managed care organization under this chapter; and
34 (2) each managed care organization shall remit the fee
35 amount to the office before March 1, 2025.
36 (b) For fees due from a managed care organization beginning
37 July 1, 2025, and thereafter:
38 (1) the office shall, before August 1 of each year, notify each
39 managed care organization of the managed care
40 organization's fee amount owed by the managed care
41 organization under this chapter; and
42 (2) each managed care organization shall remit the fee
2024 IN 1393—LS 6847/DI 104 9
1 amount to the office before October 1 of the state fiscal year
2 in which the fee is owed.
3 (c) The office may approve a monthly payment plan not to
4 exceed twelve (12) months for a managed care organization for the
5 fee amount owed by the managed care organization under this
6 chapter if the managed care organization demonstrates
7 extenuating circumstances in meeting the payment deadline
8 described in this section.
9 (d) The office shall assess a managed care organization interest
10 at the rate described in IC 12-15-21-3(6) for any fee that is at least
11 eleven (11) calendar days past the payment date set forth in this
12 section.
13 (e) The office shall report to the department each managed care
14 organization that fails to pay the fee within one hundred twenty
15 (120) calendar days after the payment date specified in this section.
16 The department shall do the following concerning the managed
17 care organization that has failed to make the payment:
18 (1) Notify the managed care organization that the managed
19 care organization's authority to do business in Indiana will be
20 revoked if the fee is not paid within thirty (30) calendar days
21 from the date of the notice.
22 (2) Revoke or suspend the managed care organization's
23 authority to do business in Indiana if the managed care
24 organization fails to make the payment in the required time
25 set forth in subdivision (1). IC 4-21.5-3-8 and IC 4-21.5-4
26 apply to this subdivision.
27 Sec. 18. (a) The office may adopt rules, including provisional
28 rules under IC 4-22-2-37.1, necessary to implement this chapter.
29 (b) Rules adopted under this section may be retroactive to the
30 effective date of any Medicaid state plan amendment or waiver
31 necessary to implement this chapter.
32 Sec. 19. This chapter expires June 30, 2025.
33 SECTION 10. IC 12-15-44.2-17, AS AMENDED BY P.L.213-2015,
34 SECTION 134, IS AMENDED TO READ AS FOLLOWS
35 [EFFECTIVE UPON PASSAGE]: Sec. 17. (a) The healthy Indiana plan
36 trust fund is established for the following purposes:
37 (1) Administering a plan created by the general assembly to
38 provide health insurance coverage for low income residents of
39 Indiana under this chapter and IC 12-15-44.5.
40 (2) Providing copayments, preventative care services, and
41 premiums for individuals enrolled in the plan.
42 (3) Funding tobacco use prevention and cessation programs,
2024 IN 1393—LS 6847/DI 104 10
1 childhood immunization programs, and other health care
2 initiatives designed to promote the general health and well being
3 of Indiana residents.
4 (4) Funding amounts necessary to match federal funds for
5 purposes set forth in this section.
6 The fund is separate from the state general fund.
7 (b) The fund shall be administered by the office of the secretary of
8 family and social services.
9 (c) The expenses of administering the fund shall be paid from
10 money in the fund.
11 (d) The fund shall consist of the following:
12 (1) Cigarette tax revenues designated by the general assembly to
13 be part of the fund.
14 (2) Other funds designated by the general assembly to be part of
15 the fund.
16 (3) Federal funds available for the purposes of the fund.
17 (4) Gifts or donations to the fund.
18 (e) The treasurer of state shall invest the money in the fund not
19 currently needed to meet the obligations of the fund in the same
20 manner as other public money may be invested.
21 (f) Money must be appropriated before funds are available for use.
22 (g) Money in the fund does not revert to the state general fund at the
23 end of any fiscal year.
24 (h) The fund is considered a trust fund for purposes of IC 4-9.1-1-7.
25 Money may not be transferred, assigned, or otherwise removed from
26 the fund by the state board of finance, the budget agency, or any other
27 state agency unless the transfer, assignment, or removal is made in
28 accordance with subsection (a)(4).
29 (i) As used in this subsection, "costs of the healthy Indiana plan 2.0"
30 includes the costs of all expenses set forth in
31 IC 16-21-10-13.3(b)(1)(A) through IC 16-21-10-13.3(b)(1)(F).
32 IC 16-21-10-13.3(b)(1)(G). Notwithstanding subsection (a), funds on
33 deposit in the fund beginning on the date the office implements the
34 healthy Indiana plan 2.0 (IC 12-15-44.5) and until the healthy Indiana
35 plan 2.0 is terminated upon the completion of a phase out period shall
36 be used exclusively for the following:
37 (1) The state share of the costs of the healthy Indiana plan 2.0 that
38 exceed other available funding sources in any given year.
39 (2) The state share of the costs of the healthy Indiana plan 2.0
40 incurred during a phase out period of the healthy Indiana plan 2.0.
41 (3) The state share of the expenses of the plan in effect under this
42 chapter immediately before the implementation of the healthy
2024 IN 1393—LS 6847/DI 104 11
1 Indiana plan 2.0 that were incurred in the regular course of the
2 plan's operation.
