Indiana 2024 Regular Session

Indiana House Bill HB1393 Compare Versions

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

Old	New	Differences
1	1
2	2	Introduced Version
3	3	HOUSE BILL No. 1393
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 12-7-2; IC 12-15; IC 16-21-10; IC 27-1-3-10.
7	7	Synopsis: Managed care and hospital assessment fee. Authorizes the
8	8	managed care assessment fee to be assessed against specified insurers
9	9	and administered by the office of the secretary of family and social
10	10	services. Establishes the managed care assessment fee committee. Sets
11	11	forth requirements of the managed care assessment fee. Establishes the
12	12	high risk pool fund. Expires the managed care assessment fee on June
13	13	30, 2025. Allows certain providers to contractually agree to a different
14	14	reimbursement rate with a managed care organization as part of a value
15	15	based services contract. Excludes hospitals and private psychiatric
16	16	hospitals. Provides for payments to hospitals out of the phase out trust
17	17	fund and expires the fund. Exempts: (1) physician owned hospitals; and
18	18	(2) hospitals that only provide respite care to certain individuals; from
19	19	the hospital assessment fee. Makes assessment of the hospital
20	20	assessment fee subject to federal approval of changes made by this act.
21	21	Requires the hospital assessment fee committee to: (1) review and
22	22	approve the quality program; and (2) be guided to ensure hospitals are
23	23	reimbursed at a rate that meets specified requirements. Specifies
24	24	components of a state directed payment program. Specifies uses of the
25	25	hospital assessment fee and that hospital assessment fees will not be
26	26	used for disproportionate share payments if the state directed payment
27	27	program is implemented. Reduces the hospital fee assessment by the
28	28	managed care assessment fee and the payment from the phase out trust
29	29	fund. Requires the commissioner of the department of insurance to
30	30	revoke or suspend the authority of a managed care organization to do
31	31	business in Indiana if the managed care organization fails to pay the
32	32	(Continued next page)
33	33	Effective: Upon passage.
34	34	Barrett
35	35	January 11, 2024, read first time and referred to Committee on Public Health.
36	36	2024 IN 1393—LS 6847/DI 104 Digest Continued
37	37	managed care assessment fee. Repeals language concerning the
38	38	hospital care for the indigent program. Repeals language specifying the
39	39	distribution of the hospital assessment fee.
40	40	2024 IN 1393—LS 6847/DI 1042024 IN 1393—LS 6847/DI 104 Introduced
41	41	Second Regular Session of the 123rd General Assembly (2024)
42	42	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
43	43	Constitution) is being amended, the text of the existing provision will appear in this style type,
44	44	additions will appear in this style type, and deletions will appear in this style type.
45	45	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
46	46	provision adopted), the text of the new provision will appear in this style type. Also, the
47	47	word NEW will appear in that style type in the introductory clause of each SECTION that adds
48	48	a new provision to the Indiana Code or the Indiana Constitution.
49	49	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
50	50	between statutes enacted by the 2023 Regular Session of the General Assembly.
51	51	HOUSE BILL No. 1393
52	52	A BILL FOR AN ACT to amend the Indiana Code concerning
53	53	Medicaid.
54	54	Be it enacted by the General Assembly of the State of Indiana:
55	55	1 SECTION 1. IC 12-7-2-16.7 IS ADDED TO THE INDIANA CODE
56	56	2 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
57	57	3 UPON PASSAGE]: Sec. 16.7. "Assessment period", for purposes of
58	58	4 IC 12-15-29.5, has the meaning set forth in IC 12-15-29.5-1.
59	59	5 SECTION 2. IC 12-7-2-35, AS AMENDED BY P.L.184-2017,
60	60	6 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
61	61	7 UPON PASSAGE]: Sec. 35. (a) "Committee", for purposes of
62	62	8 IC 12-15-29.5, has the meaning set forth in IC 12-15-29.5-2.
63	63	9 (b) "Committee", for purposes of IC 12-15-33, has the meaning set
64	64	10 forth in IC 12-15-33-1.
65	65	11 SECTION 3. IC 12-7-2-57.5, AS AMENDED BY P.L.146-2008,
66	66	12 SECTION 378, IS AMENDED TO READ AS FOLLOWS
67	67	13 [EFFECTIVE UPON PASSAGE]: Sec. 57.5. (a) "Department", for
68	68	14 purposes of IC 12-13-14, has the meaning set forth in IC 12-13-14-1.
69	69	15 (b) "Department", for purposes of IC 12-15-29.5, has the
70	70	2024 IN 1393—LS 6847/DI 104 2
71	71	1 meaning set forth in IC 12-15-29.5-3.
72	72	2 SECTION 4. IC 12-7-2-85.7 IS ADDED TO THE INDIANA CODE
73	73	3 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
74	74	4 UPON PASSAGE]: Sec. 85.7. "Fee", for purposes of IC 12-15-29.5,
75	75	5 has the meaning set forth in IC 12-15-29.5-4.
76	76	6 SECTION 5. IC 12-7-2-91, AS AMENDED BY P.L.246-2023,
77	77	7 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
78	78	8 UPON PASSAGE]: Sec. 91. "Fund" means the following:
79	79	9 (1) For purposes of IC 12-12-1-9, the fund described in
80	80	10 IC 12-12-1-9.
81	81	11 (2) For purposes of IC 12-15-20, the meaning set forth in
82	82	12 IC 12-15-20-1.
83	83	13 (3) For purposes of IC 12-15-29.5, the meaning set forth in
84	84	14 IC 12-15-29.5-5.
85	85	15 (3) (4) For purposes of IC 12-17-12, the meaning set forth in
86	86	16 IC 12-17-12-4.
87	87	17 (4) (5) For purposes of IC 12-17.2-7.2, the meaning set forth in
88	88	18 IC 12-17.2-7.2-4.7.
89	89	19 (5) (6) For purposes of IC 12-17.6, the meaning set forth in
90	90	20 IC 12-17.6-1-3.
91	91	21 (6) (7) For purposes of IC 12-23-2, the meaning set forth in
92	92	22 IC 12-23-2-1.
93	93	23 (7) (8) For purposes of IC 12-23-18, the meaning set forth in
94	94	24 IC 12-23-18-4.
95	95	25 (8) (9) For purposes of IC 12-24-6, the meaning set forth in
96	96	26 IC 12-24-6-1.
97	97	27 (9) (10) For purposes of IC 12-24-14, the meaning set forth in
98	98	28 IC 12-24-14-1.
99	99	29 (10) (11) For purposes of IC 12-30-7, the meaning set forth in
100	100	30 IC 12-30-7-3.
101	101	31 SECTION 6. IC 12-7-2-126.9, AS ADDED BY P.L.152-2017,
102	102	32 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
103	103	33 UPON PASSAGE]: Sec. 126.9. (a) "Managed care organization",
104	104	34 except as provided in subsection (b), means a person that has a
105	105	35 comprehensive risk contract with the office of Medicaid policy and
106	106	36 planning under IC 12-15.
107	107	37 (b) "Managed care organization", for purposes of
108	108	38 IC 12-15-29.5, has the meaning set forth in IC 12-15-29.5-6.
109	109	39 SECTION 7. IC 12-7-2-143.3 IS ADDED TO THE INDIANA
110	110	40 CODE AS A NEW SECTION TO READ AS FOLLOWS
111	111	41 [EFFECTIVE UPON PASSAGE]: Sec. 143.3. "Premium revenue",
112	112	42 for purposes of IC 12-15-29.5, has the meaning set forth in
113	113	2024 IN 1393—LS 6847/DI 104 3
114	114	1 IC 12-15-29.5-8.
115	115	2 SECTION 8. IC 12-7-2-186.3 IS ADDED TO THE INDIANA
116	116	3 CODE AS A NEW SECTION TO READ AS FOLLOWS
117	117	4 [EFFECTIVE UPON PASSAGE]: Sec. 186.3. "State share", for
118	118	5 purposes of IC 12-15-29.5, has the meaning set forth in
119	119	6 IC 12-15-29.5-9.
120	120	7 SECTION 9. IC 12-15-29.5 IS ADDED TO THE INDIANA CODE
121	121	8 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
122	122	9 UPON PASSAGE]:
123	123	10 Chapter 29.5. Managed Care Assessment Fee
124	124	11 Sec. 1. As used in this chapter, "assessment period" refers to the
125	125	12 state fiscal years for which a fee may be assessed under this
126	126	13 chapter.
127	127	14 Sec. 2. As used in this chapter, "committee" means the managed
128	128	15 care assessment fee committee established by section 11 of this
129	129	16 chapter.
130	130	17 Sec. 3. As used in this chapter, "department" refers to the
131	131	18 department of insurance created by IC 27-1-1-1.
132	132	19 Sec. 4. As used in this chapter, "fee" means the managed care
133	133	20 assessment fee authorized under this chapter.
134	134	21 Sec. 5. As used in this chapter, "fund" means the high risk pool
135	135	22 fund established by section 15 of this chapter.
136	136	23 Sec. 6. As used in this chapter, "managed care organization"
137	137	24 means the following:
138	138	25 (1) A health maintenance organization, as defined in
139	139	26 IC 27-13-1-19.
