Indiana 2024 Regular Session

Indiana House Bill HB1428 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. 1428
4	4	_____
5	5	DIGEST OF INTRODUCED BILL
6	6	Citations Affected: IC 12-15.
7	7	Synopsis: Reimbursement for prosthetic and orthotic devices.
8	8	Provides that, after June 30, 2025, orthotic devices are provided under
9	9	Medicaid. Requires the office of the secretary of family and social
10	10	services to apply for any state plan amendment or waiver necessary to
11	11	include prosthetic and orthotic devices under Medicaid. Specifies that
12	12	a minor may receive a prosthetic or orthotic device for the recipient's
13	13	medical needs. Requires reimbursement for the replacement of an
14	14	orthotic device or a prosthetic device for a minor for certain reasons.
15	15	Effective: July 1, 2024.
16	16	Slager
17	17	January 16, 2024, read first time and referred to Committee on Public Health.
18	18	2024 IN 1428—LS 7066/DI 147 Introduced
19	19	Second Regular Session of the 123rd General Assembly (2024)
20	20	PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
21	21	Constitution) is being amended, the text of the existing provision will appear in this style type,
22	22	additions will appear in this style type, and deletions will appear in this style type.
23	23	Additions: Whenever a new statutory provision is being enacted (or a new constitutional
24	24	provision adopted), the text of the new provision will appear in this style type. Also, the
25	25	word NEW will appear in that style type in the introductory clause of each SECTION that adds
26	26	a new provision to the Indiana Code or the Indiana Constitution.
27	27	Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
28	28	between statutes enacted by the 2023 Regular Session of the General Assembly.
29	29	HOUSE BILL No. 1428
30	30	A BILL FOR AN ACT to amend the Indiana Code concerning
31	31	human services.
32	32	Be it enacted by the General Assembly of the State of Indiana:
33	33	1 SECTION 1. IC 12-15-5-1, AS AMENDED BY P.L.180-2022(ss),
34	34	2 SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
35	35	3 JULY 1, 2024]: Sec. 1. (a) Except as provided in IC 12-15-2-12,
36	36	4 IC 12-15-6, and IC 12-15-21, the following services and supplies are
37	37	5 provided under Medicaid:
38	38	6 (1) Inpatient hospital services.
39	39	7 (2) Nursing facility services.
40	40	8 (3) Physician's services, including services provided under
41	41	9 IC 25-10-1 and IC 25-22.5-1.
42	42	10 (4) Outpatient hospital or clinic services.
43	43	11 (5) Home health care services.
44	44	12 (6) Private duty nursing services.
45	45	13 (7) Physical therapy and related services.
46	46	14 (8) Dental services.
47	47	15 (9) Prescribed laboratory and x-ray services.
48	48	16 (10) Prescribed drugs and pharmacist services.
49	49	17 (11) Eyeglasses. and
50	50	2024 IN 1428—LS 7066/DI 147 2
51	51	1 (12) Prosthetic devices and, after June 30, 2025, orthotic
52	52	2 devices.
53	53	3 (12) (13) Optometric services.
54	54	4 (13) (14) Diagnostic, screening, preventive, and rehabilitative
55	55	5 services.
56	56	6 (14) (15) Podiatric medicine services.
57	57	7 (15) (16) Hospice services.
58	58	8 (16) (17) Services or supplies recognized under Indiana law and
59	59	9 specified under rules adopted by the office.
60	60	10 (17) (18) Family planning services except the performance of
61	61	11 abortions.
62	62	12 (18) (19) Nonmedical nursing care given in accordance with the
63	63	13 tenets and practices of a recognized church or religious
64	64	14 denomination to an individual qualified for Medicaid who
65	65	15 depends upon healing by prayer and spiritual means alone in
66	66	16 accordance with the tenets and practices of the individual's church
67	67	17 or religious denomination.
68	68	18 (19) (20) Services provided to individuals described in
69	69	19 IC 12-15-2-8.
70	70	20 (20) (21) Services provided under IC 12-15-34 and IC 12-15-32.
71	71	21 (21) (22) Case management services provided to individuals
72	72	22 described in IC 12-15-2-13.
73	73	23 (22) (23) Any other type of remedial care recognized under
74	74	24 Indiana law and specified by the United States Secretary of Health
75	75	25 and Human Services.
76	76	26 (23) (24) Examinations required under IC 16-41-17-2(a)(10).
77	77	27 (24) (25) Inpatient substance abuse detoxification services.
78	78	28 (25) (26) Chronic pain management.
79	79	29 (26) (27) Donated breast milk that meets requirements developed
80	80	30 by the office of Medicaid policy and planning.