3 (j) As used in this subsection, "costs of the healthy Indiana plan 2.0"
4 include the costs of all expenses set forth in IC 16-21-10-13.3(b)(1)(A)
5 through IC 16-21-10-13.3(b)(1)(F). IC 16-21-10-13.3(b)(1)(G). Upon
6 implementation of the healthy Indiana plan 2.0 (IC 12-15-44.5), the
7 entirety of the annual cigarette tax amounts designated to the fund by
8 the general assembly shall be used exclusively to fund the state share
9 of the costs of the healthy Indiana plan 2.0, including the state share of
10 the costs of the healthy Indiana plan 2.0 incurred during a phase out
11 period of the healthy Indiana plan 2.0. This subsection may not be
12 construed to restrict the annual cigarette tax dollars annually
13 appropriated by the general assembly for childhood immunization
14 programs under subsection (a)(3).
15 SECTION 11. IC 12-15-44.5-4, AS AMENDED BY P.L.30-2016,
16 SECTION 29, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
17 UPON PASSAGE]: Sec. 4. (a) The plan:
18 (1) is not an entitlement program; and
19 (2) serves as an alternative to health care coverage under Title
20 XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
21 (b) If either of the following occurs, the office shall terminate the
22 plan in accordance with section 6(b) of this chapter:
23 (1) The:
24 (A) percentages of federal medical assistance available to the
25 plan for coverage of plan participants described in Section
26 1902(a)(10)(A)(i)(VIII) of the federal Social Security Act are
27 less than the percentages provided for in Section
28 2001(a)(3)(B) of the federal Patient Protection and Affordable
29 Care Act; and
30 (B) hospital assessment committee (IC 16-21-10), after
31 considering the modification and the reduction in available
32 funding, does not alter the formula established under
33 IC 16-21-10-13.3(b)(1) to cover the amount of the reduction
34 in federal medical assistance.
35 For purposes of this subdivision, "coverage of plan participants"
36 includes payments, contributions, and amounts referred to in
37 IC 16-21-10-13.3(b)(1)(A), IC 16-21-10-13.3(b)(1)(C), and
38 IC 16-21-10-13.3(b)(1)(D), and IC 16-21-10-13.3(b)(1)(E),
39 including payments, contributions, and amounts incurred during
40 a phase out period of the plan.
41 (2) The:
42 (A) methodology of calculating the incremental fee set forth in
2024 IN 1393—LS 6847/DI 104 12
1 IC 16-21-10-13.3 is modified in any way that results in a
2 reduction in available funding;
3 (B) hospital assessment fee committee (IC 16-21-10), after
4 considering the modification and reduction in available
5 funding, does not alter the formula established under
6 IC 16-21-10-13.3(b)(1) to cover the amount of the reduction
7 in fees; and
8 (C) office does not use alternative financial support to cover
9 the amount of the reduction in fees.
10 (c) If the plan is terminated under subsection (b), the secretary may
11 implement a plan for coverage of the affected population in a manner
12 consistent with the healthy Indiana plan (IC 12-15-44.2 (before its
13 repeal)) in effect on January 1, 2014:
14 (1) subject to prior approval of the United States Department of
15 Health and Human Services; and
16 (2) without funding from the incremental fee set forth in
17 IC 16-21-10-13.3.
18 (d) The office may not operate the plan in a manner that would
19 obligate the state to financial participation beyond the level of state
20 appropriations or funding otherwise authorized for the plan.
21 (e) The office of the secretary shall submit annually to the budget
22 committee an actuarial analysis of the plan that reflects a determination
23 that sufficient funding is reasonably estimated to be available to
24 operate the plan.
25 SECTION 12. IC 12-15-44.5-5, AS AMENDED BY P.L.201-2023,
26 SECTION 136, IS AMENDED TO READ AS FOLLOWS
27 [EFFECTIVE UPON PASSAGE]: Sec. 5. (a) A managed care
28 organization that contracts with the office to provide health coverage,
29 dental coverage, or vision coverage to an individual who participates
30 in the plan:
31 (1) is responsible for the claim processing for the coverage;
32 (2) shall, except as provided under subsection (c), reimburse
33 providers at a rate that is not less than the rate established by the
34 secretary; and
35 (3) may not deny coverage to an eligible individual who has been
36 approved by the office to participate in the plan.
37 (b) A managed care organization that contracts with the office to
38 provide health coverage under the plan must incorporate cultural
39 competency standards established by the office. The standards must
40 include standards for non-English speaking, minority, and disabled
41 populations.
42 (c) This subsection does not apply to the following:
2024 IN 1393—LS 6847/DI 104 13
1 (1) A hospital licensed under IC 16-21-2.
2 (2) A private psychiatric hospital licensed under IC 12-25.
3 A managed care organization and a provider may agree to a
4 different reimbursement rate from the rate specified in subsection
5 (a)(2) as part of a value based services contract.
6 SECTION 13. IC 12-15-44.5-6, AS AMENDED BY P.L.108-2019,
7 SECTION 198, IS AMENDED TO READ AS FOLLOWS
8 [EFFECTIVE UPON PASSAGE]: Sec. 6. (a) For a the state fiscal year
9 beginning July 1, 2018, July 1, 2024, or thereafter, the office after
10 review by the state budget committee, may determine that no
11 incremental fees collected under IC 16-21-10-13.3 are required to be
12 deposited into the phase out trust fund established under section 7 of
13 this chapter. shall use the funds in the phase out trust fund
14 established by section 7 of this chapter for a one (1) time pro rata
15 reduction in overall incremental fees paid by hospitals under
16 IC 16-21-10-13.3 for the state fiscal year.
17 (b) If the plan is to be terminated for any reason, the office shall:
18 (1) if required, provide notice of termination of the plan to the
19 United States Department of Health and Human Services and
20 begin the process of phasing out the plan; or
21 (2) if notice and a phase out plan is not required under federal
22 law, notify the hospital assessment fee committee (IC 16-21-10)
23 of the office's intent to terminate the plan and the plan shall be
24 phased out under a procedure approved by the hospital
25 assessment fee committee.