140	140	27 (2) A Medicaid managed care organization, as defined in
141	141	28 IC 12-7-2-126.9.
142	142	29 (3) A preferred provider organization that is subject to the
143	143	30 requirements of IC 27-8-11-5.
144	144	31 (4) Any other type of organization recognized as a managed
145	145	32 care organization under Indiana law, as determined by the
146	146	33 commissioner of the department in accordance with 42 U.S.C.
147	147	34 1396b(w)(7)(A)(viii).
148	148	35 Sec. 7. As used in this chapter, "office of the secretary" refers
149	149	36 to the office of the secretary of family and social services.
150	150	37 Sec. 8. As used in this chapter, "premium revenue" means
151	151	38 money or any other item of value given in consideration to a
152	152	39 managed care organization for coverage of individuals, including
153	153	40 policy fees, admission fees, or membership fees.
154	154	41 Sec. 9. As used in this chapter, "state share" means the portion
155	155	42 of allowable Medicaid expenses funded by the state or other local
156	156	2024 IN 1393—LS 6847/DI 104 4
157	157	1 units of government, or as permitted by federal Medicaid laws by
158	158	2 other entities other than the federal government.
159	159	3 Sec. 10. For purposes of this chapter, each managed care
160	160	4 organization described in section 6(1) through 6(4) of this chapter
161	161	5 is considered to be a separate class of a managed care organization.
162	162	6 Sec. 11. (a) The managed care assessment fee committee is
163	163	7 established. The committee consists of the following eight (8) voting
164	164	8 members:
165	165	9 (1) The secretary of family and social services appointed
166	166	10 under IC 12-8-1.5-2, or the secretary's designee, who shall
167	167	11 serve as chairperson of the committee.
168	168	12 (2) The commissioner of the department, or the
169	169	13 commissioner's designee.
170	170	14 (3) The state budget director, or the state budget director's
171	171	15 designee.
172	172	16 (4) One (1) member representing a health maintenance
173	173	17 organization, appointed by the governor from a list of at least
174	174	18 three (3) individuals submitted by the Insurance Institute of
175	175	19 Indiana.
176	176	20 (5) One (1) member representing a Medicaid managed care
177	177	21 organization, appointed by the governor from a list of at least
178	178	22 three (3) individuals submitted by the Insurance Institute of
179	179	23 Indiana.
180	180	24 (6) One (1) member representing a preferred provider
181	181	25 organization, appointed by the governor.
182	182	26 (7) One (1) member who represents either:
183	183	27 (A) an organization described in section 6(4) of this
184	184	28 chapter identified by the commissioner of the department
185	185	29 to be included under this chapter; or
186	186	30 (B) if the commissioner of the department does not identify
187	187	31 an organization described in section 6(4) of this chapter, a
188	188	32 preferred provider organization;
189	189	33 appointed by the governor.
190	190	34 (8) One (1) member with expertise in managed care and
191	191	35 managed care organizations, appointed by the governor.
192	192	36 (b) The committee shall perform the actions specified for the
193	193	37 committee in this chapter concerning the fee established under this
194	194	38 chapter.
195	195	39 (c) The committee shall meet at the call of the chairperson. The
196	196	40 members shall serve without compensation.
197	197	41 (d) A quorum consists of at least five (5) members. An
198	198	42 affirmative vote of at least five (5) members of the committee is
199	199	2024 IN 1393—LS 6847/DI 104 5
200	200	1 necessary to approve any matter before the committee.
201	201	2 Sec. 12. (a) Beginning July 1, 2024, except as provided in
202	202	3 subsection (b), the office shall assess a managed care assessment fee
203	203	4 to a managed care organization at a rate equal to six percent (6%)
204	204	5 of the managed care organization's premium revenue for each
205	205	6 state fiscal year during the assessment period. However, the office
206	206	7 may not use an assessment methodology that would result in a
207	207	8 collection from a managed care organization that would exceed the
208	208	9 maximum federal indirect threshold of six percent (6%) set forth
209	209	10 in 42 CFR 433.68(f)(3)(i). Any state plan amendment or waiver
210	210	11 that the office submits to the United States Department of Health
211	211	12 and Human Services must request that the fee be implemented on
212	212	13 July 1, 2024, even if that requires the assessment to be
213	213	14 implemented retroactively.
214	214	15 (b) The office may assess a fee under this section only if the
215	215	16 following conditions are met:
216	216	17 (1) The fee is used only for the purposes set forth in section 16
217	217	18 of this chapter.
218	218	19 (2) The committee approves the assessment fee methodology
219	219	20 described in subsection (a) or (c).
220	220	21 (3) The United States Department of Health and Human
221	221	22 Services approves the assessment fee methodology described
222	222	23 in subsection (a) or (c).
223	223	24 (4) The hospital assessment fee committee approves the state
224	224	25 directed payment program described in IC 16-21-10-8(a)(2).
225	225	26 (5) The United States Department of Health and Human
226	226	27 Services approves the Medicaid state plan amendments and
227	227	28 waiver requests, including revisions, that are necessary to
228	228	29 implement or maintain the state directed payment program
229	229	30 described in IC 16-21-10-8(a)(2).
230	230	31 (6) The money generated from the fee does not revert to the
231	231	32 state general fund.
232	232	33 (c) The office shall assess a fee to a managed care organization
233	233	34 in an alternative methodology if the following occur:
234	234	35 (1) Before May 1 of any year, the committee proposes and
235	235	36 approves use of any or both of the following alternative fee
236	236	37 assessment methodologies:
237	237	38 (A) A percentage of premium revenue received by a
238	238	39 managed care organization during a state fiscal year.
239	239	40 (B) A per member per month amount on a state fiscal year
240	240	41 basis, which may include the use of a tiered system
241	241	42 concerning individual enrollment of a managed care
242	242	2024 IN 1393—LS 6847/DI 104 6
243	243	1 organization.
244	244	2 The alternative methodology under this subdivision may be
245	245	3 applied in a uniform manner within each classification of
246	246	4 managed care organization and may exempt a managed care
247	247	5 organization from the fee.
248	248	6 (2) The hospital assessment fee committee established by
249	249	7 IC 16-21-10-7 approves the alternative methodology proposed
250	250	8 by the committee under subdivision (1), determining that the
251	251	9 alternative approach:
252	252	10 (A) will not impose an excessive administrative burden on
253	253	11 the office; and
254	254	12 (B) is reasonably likely to generate sufficient state share
255	255	13 dollars to meet the funding levels specified in section
256	256	14 16(a)(1) through 16(a)(3) of this chapter for each state
257	257	15 fiscal year during the assessment period.
258	258	16 An alternative methodology under this subsection may not result
259	259	17 in a collection from a managed care organization that would
260	260	18 exceed the maximum federal indirect threshold of six percent (6%)
261	261	19 set forth in 42 CFR 433.68(f)(3)(i).
262	262	20 (d) Both the committee and the hospital assessment fee
263	263	21 committee shall consult with and make available to each other data
264	264	22 and other relevant information necessary to make the
265	265	23 determinations required in subsection (c).
266	266	24 (e) Before May 31, 2024, the office shall submit the approved fee
267	267	25 assessment methodology to the United States Department of Health
268	268	26 and Human Services.
269	269	27 (f) If the United States Department of Health and Human
270	270	28 Services does not approve the fee assessment methodology or
271	271	29 proposes modifications or an alternative methodology to the fee
272	272	30 assessment methodology submitted by the office under subsection
273	273	31 (e), the office may not submit an alternative methodology or agree
274	274	32 to the United States Department of Health and Human Services'
275	275	33 modifications or alternative methodology unless the following
276	276	34 requirements are met:
277	277	35 (1) The alternative or modified methodology from the United
278	278	36 States Department of Health and Human Services complies
279	279	37 with the requirements of this chapter.
280	280	38 (2) The committee approves the alternative or modified
281	281	39 methodology.
282	282	40 (3) The hospital assessment fee committee determines by an
283	283	41 affirmative vote of a quorum that the alternative or modified
284	284	42 methodology proposed:
285	285	2024 IN 1393—LS 6847/DI 104 7
286	286	1 (A) will not impose excessive administrative burdens on the
287	287	2 office; and
288	288	3 (B) is reasonably likely to generate sufficient state share
289	289	4 dollars to meet the funding levels specified by section
290	290	5 16(a)(1) through 16(a)(3) of this chapter for each state
291	291	6 fiscal year during the assessment period.
292	292	7 (g) The office shall keep records of the fees collected under this
293	293	8 chapter and report the amount of fees collected to the
294	294	9 commissioner of the department.
295	295	10 Sec. 13. The office may seek a waiver under 42 CFR 433.68(e)
296	296	11 of any of the following federal requirements in the implementation
297	297	12 of an assessment fee methodology under section 12 of this chapter:
298	298	13 (1) The broad based requirement under 42 CFR 433.68(c).
299	299	14 (2) The uniformly imposed requirement under 42 CFR
300	300	15 433.68(d).