26 The office may not submit any phase out plan to the United States
27 Department of Health and Human Services or accept any phase out
28 plan proposed by the Department of Health and Human Services
29 without the prior approval of the hospital assessment fee committee.
30 (c) Before submitting:
31 (1) an extension of; or
32 (2) a material amendment to;
33 the plan to the United States Department of Health and Human
34 Services, the office shall inform the Indiana Hospital Association of the
35 extension or material amendment to the plan.
36 (d) This section expires June 30, 2025.
37 SECTION 14. IC 12-15-44.5-7, AS ADDED BY P.L.213-2015,
38 SECTION 136, IS AMENDED TO READ AS FOLLOWS
39 [EFFECTIVE UPON PASSAGE]: Sec. 7. (a) The phase out trust fund
40 is established. for the purpose of holding the money needed during a
41 phase out period of the plan. Funds deposited under this section shall
42 be used only:
2024 IN 1393—LS 6847/DI 104 14
1 (1) to fund the state share of the expenses described in
2 IC 16-21-10-13.3(b)(1)(A) through IC 16-21-10-13.3(b)(1)(F)
3 incurred during a phase out period of the plan;
4 (2) after funds from the healthy Indiana trust fund (IC
5 12-15-44.2-17) are exhausted; and
6 (3) to refund hospitals in the manner described in subsection (h).
7 as set forth in section 6 of this chapter. The fund is separate from the
8 state general fund.
9 (b) The fund shall be administered by the office.
10 (c) The expenses of administering the fund shall be paid from
11 money in the fund.
12 (d) The trust fund must consist of:
13 (1) the funds described in section 6 of this chapter; and
14 (2) any interest accrued under this section.
15 (e) The treasurer of state shall invest the money in the fund not
16 currently needed to meet the obligations of the fund in the same
17 manner as other public money may be invested. Interest that accrues
18 from these investments shall be deposited in the fund.
19 (f) Money in the fund does not revert to the state general fund at the
20 end of any fiscal year.
21 (g) The fund is considered a trust fund for purposes of IC 4-9.1-1-7.
22 Money may not be transferred, assigned, or otherwise removed from
23 the fund by the state board of finance, the budget agency, or any other
24 state agency unless specifically authorized under this chapter.
25 (h) At the end of the phase out period, any remaining funds and
26 accrued interest shall be distributed to the hospitals on a pro rata basis
27 based on the fees authorized by IC 16-21-10 that were paid by each
28 hospital for the state fiscal year that ended immediately before the
29 beginning of the phase out period. This section expires June 30, 2025.
30 SECTION 15. IC 16-21-10-4, AS ADDED BY P.L.205-2013,
31 SECTION 214, IS AMENDED TO READ AS FOLLOWS
32 [EFFECTIVE UPON PASSAGE]: Sec. 4. (a) As used in this chapter,
33 "hospital" means either of the following:
34 (1) A hospital (as defined in IC 16-18-2-179(b)) licensed under
35 this article.
36 (2) A private psychiatric hospital licensed under IC 12-25.
37 (b) The term does not include the following:
38 (1) A state mental health institution operated under IC 12-24-1-3.
39 (2) A hospital:
40 (A) designated by the Medicaid program as a long term care
41 hospital;
42 (B) that has an average inpatient length of stay that is greater
2024 IN 1393—LS 6847/DI 104 15
1 than twenty-five (25) days, as determined by the office of
2 Medicaid policy and planning under the Medicaid program;
3 (C) that is a Medicare certified, freestanding rehabilitation
4 hospital; or
5 (D) that is a hospital operated by the federal government;
6 (E) that is a physician owned hospital;
7 (F) that only provides respite care services to individuals
8 who are:
9 (i) medically fragile; and
10 (ii) less than nineteen (19) years of age; or
11 (G) that is a freestanding psychiatric hospital with greater
12 than ninety percent (90%) of admissions comprised of
13 individuals who are at least fifty-five (55) years of age and
14 have a primary diagnosis of:
15 (i) Alzheimer's disease;
16 (ii) early onset Alzheimer's disease;
17 (iii) dementia;
18 (iv) mood disorders;
19 (v) anxiety;
20 (vi) psychotic disorders;
21 (vii) other behavioral health illnesses or disorders; or
22 (viii) neurological disorders related to trauma or aging.
23 SECTION 16. IC 16-21-10-5.1 IS ADDED TO THE INDIANA
24 CODE AS A NEW SECTION TO READ AS FOLLOWS
25 [EFFECTIVE UPON PASSAGE]: Sec. 5.1. As used in this chapter,
26 "physician owned hospital" means a hospital licensed under
27 IC 16-21-2 that provides acute care services and that has:
28 (1) physician ownership; or
29 (2) a legal entity with one hundred percent (100%) physician
30 ownership;
31 and the ownership of the hospital is of at least fifty-one percent
32 (51%).