301	301	16 Sec. 14. The office shall cease to collect a fee under this chapter
302	302	17 if any of the following occur:
303	303	18 (1) An appellate court issues a final order that either:
304	304	19 (A) the fee described in this chapter; or
305	305	20 (B) the hospital assessment fee under IC 16-21-10;
306	306	21 cannot be implemented or continued.
307	307	22 (2) The United States Department of Health and Human
308	308	23 Services denies approval of collecting the fee under this
309	309	24 chapter.
310	310	25 (3) The hospital assessment fee under IC 16-21-10 ceases to be
311	311	26 collected for circumstances set forth under IC 16-21-10-8.
312	312	27 (4) The hospital assessment fee completes a phase out period
313	313	28 (as defined in IC 16-21-10-5.3).
314	314	29 Sec. 15. (a) The high risk pool fund is established for the
315	315	30 purpose of holding a portion of the fees collected under this
316	316	31 chapter.
317	317	32 (b) The department shall administer the fund and keep records
318	318	33 of the fees deposited into the fund. The expenses of administering
319	319	34 the fund shall be paid from money in the fund.
320	320	35 (c) Money in the fund at the end of a state fiscal year does not
321	321	36 revert to the state general fund.
322	322	37 (d) The treasurer of state shall invest the money in the fund not
323	323	38 currently needed to meet the obligations of the fund in the same
324	324	39 manner as other public money may be invested. Interest that
325	325	40 accrues from these investments shall be deposited in the fund.
326	326	41 Sec. 16. (a) Beginning July 1, 2024, and for each state fiscal year
327	327	42 during the assessment period, the fees collected under this chapter
328	328	2024 IN 1393—LS 6847/DI 104 8
329	329	1 shall be distributed as follows:
330	330	2 (1) An amount equal to twenty-eight and five-tenths percent
331	331	3 (28.5%) of the total fees collected under this IC 16-21-10-8 for
332	332	4 state fiscal year 2023, to be used to contribute to the funding
333	333	5 of the office's Medicaid expenses.
334	334	6 (2) Twenty percent (20%) of the state share dollars for the
335	335	7 state fiscal year for the programs described in
336	336	8 IC 16-21-10-8(a).
337	337	9 (3) Twenty percent (20%) of the state share dollars for the
338	338	10 state fiscal year for the expenses described in
339	339	11 IC 16-21-10-13.3(b)(1).
340	340	12 (4) Ten percent (10%) to be used to create a high risk pool for
341	341	13 high cost medical conditions, as determined by the
342	342	14 department, to help lower premiums for managed care
343	343	15 organizations.
344	344	16 (b) The fees described in subsection (a)(2) shall be deposited into
345	345	17 the hospital Medicaid fee fund established by IC 16-21-10-9.
346	346	18 (c) The fees described in subsection (a)(3) shall be deposited into
347	347	19 the incremental hospital fee fund established by IC 16-21-10-13.5.
348	348	20 (d) The funds described in subsection (a)(4) shall be deposited
349	349	21 into the fund established by section 15 of this chapter.
350	350	22 (e) If the fees collected for a state fiscal year are not sufficient to
351	351	23 fulfill the funding levels specified in subsection (a)(1) through
352	352	24 (a)(4), the fees must be applied in the following order of priority:
353	353	25 (1) First, to fund the amount described in subsection (a)(1).
354	354	26 (2) Second, to fund the amount specified in subsection (a)(3).
355	355	27 (3) Third, to fund the amount specified in subsection (a)(2).
356	356	28 (4) Fourth, to fund the amount specified in subsection (a)(4).
357	357	29 Sec. 17. (a) For fees due from a managed care organization
358	358	30 under this chapter for the state fiscal year beginning July 1, 2024:
359	359	31 (1) the office shall, before December 21, 2024, notify each
360	360	32 managed care organization of the fee amount owed by the
361	361	33 managed care organization under this chapter; and
362	362	34 (2) each managed care organization shall remit the fee
363	363	35 amount to the office before March 1, 2025.
364	364	36 (b) For fees due from a managed care organization beginning
365	365	37 July 1, 2025, and thereafter:
366	366	38 (1) the office shall, before August 1 of each year, notify each
367	367	39 managed care organization of the managed care
368	368	40 organization's fee amount owed by the managed care
369	369	41 organization under this chapter; and
370	370	42 (2) each managed care organization shall remit the fee
371	371	2024 IN 1393—LS 6847/DI 104 9
372	372	1 amount to the office before October 1 of the state fiscal year
373	373	2 in which the fee is owed.
374	374	3 (c) The office may approve a monthly payment plan not to
375	375	4 exceed twelve (12) months for a managed care organization for the
376	376	5 fee amount owed by the managed care organization under this
377	377	6 chapter if the managed care organization demonstrates
378	378	7 extenuating circumstances in meeting the payment deadline
379	379	8 described in this section.
380	380	9 (d) The office shall assess a managed care organization interest
381	381	10 at the rate described in IC 12-15-21-3(6) for any fee that is at least
382	382	11 eleven (11) calendar days past the payment date set forth in this
383	383	12 section.
384	384	13 (e) The office shall report to the department each managed care
385	385	14 organization that fails to pay the fee within one hundred twenty
386	386	15 (120) calendar days after the payment date specified in this section.
387	387	16 The department shall do the following concerning the managed
388	388	17 care organization that has failed to make the payment:
389	389	18 (1) Notify the managed care organization that the managed
390	390	19 care organization's authority to do business in Indiana will be
391	391	20 revoked if the fee is not paid within thirty (30) calendar days
392	392	21 from the date of the notice.
393	393	22 (2) Revoke or suspend the managed care organization's
394	394	23 authority to do business in Indiana if the managed care
395	395	24 organization fails to make the payment in the required time
396	396	25 set forth in subdivision (1). IC 4-21.5-3-8 and IC 4-21.5-4
397	397	26 apply to this subdivision.
398	398	27 Sec. 18. (a) The office may adopt rules, including provisional
399	399	28 rules under IC 4-22-2-37.1, necessary to implement this chapter.
400	400	29 (b) Rules adopted under this section may be retroactive to the
401	401	30 effective date of any Medicaid state plan amendment or waiver
402	402	31 necessary to implement this chapter.
403	403	32 Sec. 19. This chapter expires June 30, 2025.
404	404	33 SECTION 10. IC 12-15-44.2-17, AS AMENDED BY P.L.213-2015,
405	405	34 SECTION 134, IS AMENDED TO READ AS FOLLOWS
406	406	35 [EFFECTIVE UPON PASSAGE]: Sec. 17. (a) The healthy Indiana plan
407	407	36 trust fund is established for the following purposes:
408	408	37 (1) Administering a plan created by the general assembly to
409	409	38 provide health insurance coverage for low income residents of
410	410	39 Indiana under this chapter and IC 12-15-44.5.
411	411	40 (2) Providing copayments, preventative care services, and
412	412	41 premiums for individuals enrolled in the plan.
413	413	42 (3) Funding tobacco use prevention and cessation programs,
414	414	2024 IN 1393—LS 6847/DI 104 10
415	415	1 childhood immunization programs, and other health care
416	416	2 initiatives designed to promote the general health and well being
417	417	3 of Indiana residents.
418	418	4 (4) Funding amounts necessary to match federal funds for
419	419	5 purposes set forth in this section.
420	420	6 The fund is separate from the state general fund.
421	421	7 (b) The fund shall be administered by the office of the secretary of
422	422	8 family and social services.
423	423	9 (c) The expenses of administering the fund shall be paid from
424	424	10 money in the fund.
425	425	11 (d) The fund shall consist of the following:
426	426	12 (1) Cigarette tax revenues designated by the general assembly to
427	427	13 be part of the fund.
428	428	14 (2) Other funds designated by the general assembly to be part of
429	429	15 the fund.
430	430	16 (3) Federal funds available for the purposes of the fund.
431	431	17 (4) Gifts or donations to the fund.
432	432	18 (e) The treasurer of state shall invest the money in the fund not
433	433	19 currently needed to meet the obligations of the fund in the same
434	434	20 manner as other public money may be invested.
435	435	21 (f) Money must be appropriated before funds are available for use.
436	436	22 (g) Money in the fund does not revert to the state general fund at the
437	437	23 end of any fiscal year.
438	438	24 (h) The fund is considered a trust fund for purposes of IC 4-9.1-1-7.
439	439	25 Money may not be transferred, assigned, or otherwise removed from
440	440	26 the fund by the state board of finance, the budget agency, or any other
441	441	27 state agency unless the transfer, assignment, or removal is made in
442	442	28 accordance with subsection (a)(4).
443	443	29 (i) As used in this subsection, "costs of the healthy Indiana plan 2.0"
444	444	30 includes the costs of all expenses set forth in
445	445	31 IC 16-21-10-13.3(b)(1)(A) through IC 16-21-10-13.3(b)(1)(F).
446	446	32 IC 16-21-10-13.3(b)(1)(G). Notwithstanding subsection (a), funds on
447	447	33 deposit in the fund beginning on the date the office implements the
448	448	34 healthy Indiana plan 2.0 (IC 12-15-44.5) and until the healthy Indiana
449	449	35 plan 2.0 is terminated upon the completion of a phase out period shall
450	450	36 be used exclusively for the following:
451	451	37 (1) The state share of the costs of the healthy Indiana plan 2.0 that
452	452	38 exceed other available funding sources in any given year.
453	453	39 (2) The state share of the costs of the healthy Indiana plan 2.0
454	454	40 incurred during a phase out period of the healthy Indiana plan 2.0.
455	455	41 (3) The state share of the expenses of the plan in effect under this
456	456	42 chapter immediately before the implementation of the healthy
457	457	2024 IN 1393—LS 6847/DI 104 11
458	458	1 Indiana plan 2.0 that were incurred in the regular course of the
459	459	2 plan's operation.
460	460	3 (j) As used in this subsection, "costs of the healthy Indiana plan 2.0"
461	461	4 include the costs of all expenses set forth in IC 16-21-10-13.3(b)(1)(A)
462	462	5 through IC 16-21-10-13.3(b)(1)(F). IC 16-21-10-13.3(b)(1)(G). Upon
463	463	6 implementation of the healthy Indiana plan 2.0 (IC 12-15-44.5), the
464	464	7 entirety of the annual cigarette tax amounts designated to the fund by
465	465	8 the general assembly shall be used exclusively to fund the state share
466	466	9 of the costs of the healthy Indiana plan 2.0, including the state share of
467	467	10 the costs of the healthy Indiana plan 2.0 incurred during a phase out
468	468	11 period of the healthy Indiana plan 2.0. This subsection may not be
469	469	12 construed to restrict the annual cigarette tax dollars annually
470	470	13 appropriated by the general assembly for childhood immunization
471	471	14 programs under subsection (a)(3).
472	472	15 SECTION 11. IC 12-15-44.5-4, AS AMENDED BY P.L.30-2016,
473	473	16 SECTION 29, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
474	474	17 UPON PASSAGE]: Sec. 4. (a) The plan:
475	475	18 (1) is not an entitlement program; and
476	476	19 (2) serves as an alternative to health care coverage under Title
477	477	20 XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
478	478	21 (b) If either of the following occurs, the office shall terminate the
479	479	22 plan in accordance with section 6(b) of this chapter:
480	480	23 (1) The:
481	481	24 (A) percentages of federal medical assistance available to the
482	482	25 plan for coverage of plan participants described in Section
483	483	26 1902(a)(10)(A)(i)(VIII) of the federal Social Security Act are
484	484	27 less than the percentages provided for in Section
485	485	28 2001(a)(3)(B) of the federal Patient Protection and Affordable
486	486	29 Care Act; and
487	487	30 (B) hospital assessment committee (IC 16-21-10), after
488	488	31 considering the modification and the reduction in available
489	489	32 funding, does not alter the formula established under
490	490	33 IC 16-21-10-13.3(b)(1) to cover the amount of the reduction
491	491	34 in federal medical assistance.
492	492	35 For purposes of this subdivision, "coverage of plan participants"
493	493	36 includes payments, contributions, and amounts referred to in
494	494	37 IC 16-21-10-13.3(b)(1)(A), IC 16-21-10-13.3(b)(1)(C), and
495	495	38 IC 16-21-10-13.3(b)(1)(D), and IC 16-21-10-13.3(b)(1)(E),
496	496	39 including payments, contributions, and amounts incurred during
497	497	40 a phase out period of the plan.
498	498	41 (2) The:
499	499	42 (A) methodology of calculating the incremental fee set forth in
500	500	2024 IN 1393—LS 6847/DI 104 12
501	501	1 IC 16-21-10-13.3 is modified in any way that results in a
502	502	2 reduction in available funding;
503	503	3 (B) hospital assessment fee committee (IC 16-21-10), after
504	504	4 considering the modification and reduction in available
505	505	5 funding, does not alter the formula established under
506	506	6 IC 16-21-10-13.3(b)(1) to cover the amount of the reduction
507	507	7 in fees; and
508	508	8 (C) office does not use alternative financial support to cover
509	509	9 the amount of the reduction in fees.
510	510	10 (c) If the plan is terminated under subsection (b), the secretary may
511	511	11 implement a plan for coverage of the affected population in a manner
512	512	12 consistent with the healthy Indiana plan (IC 12-15-44.2 (before its
513	513	13 repeal)) in effect on January 1, 2014:
514	514	14 (1) subject to prior approval of the United States Department of
515	515	15 Health and Human Services; and
516	516	16 (2) without funding from the incremental fee set forth in
517	517	17 IC 16-21-10-13.3.
518	518	18 (d) The office may not operate the plan in a manner that would
519	519	19 obligate the state to financial participation beyond the level of state
520	520	20 appropriations or funding otherwise authorized for the plan.
521	521	21 (e) The office of the secretary shall submit annually to the budget
522	522	22 committee an actuarial analysis of the plan that reflects a determination
523	523	23 that sufficient funding is reasonably estimated to be available to
524	524	24 operate the plan.
525	525	25 SECTION 12. IC 12-15-44.5-5, AS AMENDED BY P.L.201-2023,
526	526	26 SECTION 136, IS AMENDED TO READ AS FOLLOWS
527	527	27 [EFFECTIVE UPON PASSAGE]: Sec. 5. (a) A managed care
528	528	28 organization that contracts with the office to provide health coverage,
529	529	29 dental coverage, or vision coverage to an individual who participates
530	530	30 in the plan:
531	531	31 (1) is responsible for the claim processing for the coverage;
532	532	32 (2) shall, except as provided under subsection (c), reimburse
533	533	33 providers at a rate that is not less than the rate established by the
534	534	34 secretary; and
535	535	35 (3) may not deny coverage to an eligible individual who has been
536	536	36 approved by the office to participate in the plan.
537	537	37 (b) A managed care organization that contracts with the office to
538	538	38 provide health coverage under the plan must incorporate cultural
539	539	39 competency standards established by the office. The standards must
540	540	40 include standards for non-English speaking, minority, and disabled
541	541	41 populations.
542	542	42 (c) This subsection does not apply to the following:
543	543	2024 IN 1393—LS 6847/DI 104 13
544	544	1 (1) A hospital licensed under IC 16-21-2.
545	545	2 (2) A private psychiatric hospital licensed under IC 12-25.
546	546	3 A managed care organization and a provider may agree to a
547	547	4 different reimbursement rate from the rate specified in subsection
548	548	5 (a)(2) as part of a value based services contract.
549	549	6 SECTION 13. IC 12-15-44.5-6, AS AMENDED BY P.L.108-2019,
550	550	7 SECTION 198, IS AMENDED TO READ AS FOLLOWS
551	551	8 [EFFECTIVE UPON PASSAGE]: Sec. 6. (a) For a the state fiscal year
552	552	9 beginning July 1, 2018, July 1, 2024, or thereafter, the office after
553	553	10 review by the state budget committee, may determine that no
554	554	11 incremental fees collected under IC 16-21-10-13.3 are required to be
555	555	12 deposited into the phase out trust fund established under section 7 of
556	556	13 this chapter. shall use the funds in the phase out trust fund
557	557	14 established by section 7 of this chapter for a one (1) time pro rata
558	558	15 reduction in overall incremental fees paid by hospitals under
559	559	16 IC 16-21-10-13.3 for the state fiscal year.
560	560	17 (b) If the plan is to be terminated for any reason, the office shall:
561	561	18 (1) if required, provide notice of termination of the plan to the
562	562	19 United States Department of Health and Human Services and
563	563	20 begin the process of phasing out the plan; or
564	564	21 (2) if notice and a phase out plan is not required under federal
565	565	22 law, notify the hospital assessment fee committee (IC 16-21-10)
566	566	23 of the office's intent to terminate the plan and the plan shall be
567	567	24 phased out under a procedure approved by the hospital
568	568	25 assessment fee committee.
569	569	26 The office may not submit any phase out plan to the United States
570	570	27 Department of Health and Human Services or accept any phase out
571	571	28 plan proposed by the Department of Health and Human Services
572	572	29 without the prior approval of the hospital assessment fee committee.
573	573	30 (c) Before submitting:
574	574	31 (1) an extension of; or
575	575	32 (2) a material amendment to;
576	576	33 the plan to the United States Department of Health and Human
577	577	34 Services, the office shall inform the Indiana Hospital Association of the
578	578	35 extension or material amendment to the plan.
579	579	36 (d) This section expires June 30, 2025.
580	580	37 SECTION 14. IC 12-15-44.5-7, AS ADDED BY P.L.213-2015,
581	581	38 SECTION 136, IS AMENDED TO READ AS FOLLOWS
582	582	39 [EFFECTIVE UPON PASSAGE]: Sec. 7. (a) The phase out trust fund
583	583	40 is established. for the purpose of holding the money needed during a
584	584	41 phase out period of the plan. Funds deposited under this section shall
585	585	42 be used only:
586	586	2024 IN 1393—LS 6847/DI 104 14
587	587	1 (1) to fund the state share of the expenses described in
588	588	2 IC 16-21-10-13.3(b)(1)(A) through IC 16-21-10-13.3(b)(1)(F)
589	589	3 incurred during a phase out period of the plan;
590	590	4 (2) after funds from the healthy Indiana trust fund (IC
591	591	5 12-15-44.2-17) are exhausted; and
592	592	6 (3) to refund hospitals in the manner described in subsection (h).