33 SECTION 17. IC 16-21-10-5.2 IS ADDED TO THE INDIANA
34 CODE AS A NEW SECTION TO READ AS FOLLOWS
35 [EFFECTIVE UPON PASSAGE]: Sec. 5.2. As used in this chapter,
36 "state directed payment program" means a payment arrangement
37 under 42 CFR 438.6(c) that allows the office, through separate
38 payment terms, to direct specific payments to a hospital by a
39 managed care organization that contracts with the office to provide
40 health coverage.
41 SECTION 18. IC 16-21-10-6, AS AMENDED BY P.L.213-2015,
42 SECTION 141, IS AMENDED TO READ AS FOLLOWS
2024 IN 1393—LS 6847/DI 104 16
1 [EFFECTIVE UPON PASSAGE]: Sec. 6. (a) Subject to subsection (b)
2 and section 8(b) of this chapter, the office may assess a hospital
3 assessment fee to hospitals during the fee period if the following
4 conditions are met:
5 (1) The fee may be used only for the purposes described in the
6 following:
7 (A) Section 8(c)(1) of this chapter.
8 (B) Section 9 of this chapter.
9 (C) Section 11 of this chapter (when in effect).
10 (D) Section 13.3 of this chapter.
11 (E) Section 14 of this chapter.
12 (2) The Medicaid state plan amendments and waiver requests
13 required for the implementation of this chapter are submitted by
14 the office to the United States Department of Health and Human
15 Services before October 1, 2013.
16 (3) (2) The United States Department of Health and Human
17 Services approves the Medicaid state plan amendments and
18 waiver requests, or revisions of the Medicaid state plan
19 amendments and waiver requests described in subdivision (2):
20 (A) not later than October 1, 2014; or
21 (B) after October 1, 2014, if a date is established by the
22 committee. to this chapter that are to go into effect on July
23 1, 2024, and are submitted by the office to the United
24 States Department of Health and Human Services not later
25 than May 1, 2024.
26 (4) (3) The funds generated from the fee do not revert to the state
27 general fund.
28 (b) The office shall stop collecting a fee, the programs described in
29 section 8(a) of this chapter shall be reconciled and terminated subject
30 to section 9(c) of this chapter, and the operation of section 11 of this
31 chapter (when in effect) ends subject to section 9(c) of this chapter, if
32 any of the following occurs:
33 (1) An appellate court makes a final determination that either:
34 (A) the fee; or
35 (B) any of the programs described in section 8(a) of this
36 chapter;
37 cannot be implemented or maintained.
38 (2) The United States Department of Health and Human Services
39 makes a final determination that the Medicaid state plan
40 amendments or waivers submitted under this chapter are not
41 approved or cannot be validly implemented.
42 (3) The fee is not collected because of circumstances described in
2024 IN 1393—LS 6847/DI 104 17
1 section 8(d) of this chapter.
2 (c) The office shall keep records of the fees collected by the office
3 and report the amount of fees collected under this chapter to the budget
4 committee.
5 SECTION 19. IC 16-21-10-7, AS AMENDED BY P.L.108-2019,
6 SECTION 202, IS AMENDED TO READ AS FOLLOWS
7 [EFFECTIVE UPON PASSAGE]: Sec. 7. (a) The hospital assessment
8 fee committee is established. The committee consists of the following
9 four (4) voting members:
10 (1) The secretary of family and social services appointed under
11 IC 12-8-1.5-2 or the secretary's designee, who shall serve as the
12 chair of the committee.
13 (2) The budget director or the budget director's designee.
14 (3) Two (2) individuals appointed by the governor from a list of
15 at least four (4) individuals submitted by the Indiana Hospital
16 Association.
17 The committee members described in subdivision (3) serve at the
18 pleasure of the governor. If a vacancy occurs among the members
19 appointed under subdivision (3), the governor shall appoint a
20 replacement committee member from a list of at least two (2)
21 individuals submitted by the Indiana Hospital Association.
22 (b) The committee shall do the following:
23 (1) Review any Medicaid state plan amendments, waiver requests,
24 or revisions to any Medicaid state plan amendments or waiver
25 requests, to implement or continue the implementation of this
26 chapter for the purpose of establishing favorable review of the
27 amendments, requests, and revisions by the United States
28 Department of Health and Human Services. The committee shall
29 also develop a disproportionate share payment plan or submit to
30 the office the default plan, if applicable, as set forth in
31 IC 12-15-16-7.5 and IC 12-15-16-7.7.
32 (2) Review and approve the quality program described in
33 section 8(a)(2) of this chapter, including:
34 (A) the initial development of the quality program before
35 any Medicaid state plan amendment, waiver request, or
36 any other request for approval of the program is submitted
37 to the United States Department of Health and Human
38 Services; and
39 (B) any subsequent revisions to the initially submitted
40 quality program, including the acceptance by the office of
41 the secretary of family and social services of the terms and
42 conditions of the quality program proposed by the United
2024 IN 1393—LS 6847/DI 104 18
1 States Department of Health and Human Services.
2 (c) The committee shall meet at the call of the chair. The members
3 serve without compensation.
4 (d) A quorum consists of at least three (3) members. An affirmative
5 vote of at least three (3) members of the committee is necessary to
6 approve Medicaid state plan amendments, waiver requests, revisions
7 to the Medicaid state plan or waiver requests, and the approvals and
8 other determinations required of the committee under IC 12-15-44.5
9 and section 13.3 of this chapter.