593	593	7 as set forth in section 6 of this chapter. The fund is separate from the
594	594	8 state general fund.
595	595	9 (b) The fund shall be administered by the office.
596	596	10 (c) The expenses of administering the fund shall be paid from
597	597	11 money in the fund.
598	598	12 (d) The trust fund must consist of:
599	599	13 (1) the funds described in section 6 of this chapter; and
600	600	14 (2) any interest accrued under this section.
601	601	15 (e) The treasurer of state shall invest the money in the fund not
602	602	16 currently needed to meet the obligations of the fund in the same
603	603	17 manner as other public money may be invested. Interest that accrues
604	604	18 from these investments shall be deposited in the fund.
605	605	19 (f) Money in the fund does not revert to the state general fund at the
606	606	20 end of any fiscal year.
607	607	21 (g) The fund is considered a trust fund for purposes of IC 4-9.1-1-7.
608	608	22 Money may not be transferred, assigned, or otherwise removed from
609	609	23 the fund by the state board of finance, the budget agency, or any other
610	610	24 state agency unless specifically authorized under this chapter.
611	611	25 (h) At the end of the phase out period, any remaining funds and
612	612	26 accrued interest shall be distributed to the hospitals on a pro rata basis
613	613	27 based on the fees authorized by IC 16-21-10 that were paid by each
614	614	28 hospital for the state fiscal year that ended immediately before the
615	615	29 beginning of the phase out period. This section expires June 30, 2025.
616	616	30 SECTION 15. IC 16-21-10-4, AS ADDED BY P.L.205-2013,
617	617	31 SECTION 214, IS AMENDED TO READ AS FOLLOWS
618	618	32 [EFFECTIVE UPON PASSAGE]: Sec. 4. (a) As used in this chapter,
619	619	33 "hospital" means either of the following:
620	620	34 (1) A hospital (as defined in IC 16-18-2-179(b)) licensed under
621	621	35 this article.
622	622	36 (2) A private psychiatric hospital licensed under IC 12-25.
623	623	37 (b) The term does not include the following:
624	624	38 (1) A state mental health institution operated under IC 12-24-1-3.
625	625	39 (2) A hospital:
626	626	40 (A) designated by the Medicaid program as a long term care
627	627	41 hospital;
628	628	42 (B) that has an average inpatient length of stay that is greater
629	629	2024 IN 1393—LS 6847/DI 104 15
630	630	1 than twenty-five (25) days, as determined by the office of
631	631	2 Medicaid policy and planning under the Medicaid program;
632	632	3 (C) that is a Medicare certified, freestanding rehabilitation
633	633	4 hospital; or
634	634	5 (D) that is a hospital operated by the federal government;
635	635	6 (E) that is a physician owned hospital;
636	636	7 (F) that only provides respite care services to individuals
637	637	8 who are:
638	638	9 (i) medically fragile; and
639	639	10 (ii) less than nineteen (19) years of age; or
640	640	11 (G) that is a freestanding psychiatric hospital with greater
641	641	12 than ninety percent (90%) of admissions comprised of
642	642	13 individuals who are at least fifty-five (55) years of age and
643	643	14 have a primary diagnosis of:
644	644	15 (i) Alzheimer's disease;
645	645	16 (ii) early onset Alzheimer's disease;
646	646	17 (iii) dementia;
647	647	18 (iv) mood disorders;
648	648	19 (v) anxiety;
649	649	20 (vi) psychotic disorders;
650	650	21 (vii) other behavioral health illnesses or disorders; or
651	651	22 (viii) neurological disorders related to trauma or aging.
652	652	23 SECTION 16. IC 16-21-10-5.1 IS ADDED TO THE INDIANA
653	653	24 CODE AS A NEW SECTION TO READ AS FOLLOWS
654	654	25 [EFFECTIVE UPON PASSAGE]: Sec. 5.1. As used in this chapter,
655	655	26 "physician owned hospital" means a hospital licensed under
656	656	27 IC 16-21-2 that provides acute care services and that has:
657	657	28 (1) physician ownership; or
658	658	29 (2) a legal entity with one hundred percent (100%) physician
659	659	30 ownership;
660	660	31 and the ownership of the hospital is of at least fifty-one percent
661	661	32 (51%).
662	662	33 SECTION 17. IC 16-21-10-5.2 IS ADDED TO THE INDIANA
663	663	34 CODE AS A NEW SECTION TO READ AS FOLLOWS
664	664	35 [EFFECTIVE UPON PASSAGE]: Sec. 5.2. As used in this chapter,
665	665	36 "state directed payment program" means a payment arrangement
666	666	37 under 42 CFR 438.6(c) that allows the office, through separate
667	667	38 payment terms, to direct specific payments to a hospital by a
668	668	39 managed care organization that contracts with the office to provide
669	669	40 health coverage.
670	670	41 SECTION 18. IC 16-21-10-6, AS AMENDED BY P.L.213-2015,
671	671	42 SECTION 141, IS AMENDED TO READ AS FOLLOWS
672	672	2024 IN 1393—LS 6847/DI 104 16
673	673	1 [EFFECTIVE UPON PASSAGE]: Sec. 6. (a) Subject to subsection (b)
674	674	2 and section 8(b) of this chapter, the office may assess a hospital
675	675	3 assessment fee to hospitals during the fee period if the following
676	676	4 conditions are met:
677	677	5 (1) The fee may be used only for the purposes described in the
678	678	6 following:
679	679	7 (A) Section 8(c)(1) of this chapter.
680	680	8 (B) Section 9 of this chapter.
681	681	9 (C) Section 11 of this chapter (when in effect).
682	682	10 (D) Section 13.3 of this chapter.
683	683	11 (E) Section 14 of this chapter.
684	684	12 (2) The Medicaid state plan amendments and waiver requests
685	685	13 required for the implementation of this chapter are submitted by
686	686	14 the office to the United States Department of Health and Human
687	687	15 Services before October 1, 2013.
688	688	16 (3) (2) The United States Department of Health and Human
689	689	17 Services approves the Medicaid state plan amendments and
690	690	18 waiver requests, or revisions of the Medicaid state plan
691	691	19 amendments and waiver requests described in subdivision (2):
692	692	20 (A) not later than October 1, 2014; or
693	693	21 (B) after October 1, 2014, if a date is established by the
694	694	22 committee. to this chapter that are to go into effect on July
695	695	23 1, 2024, and are submitted by the office to the United
696	696	24 States Department of Health and Human Services not later
697	697	25 than May 1, 2024.
698	698	26 (4) (3) The funds generated from the fee do not revert to the state
699	699	27 general fund.
700	700	28 (b) The office shall stop collecting a fee, the programs described in
701	701	29 section 8(a) of this chapter shall be reconciled and terminated subject
702	702	30 to section 9(c) of this chapter, and the operation of section 11 of this
703	703	31 chapter (when in effect) ends subject to section 9(c) of this chapter, if
704	704	32 any of the following occurs:
705	705	33 (1) An appellate court makes a final determination that either:
706	706	34 (A) the fee; or
707	707	35 (B) any of the programs described in section 8(a) of this
708	708	36 chapter;
709	709	37 cannot be implemented or maintained.
710	710	38 (2) The United States Department of Health and Human Services
711	711	39 makes a final determination that the Medicaid state plan
712	712	40 amendments or waivers submitted under this chapter are not
713	713	41 approved or cannot be validly implemented.
714	714	42 (3) The fee is not collected because of circumstances described in
715	715	2024 IN 1393—LS 6847/DI 104 17
716	716	1 section 8(d) of this chapter.
717	717	2 (c) The office shall keep records of the fees collected by the office
718	718	3 and report the amount of fees collected under this chapter to the budget
719	719	4 committee.
720	720	5 SECTION 19. IC 16-21-10-7, AS AMENDED BY P.L.108-2019,
721	721	6 SECTION 202, IS AMENDED TO READ AS FOLLOWS
722	722	7 [EFFECTIVE UPON PASSAGE]: Sec. 7. (a) The hospital assessment
723	723	8 fee committee is established. The committee consists of the following
724	724	9 four (4) voting members:
725	725	10 (1) The secretary of family and social services appointed under
726	726	11 IC 12-8-1.5-2 or the secretary's designee, who shall serve as the
727	727	12 chair of the committee.
728	728	13 (2) The budget director or the budget director's designee.
729	729	14 (3) Two (2) individuals appointed by the governor from a list of
730	730	15 at least four (4) individuals submitted by the Indiana Hospital
731	731	16 Association.
732	732	17 The committee members described in subdivision (3) serve at the
733	733	18 pleasure of the governor. If a vacancy occurs among the members
734	734	19 appointed under subdivision (3), the governor shall appoint a
735	735	20 replacement committee member from a list of at least two (2)
736	736	21 individuals submitted by the Indiana Hospital Association.