10 (e) The following apply to the approvals and any other
11 determinations required by the committee under IC 12-15-44.5 and
12 section 13.3 of this chapter:
13 (1) The committee shall:
14 (A) be guided and subject to the intent of the general assembly
15 in the passage of IC 12-15-44.5 and section 13.3 of this
16 chapter; and
17 (B) be guided to ensure hospitals are reimbursed under the
18 Medicaid program at a reimbursement rate that is:
19 (i) at least the level of reimbursement that would be paid
20 under the federal Medicare payment principles; and
21 (ii) at the maximum reimbursement rate allowable under
22 the federal Medicaid law.
23 (2) The chair of the committee shall report any approval and other
24 determination by the committee to the budget committee.
25 (3) If, in taking action, the committee's vote is tied, the committee
26 shall follow the following procedure:
27 (A) The chair of the committee shall notify the chairman of the
28 budget committee of the tied vote and provide a summary of
29 that matter that was the subject of the vote.
30 (B) The chairman of the budget committee shall provide each
31 committee member who voted an opportunity to appear before
32 the budget committee to present information and materials to
33 the budget committee concerning the matter that was the
34 subject of the tied vote.
35 (C) Following a presentation of the information and the
36 materials described in clause (B), the budget committee may
37 make recommendations to the committee concerning the
38 matter that was the subject of the tied vote.
39 SECTION 20. IC 16-21-10-8, AS AMENDED BY P.L.213-2015,
40 SECTION 143, IS AMENDED TO READ AS FOLLOWS
41 [EFFECTIVE UPON PASSAGE]: Sec. 8. (a) This section does not
42 apply to the use of the incremental fee described in section 13.3 of this
2024 IN 1393—LS 6847/DI 104 19
1 chapter. Subject to subsection (b), the office shall develop the
2 following programs designed to increase to the extent allowable under
3 federal law, Medicaid reimbursement for inpatient and outpatient
4 hospital services provided by a hospital to Medicaid recipients:
5 (1) A program concerning reimbursement for the Medicaid
6 fee-for-service program that, in the aggregate, will result in
7 payments equivalent to the level of payment that would be paid
8 under federal Medicare payment principles.
9 (2) Beginning July 1, 2024, subject to approval of any
10 Medicaid state plan amendment or Medicaid waiver by the
11 committee and by the United States Department of Health and
12 Human Services, a state directed payment program concerning
13 reimbursement for the Medicaid risk based managed care
14 program that, in the aggregate, will result in enhanced payments
15 equivalent to the level of payment that would be paid under
16 federal Medicare payment principles. for:
17 (A) inpatient hospital services; and
18 (B) outpatient hospital services;
19 that are at least greater than what would be paid under
20 federal Medicare principles, and at the maximum
21 reimbursement rate allowable under federal Medicaid law.
22 Subject to section 7(b) of this chapter, the program in this
23 subdivision is subject to a quality program that is linked to
24 the office's quality strategy approved by the committee. Any
25 state plan amendment or waiver that the office submits to the
26 United States Department of Health and Human Services
27 must request that the fee be implemented on July 1, 2024,
28 even if that requires the assessment to be implemented
29 retroactively.
30 (b) The office shall not submit to the United States Department of
31 Health and Human Services any Medicaid state plan amendments,
32 waiver requests, or revisions to any Medicaid state plan amendments
33 or waiver requests, to implement or continue the implementation of this
34 chapter until the committee has reviewed and approved the
35 amendments, waivers, or revisions described in this subsection and has
36 submitted a written report to the budget committee concerning the
37 amendments, waivers, or revisions described in this subsection,
38 including the following:
39 (1) The methodology to be used by the office in calculating the
40 increased Medicaid reimbursement under the programs described
41 in subsection (a).
42 (2) The methodology to be used by the office in calculating,
2024 IN 1393—LS 6847/DI 104 20
1 imposing, or collecting the fee, or any other matter relating to the
2 fee.
3 (3) The determination of Medicaid disproportionate share
4 allotments under section 11 of this chapter, if in effect, that are to
5 be funded by the fee, including the formula for distributing the
6 Medicaid disproportionate share allotments.
7 (4) The distribution to private psychiatric institutions under
8 section 13 of this chapter.
9 (c) This subsection applies to the programs described in subsection
10 (a). The state share dollars for the programs must consist of the
11 following:
12 (1) Fees paid under this chapter. However, fees may not be used
13 to fund the state share of the portion of capitation payments
14 attributable to a managed care organization's payment of the
15 managed care assessment fee under IC 12-15-29.5.
16 (2) The hospital care for the indigent funds allocated under
17 section 10 of this chapter. The managed care assessment fee
18 authorized under IC 12-15-29.5, subject to the requirements
19 of IC 12-15-29.5-16.
20 (3) Other sources of state share dollars available to the office,
21 excluding intergovernmental transfers of funds made by or on
22 behalf of a hospital.
23 The money described in subdivisions (1) and (2) may be used only to
24 fund the part of the payments that exceed the Medicaid reimbursement
25 rates in effect on June 30, 2011.
26 (d) This subsection applies to the programs described in subsection
27 (a). If the state is unable to maintain the funding under subsection
28 (c)(3) for the payments at Medicaid reimbursement levels in effect on
29 June 30, 2011, because of budgetary constraints, the office shall reduce
30 inpatient and outpatient hospital Medicaid reimbursement rates under
31 subsection (a)(1) or (a)(2) or request approval from the committee and
32 the United States Department of Health and Human Services to
33 increase the fee to prevent a decrease in Medicaid reimbursement for
34 hospital services. If:
35 (1) the committee:
36 (A) does not approve a reimbursement reduction; or
37 (B) does not approve an increase in the fee; or
38 (2) the United States Department of Health and Human Services
39 does not approve an increase in the fee;
40 the office shall cease to collect the fee and the programs described in
41 subsection (a) are terminated.
42 (e) If the state directed payment program described in
2024 IN 1393—LS 6847/DI 104 21
1 subsection (a)(2) is not approved by the committee or the United
2 States Department of Health and Human Services, the state shall
3 return to making payments equivalent to the level of payment that
4 would be paid under federal Medicare payment principles.
5 SECTION 21. IC 16-21-10-9, AS AMENDED BY P.L.213-2015,
6 SECTION 144, IS AMENDED TO READ AS FOLLOWS
7 [EFFECTIVE UPON PASSAGE]: Sec. 9. (a) This section is effective
8 upon implementation of the fee. The hospital Medicaid fee fund is
9 established for the purpose of holding fees collected under section 6 of
10 this chapter, excluding the part of the fee used for purposes of section
11 13.3 if of this chapter, that are not necessary to match federal funds.
12 (b) The office shall administer the fund.
13 (c) Money in the fund at the end of a state fiscal year attributable to
14 fees collected to fund the programs described in section 8 of this
15 chapter does not revert to the state general fund. However, money
16 remaining in the fund after the cessation of the collection of the fee
17 under section 6(b) of this chapter shall be used for the payments
18 described in sections section 8(a) and section 11 (if in effect) of this
19 chapter. Any money not required for the payments described in
20 sections section 8(a) and section 11 (if in effect) of this chapter after
21 the cessation of the collection of the fee under section 6(b) of this
22 chapter shall be distributed to the hospitals on a pro rata basis based
23 upon the fees paid by each hospital for the state fiscal year that ended
24 immediately before the cessation of the collection of the fee under
25 section 6(b) of this chapter.
26 (d) The treasurer of state shall invest the money in the fund not
27 currently needed to meet the obligations of the fund in the same
28 manner as other public funds may be invested. Interest that accrues
29 from these investments shall be deposited in the fund.
30 SECTION 22. IC 16-21-10-10 IS REPEALED [EFFECTIVE UPON
31 PASSAGE]. Sec. 10. This section:
32 (1) is effective upon implementation of the fee; and
33 (2) does not apply to funds under IC 12-16-17.
34 Notwithstanding any other law, the part of the amounts appropriated
35 for or transferred to the hospital care for the indigent program for the
36 state fiscal year beginning July 1, 2013, and each state fiscal year
37 thereafter that are not required to be paid to the office by law shall be
38 used exclusively as state share dollars for the payments described in
39 sections 8(a) and 11 of this chapter. Any hospital care for the indigent
40 funds that are not required for the payments described in sections 8(a)
41 and 11 of this chapter after the cessation of the collection of the fee
42 under section 6(b) of this chapter shall be used for the state share
2024 IN 1393—LS 6847/DI 104 22
1 dollars of the payments in IC 12-15-20-2(8)(G)(ii) through
2 IC 12-15-20-2(8)(G)(x).
3 SECTION 23. IC 16-21-10-11, AS AMENDED BY P.L.30-2016,
4 SECTION 38, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
5 UPON PASSAGE]: Sec. 11. (a) This section:
6 (1) does not apply if the state directed payment program
7 under section 8(a)(2) of this chapter is in effect; and
8 (1) (2) does not apply to the incremental fee described in section
9 13.3 of this chapter at any time.
10 (2) is effective upon the implementation of the fee described in
11 section 6 of this chapter, excluding the part of the fee used for
12 purposes of section 13.3 of this chapter; and
13 (3) applies to the Medicaid disproportionate share payments for
14 the state fiscal year beginning July 1, 2013, and each state fiscal
15 year thereafter.
16 (b) The state share dollars used to fund disproportionate share
17 payments to acute care hospitals licensed under IC 16-21-2 that qualify
18 as disproportionate share providers or municipal disproportionate share
19 providers under IC 12-15-16-1(a) or IC 12-15-16-1(b) shall be paid
20 with money collected through the fee and the hospital care for the
21 indigent dollars described in section 10 of this chapter (before its
22 repeal).
23 (c) The federal Medicaid disproportionate share allotments for the
24 state fiscal years beginning July 1, 2013, and each state fiscal year
25 thereafter shall be allocated in their entirety to acute care hospitals
26 licensed under IC 16-21-2 that qualify as disproportionate share
27 providers or municipal disproportionate share providers under
28 IC 12-15-16-1(a) or IC 12-15-16-1(b). No part of the federal
29 disproportionate share allotments applicable for disproportionate share
30 payments for the state fiscal year beginning July 1, 2013, and each state
31 fiscal year thereafter may be allocated to institutions for mental disease
32 or other mental health facilities, as defined by applicable federal law.