737	737	22 (b) The committee shall do the following:
738	738	23 (1) Review any Medicaid state plan amendments, waiver requests,
739	739	24 or revisions to any Medicaid state plan amendments or waiver
740	740	25 requests, to implement or continue the implementation of this
741	741	26 chapter for the purpose of establishing favorable review of the
742	742	27 amendments, requests, and revisions by the United States
743	743	28 Department of Health and Human Services. The committee shall
744	744	29 also develop a disproportionate share payment plan or submit to
745	745	30 the office the default plan, if applicable, as set forth in
746	746	31 IC 12-15-16-7.5 and IC 12-15-16-7.7.
747	747	32 (2) Review and approve the quality program described in
748	748	33 section 8(a)(2) of this chapter, including:
749	749	34 (A) the initial development of the quality program before
750	750	35 any Medicaid state plan amendment, waiver request, or
751	751	36 any other request for approval of the program is submitted
752	752	37 to the United States Department of Health and Human
753	753	38 Services; and
754	754	39 (B) any subsequent revisions to the initially submitted
755	755	40 quality program, including the acceptance by the office of
756	756	41 the secretary of family and social services of the terms and
757	757	42 conditions of the quality program proposed by the United
758	758	2024 IN 1393—LS 6847/DI 104 18
759	759	1 States Department of Health and Human Services.
760	760	2 (c) The committee shall meet at the call of the chair. The members
761	761	3 serve without compensation.
762	762	4 (d) A quorum consists of at least three (3) members. An affirmative
763	763	5 vote of at least three (3) members of the committee is necessary to
764	764	6 approve Medicaid state plan amendments, waiver requests, revisions
765	765	7 to the Medicaid state plan or waiver requests, and the approvals and
766	766	8 other determinations required of the committee under IC 12-15-44.5
767	767	9 and section 13.3 of this chapter.
768	768	10 (e) The following apply to the approvals and any other
769	769	11 determinations required by the committee under IC 12-15-44.5 and
770	770	12 section 13.3 of this chapter:
771	771	13 (1) The committee shall:
772	772	14 (A) be guided and subject to the intent of the general assembly
773	773	15 in the passage of IC 12-15-44.5 and section 13.3 of this
774	774	16 chapter; and
775	775	17 (B) be guided to ensure hospitals are reimbursed under the
776	776	18 Medicaid program at a reimbursement rate that is:
777	777	19 (i) at least the level of reimbursement that would be paid
778	778	20 under the federal Medicare payment principles; and
779	779	21 (ii) at the maximum reimbursement rate allowable under
780	780	22 the federal Medicaid law.
781	781	23 (2) The chair of the committee shall report any approval and other
782	782	24 determination by the committee to the budget committee.
783	783	25 (3) If, in taking action, the committee's vote is tied, the committee
784	784	26 shall follow the following procedure:
785	785	27 (A) The chair of the committee shall notify the chairman of the
786	786	28 budget committee of the tied vote and provide a summary of
787	787	29 that matter that was the subject of the vote.
788	788	30 (B) The chairman of the budget committee shall provide each
789	789	31 committee member who voted an opportunity to appear before
790	790	32 the budget committee to present information and materials to
791	791	33 the budget committee concerning the matter that was the
792	792	34 subject of the tied vote.
793	793	35 (C) Following a presentation of the information and the
794	794	36 materials described in clause (B), the budget committee may
795	795	37 make recommendations to the committee concerning the
796	796	38 matter that was the subject of the tied vote.
797	797	39 SECTION 20. IC 16-21-10-8, AS AMENDED BY P.L.213-2015,
798	798	40 SECTION 143, IS AMENDED TO READ AS FOLLOWS
799	799	41 [EFFECTIVE UPON PASSAGE]: Sec. 8. (a) This section does not
800	800	42 apply to the use of the incremental fee described in section 13.3 of this
801	801	2024 IN 1393—LS 6847/DI 104 19
802	802	1 chapter. Subject to subsection (b), the office shall develop the
803	803	2 following programs designed to increase to the extent allowable under
804	804	3 federal law, Medicaid reimbursement for inpatient and outpatient
805	805	4 hospital services provided by a hospital to Medicaid recipients:
806	806	5 (1) A program concerning reimbursement for the Medicaid
807	807	6 fee-for-service program that, in the aggregate, will result in
808	808	7 payments equivalent to the level of payment that would be paid
809	809	8 under federal Medicare payment principles.
810	810	9 (2) Beginning July 1, 2024, subject to approval of any
811	811	10 Medicaid state plan amendment or Medicaid waiver by the
812	812	11 committee and by the United States Department of Health and
813	813	12 Human Services, a state directed payment program concerning
814	814	13 reimbursement for the Medicaid risk based managed care
815	815	14 program that, in the aggregate, will result in enhanced payments
816	816	15 equivalent to the level of payment that would be paid under
817	817	16 federal Medicare payment principles. for:
818	818	17 (A) inpatient hospital services; and
819	819	18 (B) outpatient hospital services;
820	820	19 that are at least greater than what would be paid under
821	821	20 federal Medicare principles, and at the maximum
822	822	21 reimbursement rate allowable under federal Medicaid law.
823	823	22 Subject to section 7(b) of this chapter, the program in this
824	824	23 subdivision is subject to a quality program that is linked to
825	825	24 the office's quality strategy approved by the committee. Any
826	826	25 state plan amendment or waiver that the office submits to the
827	827	26 United States Department of Health and Human Services
828	828	27 must request that the fee be implemented on July 1, 2024,
829	829	28 even if that requires the assessment to be implemented
830	830	29 retroactively.
831	831	30 (b) The office shall not submit to the United States Department of
832	832	31 Health and Human Services any Medicaid state plan amendments,
833	833	32 waiver requests, or revisions to any Medicaid state plan amendments
834	834	33 or waiver requests, to implement or continue the implementation of this
835	835	34 chapter until the committee has reviewed and approved the
836	836	35 amendments, waivers, or revisions described in this subsection and has
837	837	36 submitted a written report to the budget committee concerning the
838	838	37 amendments, waivers, or revisions described in this subsection,
839	839	38 including the following:
840	840	39 (1) The methodology to be used by the office in calculating the
841	841	40 increased Medicaid reimbursement under the programs described
842	842	41 in subsection (a).
843	843	42 (2) The methodology to be used by the office in calculating,
844	844	2024 IN 1393—LS 6847/DI 104 20
845	845	1 imposing, or collecting the fee, or any other matter relating to the
846	846	2 fee.
847	847	3 (3) The determination of Medicaid disproportionate share
848	848	4 allotments under section 11 of this chapter, if in effect, that are to
849	849	5 be funded by the fee, including the formula for distributing the
850	850	6 Medicaid disproportionate share allotments.
851	851	7 (4) The distribution to private psychiatric institutions under
852	852	8 section 13 of this chapter.
853	853	9 (c) This subsection applies to the programs described in subsection
854	854	10 (a). The state share dollars for the programs must consist of the
855	855	11 following:
856	856	12 (1) Fees paid under this chapter. However, fees may not be used
857	857	13 to fund the state share of the portion of capitation payments
858	858	14 attributable to a managed care organization's payment of the
859	859	15 managed care assessment fee under IC 12-15-29.5.
860	860	16 (2) The hospital care for the indigent funds allocated under
861	861	17 section 10 of this chapter. The managed care assessment fee
862	862	18 authorized under IC 12-15-29.5, subject to the requirements
863	863	19 of IC 12-15-29.5-16.
864	864	20 (3) Other sources of state share dollars available to the office,
865	865	21 excluding intergovernmental transfers of funds made by or on
866	866	22 behalf of a hospital.
867	867	23 The money described in subdivisions (1) and (2) may be used only to
868	868	24 fund the part of the payments that exceed the Medicaid reimbursement
869	869	25 rates in effect on June 30, 2011.
870	870	26 (d) This subsection applies to the programs described in subsection
871	871	27 (a). If the state is unable to maintain the funding under subsection
872	872	28 (c)(3) for the payments at Medicaid reimbursement levels in effect on
873	873	29 June 30, 2011, because of budgetary constraints, the office shall reduce
874	874	30 inpatient and outpatient hospital Medicaid reimbursement rates under
875	875	31 subsection (a)(1) or (a)(2) or request approval from the committee and
876	876	32 the United States Department of Health and Human Services to
877	877	33 increase the fee to prevent a decrease in Medicaid reimbursement for
878	878	34 hospital services. If:
879	879	35 (1) the committee:
880	880	36 (A) does not approve a reimbursement reduction; or
881	881	37 (B) does not approve an increase in the fee; or
882	882	38 (2) the United States Department of Health and Human Services
883	883	39 does not approve an increase in the fee;
884	884	40 the office shall cease to collect the fee and the programs described in
885	885	41 subsection (a) are terminated.
886	886	42 (e) If the state directed payment program described in
887	887	2024 IN 1393—LS 6847/DI 104 21
888	888	1 subsection (a)(2) is not approved by the committee or the United
889	889	2 States Department of Health and Human Services, the state shall
890	890	3 return to making payments equivalent to the level of payment that
891	891	4 would be paid under federal Medicare payment principles.
892	892	5 SECTION 21. IC 16-21-10-9, AS AMENDED BY P.L.213-2015,
893	893	6 SECTION 144, IS AMENDED TO READ AS FOLLOWS
894	894	7 [EFFECTIVE UPON PASSAGE]: Sec. 9. (a) This section is effective
895	895	8 upon implementation of the fee. The hospital Medicaid fee fund is
896	896	9 established for the purpose of holding fees collected under section 6 of
897	897	10 this chapter, excluding the part of the fee used for purposes of section
898	898	11 13.3 if of this chapter, that are not necessary to match federal funds.
899	899	12 (b) The office shall administer the fund.
900	900	13 (c) Money in the fund at the end of a state fiscal year attributable to
901	901	14 fees collected to fund the programs described in section 8 of this
902	902	15 chapter does not revert to the state general fund. However, money
903	903	16 remaining in the fund after the cessation of the collection of the fee
904	904	17 under section 6(b) of this chapter shall be used for the payments
905	905	18 described in sections section 8(a) and section 11 (if in effect) of this
906	906	19 chapter. Any money not required for the payments described in
907	907	20 sections section 8(a) and section 11 (if in effect) of this chapter after
908	908	21 the cessation of the collection of the fee under section 6(b) of this
909	909	22 chapter shall be distributed to the hospitals on a pro rata basis based
910	910	23 upon the fees paid by each hospital for the state fiscal year that ended
911	911	24 immediately before the cessation of the collection of the fee under
912	912	25 section 6(b) of this chapter.
913	913	26 (d) The treasurer of state shall invest the money in the fund not
914	914	27 currently needed to meet the obligations of the fund in the same
915	915	28 manner as other public funds may be invested. Interest that accrues
916	916	29 from these investments shall be deposited in the fund.
917	917	30 SECTION 22. IC 16-21-10-10 IS REPEALED [EFFECTIVE UPON
918	918	31 PASSAGE]. Sec. 10. This section:
919	919	32 (1) is effective upon implementation of the fee; and
920	920	33 (2) does not apply to funds under IC 12-16-17.
921	921	34 Notwithstanding any other law, the part of the amounts appropriated
922	922	35 for or transferred to the hospital care for the indigent program for the
923	923	36 state fiscal year beginning July 1, 2013, and each state fiscal year
924	924	37 thereafter that are not required to be paid to the office by law shall be
925	925	38 used exclusively as state share dollars for the payments described in
926	926	39 sections 8(a) and 11 of this chapter. Any hospital care for the indigent
927	927	40 funds that are not required for the payments described in sections 8(a)
928	928	41 and 11 of this chapter after the cessation of the collection of the fee
929	929	42 under section 6(b) of this chapter shall be used for the state share
930	930	2024 IN 1393—LS 6847/DI 104 22
931	931	1 dollars of the payments in IC 12-15-20-2(8)(G)(ii) through
932	932	2 IC 12-15-20-2(8)(G)(x).
933	933	3 SECTION 23. IC 16-21-10-11, AS AMENDED BY P.L.30-2016,
934	934	4 SECTION 38, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
935	935	5 UPON PASSAGE]: Sec. 11. (a) This section:
936	936	6 (1) does not apply if the state directed payment program
937	937	7 under section 8(a)(2) of this chapter is in effect; and
938	938	8 (1) (2) does not apply to the incremental fee described in section
939	939	9 13.3 of this chapter at any time.
940	940	10 (2) is effective upon the implementation of the fee described in
941	941	11 section 6 of this chapter, excluding the part of the fee used for
942	942	12 purposes of section 13.3 of this chapter; and
943	943	13 (3) applies to the Medicaid disproportionate share payments for
944	944	14 the state fiscal year beginning July 1, 2013, and each state fiscal
945	945	15 year thereafter.
946	946	16 (b) The state share dollars used to fund disproportionate share
947	947	17 payments to acute care hospitals licensed under IC 16-21-2 that qualify
948	948	18 as disproportionate share providers or municipal disproportionate share
949	949	19 providers under IC 12-15-16-1(a) or IC 12-15-16-1(b) shall be paid
950	950	20 with money collected through the fee and the hospital care for the
951	951	21 indigent dollars described in section 10 of this chapter (before its
952	952	22 repeal).
953	953	23 (c) The federal Medicaid disproportionate share allotments for the
954	954	24 state fiscal years beginning July 1, 2013, and each state fiscal year
955	955	25 thereafter shall be allocated in their entirety to acute care hospitals
956	956	26 licensed under IC 16-21-2 that qualify as disproportionate share
957	957	27 providers or municipal disproportionate share providers under
958	958	28 IC 12-15-16-1(a) or IC 12-15-16-1(b). No part of the federal
959	959	29 disproportionate share allotments applicable for disproportionate share
960	960	30 payments for the state fiscal year beginning July 1, 2013, and each state
961	961	31 fiscal year thereafter may be allocated to institutions for mental disease
962	962	32 or other mental health facilities, as defined by applicable federal law.
963	963	33 SECTION 24. IC 16-21-10-13.3, AS AMENDED BY P.L.201-2023,
964	964	34 SECTION 147, IS AMENDED TO READ AS FOLLOWS
965	965	35 [EFFECTIVE UPON PASSAGE]: Sec. 13.3. (a) This section is
966	966	36 effective beginning February 1, 2015. As used in this section, "plan"
967	967	37 refers to the healthy Indiana plan established in IC 12-15-44.5.
968	968	38 (b) Subject to subsections (c) through (e), the incremental fee under
969	969	39 this section may be used to fund the state share of the expenses
970	970	40 specified in this subsection if, after January 31, 2015, but before the
971	971	41 collection of the fee under this section, the following occur:
972	972	42 (1) The committee establishes a fee formula to be used to fund the
973	973	2024 IN 1393—LS 6847/DI 104 23
974	974	1 state share of the following expenses described in this
975	975	2 subdivision:
976	976	3 (A) Subject to clause (C), the state share of the capitated
977	977	4 payments made to a managed care organization that contracts
978	978	5 with the office to provide health coverage under the plan to
979	979	6 plan enrollees other than plan enrollees who are eligible for
980	980	7 the plan under Section 1931 of the federal Social Security Act.
981	981	8 (B) Subject to clause (C), the state share of capitated
982	982	9 payments described in clause (A) for plan enrollees who are
983	983	10 eligible for the plan under Section 1931 of the federal Social
984	984	11 Security Act that are limited to the difference between:
985	985	12 (i) the capitation rates effective September 1, 2014,
986	986	13 developed using Medicaid reimbursement rates; and
987	987	14 (ii) the capitation rates applicable for the plan developed
988	988	15 using the plan's Medicare reimbursement rates described in
989	989	16 IC 12-15-44.5-5(a)(2).
990	990	17 (C) Beginning July 1, 2024, and subject to approval of any
991	991	18 Medicaid state plan amendment or Medicaid waiver by the
992	992	19 committee and by the United States Department of Health
993	993	20 and Human Services, the state share of capitated payments
994	994	21 and state directed payment programs for inpatient and
995	995	22 outpatient hospital services are to be determined as
996	996	23 follows:
997	997	24 (i) The state share of capitated payments made to a
998	998	25 managed care organization that contracts with the office
999	999	26 to provide health coverage under the plan to plan
1000	1000	27 enrollees shall provide Medicaid reimbursement for
1001	1001	28 inpatient and outpatient hospital services at a rate that
1002	1002	29 is equal to the base Medicaid reimbursement rate in
1003	1003	30 effect on September 1, 2014. However, fees under this
1004	1004	31 section may not be used to fund the state share of the
1005	1005	32 portion of capitation payments attributable to a
1006	1006	33 managed care organization's (as defined in
1007	1007	34 IC 12-15-29.5-6) payment of the managed care
1008	1008	35 assessment fee.
1009	1009	36 (ii) The state share of payments made under a state
1010	1010	37 directed payment program described in section 8 of this
1011	1011	38 chapter for inpatient and outpatient hospital services
1012	1012	39 provided to plan enrollees at a rate above the rate
1013	1013	40 calculated in item (i) and at the maximum rate allowable
1014	1014	41 under federal Medicaid law.
1015	1015	42 (C) (D) The state share of the state's contributions to plan
1016	1016	2024 IN 1393—LS 6847/DI 104 24
1017	1017	1 enrollee accounts.
1018	1018	2 (D) (E) The state share of amounts used to pay premiums for
1019	1019	3 a premium assistance plan implemented under
1020	1020	4 IC 12-15-44.2-20.
1021	1021	5 (E) (F) The state share of the costs of increasing
1022	1022	6 reimbursement rates for physician services provided to
1023	1023	7 individuals enrolled in Medicaid programs other than the plan,
1024	1024	8 but not to exceed the difference between the Medicaid fee
1025	1025	9 schedule for a physician service that was in effect before the
1026	1026	10 implementation of the plan and the amount equal to
1027	1027	11 seventy-five percent (75%) of the previous year federal
1028	1028	12 Medicare reimbursement rate for a physician service. The
1029	1029	13 incremental fee may not be used for the amount that exceeds
1030	1030	14 seventy-five percent (75%) of the federal Medicare
1031	1031	15 reimbursement rate for a physician service.
1032	1032	16 (F) (G) The state share of the state's administrative costs that,
1033	1033	17 for purposes of this clause, may not exceed one hundred
1034	1034	18 seventy dollars ($170) per person per plan enrollee per year,
1035	1035	19 and adjusted annually by the Consumer Price Index.