33 SECTION 24. IC 16-21-10-13.3, AS AMENDED BY P.L.201-2023,
34 SECTION 147, IS AMENDED TO READ AS FOLLOWS
35 [EFFECTIVE UPON PASSAGE]: Sec. 13.3. (a) This section is
36 effective beginning February 1, 2015. As used in this section, "plan"
37 refers to the healthy Indiana plan established in IC 12-15-44.5.
38 (b) Subject to subsections (c) through (e), the incremental fee under
39 this section may be used to fund the state share of the expenses
40 specified in this subsection if, after January 31, 2015, but before the
41 collection of the fee under this section, the following occur:
42 (1) The committee establishes a fee formula to be used to fund the
2024 IN 1393—LS 6847/DI 104 23
1 state share of the following expenses described in this
2 subdivision:
3 (A) Subject to clause (C), the state share of the capitated
4 payments made to a managed care organization that contracts
5 with the office to provide health coverage under the plan to
6 plan enrollees other than plan enrollees who are eligible for
7 the plan under Section 1931 of the federal Social Security Act.
8 (B) Subject to clause (C), the state share of capitated
9 payments described in clause (A) for plan enrollees who are
10 eligible for the plan under Section 1931 of the federal Social
11 Security Act that are limited to the difference between:
12 (i) the capitation rates effective September 1, 2014,
13 developed using Medicaid reimbursement rates; and
14 (ii) the capitation rates applicable for the plan developed
15 using the plan's Medicare reimbursement rates described in
16 IC 12-15-44.5-5(a)(2).
17 (C) Beginning July 1, 2024, and subject to approval of any
18 Medicaid state plan amendment or Medicaid waiver by the
19 committee and by the United States Department of Health
20 and Human Services, the state share of capitated payments
21 and state directed payment programs for inpatient and
22 outpatient hospital services are to be determined as
23 follows:
24 (i) The state share of capitated payments made to a
25 managed care organization that contracts with the office
26 to provide health coverage under the plan to plan
27 enrollees shall provide Medicaid reimbursement for
28 inpatient and outpatient hospital services at a rate that
29 is equal to the base Medicaid reimbursement rate in
30 effect on September 1, 2014. However, fees under this
31 section may not be used to fund the state share of the
32 portion of capitation payments attributable to a
33 managed care organization's (as defined in
34 IC 12-15-29.5-6) payment of the managed care
35 assessment fee.
36 (ii) The state share of payments made under a state
37 directed payment program described in section 8 of this
38 chapter for inpatient and outpatient hospital services
39 provided to plan enrollees at a rate above the rate
40 calculated in item (i) and at the maximum rate allowable
41 under federal Medicaid law.
42 (C) (D) The state share of the state's contributions to plan
2024 IN 1393—LS 6847/DI 104 24
1 enrollee accounts.
2 (D) (E) The state share of amounts used to pay premiums for
3 a premium assistance plan implemented under
4 IC 12-15-44.2-20.
5 (E) (F) The state share of the costs of increasing
6 reimbursement rates for physician services provided to
7 individuals enrolled in Medicaid programs other than the plan,
8 but not to exceed the difference between the Medicaid fee
9 schedule for a physician service that was in effect before the
10 implementation of the plan and the amount equal to
11 seventy-five percent (75%) of the previous year federal
12 Medicare reimbursement rate for a physician service. The
13 incremental fee may not be used for the amount that exceeds
14 seventy-five percent (75%) of the federal Medicare
15 reimbursement rate for a physician service.
16 (F) (G) The state share of the state's administrative costs that,
17 for purposes of this clause, may not exceed one hundred
18 seventy dollars ($170) per person per plan enrollee per year,
19 and adjusted annually by the Consumer Price Index.
20 (G) The money described in IC 12-15-44.5-6(a) for the phase
21 out period of the plan.
22 (2) The committee approves a process to be used for reconciling:
23 (A) the state share of the costs of the plan;
24 (B) the amounts used to fund the state share of the costs of the
25 plan; and
26 (C) the amount of fees assessed for funding the state share of
27 the costs of the plan.
28 For purposes of this subdivision, "costs of the plan" includes the
29 costs of the expenses listed in subdivision (1)(A) through (1)(G).
30 The fees collected under subdivision (1)(A) through (1)(F) (1)(G) shall
31 be deposited into the incremental hospital fee fund established by
32 section 13.5 of this chapter. Fees described in subdivision (1)(G) shall
33 be deposited into the phase out trust fund described in IC 12-15-44.5-7.
34 The fees used for purposes of funding the state share of expenses listed
35 in subdivision (1)(A) through (1)(F) (1)(G) may not be used to fund
36 expenses incurred on or after the commencement of a phase out period
37 of the plan.
38 (c) For each state fiscal year for which the fee authorized by this
39 section is used to fund the state share of the expenses described in
40 subsection (b)(1), the amount of fees shall be reduced by the
41 following:
42 (1) The amount of funds annually designated by the general
2024 IN 1393—LS 6847/DI 104 25
1 assembly to be deposited in the healthy Indiana plan trust fund
2 established by IC 12-15-44.2-17. less
3 (2) The annual cigarette tax funds annually appropriated by the
4 general assembly for childhood immunization programs under
5 IC 12-15-44.2-17(a)(3).
6 (3) The managed care assessment fee authorized under
7 IC 12-15-29.5, subject to IC 12-15-29.5-16.
8 (4) The amount of funds in the phase out trust fund set forth
9 in IC 12-15-44.5-6, before its expiration.