1036	1036	20 (G) The money described in IC 12-15-44.5-6(a) for the phase
1037	1037	21 out period of the plan.
1038	1038	22 (2) The committee approves a process to be used for reconciling:
1039	1039	23 (A) the state share of the costs of the plan;
1040	1040	24 (B) the amounts used to fund the state share of the costs of the
1041	1041	25 plan; and
1042	1042	26 (C) the amount of fees assessed for funding the state share of
1043	1043	27 the costs of the plan.
1044	1044	28 For purposes of this subdivision, "costs of the plan" includes the
1045	1045	29 costs of the expenses listed in subdivision (1)(A) through (1)(G).
1046	1046	30 The fees collected under subdivision (1)(A) through (1)(F) (1)(G) shall
1047	1047	31 be deposited into the incremental hospital fee fund established by
1048	1048	32 section 13.5 of this chapter. Fees described in subdivision (1)(G) shall
1049	1049	33 be deposited into the phase out trust fund described in IC 12-15-44.5-7.
1050	1050	34 The fees used for purposes of funding the state share of expenses listed
1051	1051	35 in subdivision (1)(A) through (1)(F) (1)(G) may not be used to fund
1052	1052	36 expenses incurred on or after the commencement of a phase out period
1053	1053	37 of the plan.
1054	1054	38 (c) For each state fiscal year for which the fee authorized by this
1055	1055	39 section is used to fund the state share of the expenses described in
1056	1056	40 subsection (b)(1), the amount of fees shall be reduced by the
1057	1057	41 following:
1058	1058	42 (1) The amount of funds annually designated by the general
1059	1059	2024 IN 1393—LS 6847/DI 104 25
1060	1060	1 assembly to be deposited in the healthy Indiana plan trust fund
1061	1061	2 established by IC 12-15-44.2-17. less
1062	1062	3 (2) The annual cigarette tax funds annually appropriated by the
1063	1063	4 general assembly for childhood immunization programs under
1064	1064	5 IC 12-15-44.2-17(a)(3).
1065	1065	6 (3) The managed care assessment fee authorized under
1066	1066	7 IC 12-15-29.5, subject to IC 12-15-29.5-16.
1067	1067	8 (4) The amount of funds in the phase out trust fund set forth
1068	1068	9 in IC 12-15-44.5-6, before its expiration.
1069	1069	10 (d) The incremental fee described in this section may not:
1070	1070	11 (1) be assessed before July 1, 2016; and
1071	1071	12 (2) be assessed or collected on or after the beginning of a phase
1072	1072	13 out period of the plan.
1073	1073	14 (e) This section is not intended to and may not be construed to
1074	1074	15 change or affect any component of the programs established under
1075	1075	16 section 8 of this chapter.
1076	1076	17 SECTION 25. IC 16-21-10-14 IS REPEALED [EFFECTIVE UPON
1077	1077	18 PASSAGE]. Sec. 14. This section does not apply to the use of the
1078	1078	19 incremental fee described in section 13.3 of this chapter. The fees
1079	1079	20 collected under section 8 of this chapter may be used only as described
1080	1080	21 in this chapter or to pay the state's share of the cost for Medicaid
1081	1081	22 services provided under the federal Medicaid program (42 U.S.C. 1396
1082	1082	23 et seq.) as follows:
1083	1083	24 (1) Twenty-eight and five-tenths percent (28.5%) may be used by
1084	1084	25 the office for Medicaid expenses.
1085	1085	26 (2) Seventy-one and five-tenths percent (71.5%) to hospitals.
1086	1086	27 SECTION 26. IC 16-21-10-15, AS ADDED BY P.L.205-2013,
1087	1087	28 SECTION 214, IS AMENDED TO READ AS FOLLOWS
1088	1088	29 [EFFECTIVE UPON PASSAGE]: Sec. 15. (a) This chapter may not be
1089	1089	30 construed to authorize any county, municipality, district, or authority
1090	1090	31 to impose a fee, tax, or assessment on a hospital.
1091	1091	32 (b) This chapter may not be construed to prohibit a hospital
1092	1092	33 licensed under IC 16-21-2 that is established and operated under
1093	1093	34 IC 16-22-2 or IC 16-23 from making an intergovernmental transfer
1094	1094	35 as the state match for disproportionate share payments under
1095	1095	36 IC 12-15-16-6.
1096	1096	37 SECTION 27. IC 16-21-10-19, AS ADDED BY P.L.205-2013,
1097	1097	38 SECTION 214, IS AMENDED TO READ AS FOLLOWS
1098	1098	39 [EFFECTIVE UPON PASSAGE]: Sec. 19. Payments for the programs
1099	1099	40 described in section 8(a) of this chapter are limited to claims for dates
1100	1100	41 of services provided during the fee period and that are timely filed with
1101	1101	42 the office or a contractor of the office. Payments for the programs
1102	1102	2024 IN 1393—LS 6847/DI 104 26
1103	1103	1 described in section 8(a) of this chapter and payments to hospitals in
1104	1104	2 accordance with section 11 of this chapter (if in effect) may occur at
1105	1105	3 any time, including after collection of the fee is stopped under section
1106	1106	4 6(b) of this chapter, to the extent the funding provided for the payments
1107	1107	5 by this chapter is available under section 9(c) of this chapter. Payments
1108	1108	6 for the program described in section 13 of this chapter may occur at
1109	1109	7 any time, including after the collection of the fee is stopped under
1110	1110	8 section 6(b) of this chapter, subject to the reconciliation and
1111	1111	9 termination of the program required by section 6(b) of this chapter.
1112	1112	10 SECTION 28. IC 27-1-3-10 IS AMENDED TO READ AS
1113	1113	11 FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 10. The
1114	1114	12 commissioner shall have power:
1115	1115	13 (1) to revoke or suspend the authority to do business in this state
1116	1116	14 of:
1117	1117	15 (A) any company which refuses to permit an examination
1118	1118	16 under IC 27-1-3.1; or
1119	1119	17 (B) any managed care organization (as defined in
1120	1120	18 IC 12-15-29.5-6) that fails to pay the managed care
1121	1121	19 organization's fee assessed under IC 12-15-29.5; and
1122	1122	20 (2) to revoke or suspend any certificate of authority when any
1123	1123	21 condition prescribed by law for granting it no longer exists.
1124	1124	22 SECTION 29. [EFFECTIVE UPON PASSAGE] (a) The office of
1125	1125	23 the secretary of family and social services may continue to collect
1126	1126	24 unpaid managed care assessment fees owed by a managed care
1127	1127	25 organization under IC 12-15-29.5, as added by this act, including
1128	1128	26 after the expiration of IC 12-15-29.5, as added by this act.
1129	1129	27 (b) This SECTION expires December 31, 2026.
1130	1130	28 SECTION 30. [EFFECTIVE UPON PASSAGE] (a) Any balance
1131	1131	29 resulting from interest payments in the phase out trust fund
1132	1132	30 established by IC 12-15-44.5-7 after distribution of payments
1133	1133	31 required by IC 12-15-44.5-6, as amended by this act, and upon
1134	1134	32 expiration of the phase out trust fund on June 30, 2025, shall be
1135	1135	33 transferred to the state general fund.
1136	1136	34 (b) This SECTION expires December 31, 2025.
1137	1137	35 SECTION 31. [EFFECTIVE UPON PASSAGE] (a) The office of
1138	1138	36 the secretary of family and social services shall amend 405
1139	1139	37 IAC 1-8-5 and 405 IAC 1-10.5-7 to reflect the amendments in this
1140	1140	38 act and any Medicaid state plan amendment or Medicaid waiver:
1141	1141	39 (1) approved by the hospital assessment fee committee under
1142	1142	40 IC 16-21-10-7, as amended by this act;
1143	1143	41 (2) submitted to the budget committee in accordance with
1144	1144	42 IC 12-15-1.3-17.5; and
1145	1145	2024 IN 1393—LS 6847/DI 104 27
1146	1146	1 (3) approved by the United States Department of Health and
1147	1147	2 Human Services.
1148	1148	3 The office of the secretary may adopt the changes required by this
1149	1149	4 subsection as provisional rules in the manner set forth in
1150	1150	5 IC 4-22-2-37.1.
1151	1151	6 (b) The administrative rules amended under subsection (a) are
1152	1152	7 effective and may be retroactive to the date the United States
1153	1153	8 Department of Health and Human Services approved a Medicaid
1154	1154	9 state plan amendment or Medicaid waiver described in subsection
1155	1155	10 (a).
1156	1156	11 (c) If the office of the secretary adopts the changes to the
1157	1157	12 administrative rules as required in subsection (a) through a
1158	1158	13 provisional rule, the provisional rule expires on the date on which
1159	1159	14 a rule that supersedes the provisional rule is adopted by the office
1160	1160	15 of the secretary under IC 4-22-2-19.7 through IC 4-22-2-36.
1161	1161	16 (d) This SECTION expires December 31, 2025.
1162	1162	17 SECTION 32. An emergency is declared for this act.
1163	1163	2024 IN 1393—LS 6847/DI 104