10 (d) The incremental fee described in this section may not:
11 (1) be assessed before July 1, 2016; and
12 (2) be assessed or collected on or after the beginning of a phase
13 out period of the plan.
14 (e) This section is not intended to and may not be construed to
15 change or affect any component of the programs established under
16 section 8 of this chapter.
17 SECTION 25. IC 16-21-10-14 IS REPEALED [EFFECTIVE UPON
18 PASSAGE]. Sec. 14. This section does not apply to the use of the
19 incremental fee described in section 13.3 of this chapter. The fees
20 collected under section 8 of this chapter may be used only as described
21 in this chapter or to pay the state's share of the cost for Medicaid
22 services provided under the federal Medicaid program (42 U.S.C. 1396
23 et seq.) as follows:
24 (1) Twenty-eight and five-tenths percent (28.5%) may be used by
25 the office for Medicaid expenses.
26 (2) Seventy-one and five-tenths percent (71.5%) to hospitals.
27 SECTION 26. IC 16-21-10-15, AS ADDED BY P.L.205-2013,
28 SECTION 214, IS AMENDED TO READ AS FOLLOWS
29 [EFFECTIVE UPON PASSAGE]: Sec. 15. (a) This chapter may not be
30 construed to authorize any county, municipality, district, or authority
31 to impose a fee, tax, or assessment on a hospital.
32 (b) This chapter may not be construed to prohibit a hospital
33 licensed under IC 16-21-2 that is established and operated under
34 IC 16-22-2 or IC 16-23 from making an intergovernmental transfer
35 as the state match for disproportionate share payments under
36 IC 12-15-16-6.
37 SECTION 27. IC 16-21-10-19, AS ADDED BY P.L.205-2013,
38 SECTION 214, IS AMENDED TO READ AS FOLLOWS
39 [EFFECTIVE UPON PASSAGE]: Sec. 19. Payments for the programs
40 described in section 8(a) of this chapter are limited to claims for dates
41 of services provided during the fee period and that are timely filed with
42 the office or a contractor of the office. Payments for the programs
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1 described in section 8(a) of this chapter and payments to hospitals in
2 accordance with section 11 of this chapter (if in effect) may occur at
3 any time, including after collection of the fee is stopped under section
4 6(b) of this chapter, to the extent the funding provided for the payments
5 by this chapter is available under section 9(c) of this chapter. Payments
6 for the program described in section 13 of this chapter may occur at
7 any time, including after the collection of the fee is stopped under
8 section 6(b) of this chapter, subject to the reconciliation and
9 termination of the program required by section 6(b) of this chapter.
10 SECTION 28. IC 27-1-3-10 IS AMENDED TO READ AS
11 FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 10. The
12 commissioner shall have power:
13 (1) to revoke or suspend the authority to do business in this state
14 of:
15 (A) any company which refuses to permit an examination
16 under IC 27-1-3.1; or
17 (B) any managed care organization (as defined in
18 IC 12-15-29.5-6) that fails to pay the managed care
19 organization's fee assessed under IC 12-15-29.5; and
20 (2) to revoke or suspend any certificate of authority when any
21 condition prescribed by law for granting it no longer exists.
22 SECTION 29. [EFFECTIVE UPON PASSAGE] (a) The office of
23 the secretary of family and social services may continue to collect
24 unpaid managed care assessment fees owed by a managed care
25 organization under IC 12-15-29.5, as added by this act, including
26 after the expiration of IC 12-15-29.5, as added by this act.
27 (b) This SECTION expires December 31, 2026.
28 SECTION 30. [EFFECTIVE UPON PASSAGE] (a) Any balance
29 resulting from interest payments in the phase out trust fund
30 established by IC 12-15-44.5-7 after distribution of payments
31 required by IC 12-15-44.5-6, as amended by this act, and upon
32 expiration of the phase out trust fund on June 30, 2025, shall be
33 transferred to the state general fund.
34 (b) This SECTION expires December 31, 2025.
35 SECTION 31. [EFFECTIVE UPON PASSAGE] (a) The office of
36 the secretary of family and social services shall amend 405
37 IAC 1-8-5 and 405 IAC 1-10.5-7 to reflect the amendments in this
38 act and any Medicaid state plan amendment or Medicaid waiver:
39 (1) approved by the hospital assessment fee committee under
40 IC 16-21-10-7, as amended by this act;
41 (2) submitted to the budget committee in accordance with
42 IC 12-15-1.3-17.5; and
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1 (3) approved by the United States Department of Health and
2 Human Services.
3 The office of the secretary may adopt the changes required by this
4 subsection as provisional rules in the manner set forth in
5 IC 4-22-2-37.1.
6 (b) The administrative rules amended under subsection (a) are
7 effective and may be retroactive to the date the United States
8 Department of Health and Human Services approved a Medicaid
9 state plan amendment or Medicaid waiver described in subsection
10 (a).
11 (c) If the office of the secretary adopts the changes to the
12 administrative rules as required in subsection (a) through a
13 provisional rule, the provisional rule expires on the date on which
14 a rule that supersedes the provisional rule is adopted by the office
15 of the secretary under IC 4-22-2-19.7 through IC 4-22-2-36.
16 (d) This SECTION expires December 31, 2025.
17 SECTION 32. An emergency is declared for this act.
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