81	81	31 (b) The office shall do the following:
82	82	32 (1) Apply to the United States Department of Health and Human
83	83	33 Services for any state plan amendment or waiver necessary to
84	84	34 implement the services or supplies described in subsection
85	85	35 (a)(26). (a)(27).
86	86	36 (2) Develop requirements for donated breast milk as described in
87	87	37 subsection (a)(26). (a)(27).
88	88	38 (3) As soon as practicable, but not later than January 1, 2023, the
89	89	39 office shall:
90	90	40 (A) seek any necessary approval from the United States
91	91	41 Department of Health and Human Services; and
92	92	42 (B) adopt any written policies, procedures, or regulations
93	93	2024 IN 1428—LS 7066/DI 147 3
94	94	1 determined necessary;
95	95	2 to provide reimbursement for long-acting reversible
96	96	3 contraception. This subdivision expires June 30, 2023.
97	97	4 (4) Not later than October 1, 2024, apply to the United States
98	98	5 Department of Health and Human Services for any state plan
99	99	6 amendment or waiver necessary to provide the supplies
100	100	7 described in subsection (a)(12).
101	101	8 SECTION 2. IC 12-15-5-22 IS ADDED TO THE INDIANA CODE
102	102	9 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
103	103	10 1, 2024]: Sec. 22. (a) This section applies after June 30, 2025.
104	104	11 (b) As used in this section, "orthotic device" means a medically
105	105	12 necessary rigid or semi-rigid device used for the purpose of
106	106	13 supporting a weak or deformed body member or restricting or
107	107	14 eliminating motion in a diseased or injured part of the body.
108	108	15 (c) As used in this section, "prosthetic device" means an
109	109	16 artificial leg or arm, or any component part of the device.
110	110	17 (d) This section applies to an eligible provider that provides
111	111	18 orthotic devices or prosthetic devices, including repairs or
112	112	19 replacements, that are:
113	113	20 (1) provided or performed by a person that is:
114	114	21 (A) accredited as required under 42 U.S.C. 1395m(a)(20);
115	115	22 or
116	116	23 (B) a qualified practitioner (as defined in 42 U.S.C.
117	117	24 1395m(h)(1)(F)(iii));
118	118	25 (2) determined by the Medicaid recipient's physician to be
119	119	26 medically necessary to restore or maintain the recipient's
120	120	27 ability to perform activities of daily living or essential job
121	121	28 related activities and may include the appropriate model
122	122	29 determined to meet the recipient's medical needs; and
123	123	30 (3) not solely for comfort or convenience.
124	124	31 However, if the Medicaid recipient is less than eighteen (18) years
125	125	32 of age, the eligible provider may specify an appropriate model that
126	126	33 meets the recipient's medical needs as well as maximizes the
127	127	34 recipient's ability to move and engage in recreational activities,
128	128	35 including biking, swimming, and maximizing upper limb function.
129	129	36 (e) If the Medicaid recipient is less than eighteen (18) years of
130	130	37 age and supporting documentation is provided by the recipient's
131	131	38 eligible provider, reimbursement under this section for
132	132	39 replacement of an orthotic device or a prosthetic device must be
133	133	40 allowed for any of the following reasons:
134	134	41 (1) The orthotic device or prosthetic device has been lost or
135	135	42 stolen.
136	136	2024 IN 1428—LS 7066/DI 147 4
137	137	1 (2) The orthotic device or prosthetic device has suffered
138	138	2 irreparable damage.
139	139	3 (3) The orthotic device or prosthetic device has suffered
140	140	4 irreparable wear and tear beyond repair.
141	141	5 (4) The Medicaid recipient had a change in condition
142	142	6 necessitating a replacement, including:
143	143	7 (A) growth of the recipient;
144	144	8 (B) change in the recipient's anatomical presentation,
145	145	9 including weight gain, weight loss, or change in anatomy;
146	146	10 (C) change in the recipient's condition; or
147	147	11 (D) change in the recipient's functional activity level.
148	148	12 Except as provided in this chapter for a Medicaid recipient who is
149	149	13 less than eighteen (18) years of age, coverage is not required under
150	150	14 this section for a prosthetic device that is designed exclusively for
151	151	15 an athletic purpose.
152	152	16 SECTION 3. IC 12-15-12-24 IS ADDED TO THE INDIANA
153	153	17 CODE AS A NEW SECTION TO READ AS FOLLOWS
154	154	18 [EFFECTIVE JULY 1, 2024]: Sec. 24. (a) This section applies after
155	155	19 June 30, 2025.
156	156	20 (b) As used in this section, "orthotic device" means a medically
157	157	21 necessary rigid or semi-rigid device used for the purpose of
158	158	22 supporting a weak or deformed body member or restricting or
159	159	23 eliminating motion in a diseased or injured part of the body.
160	160	24 (c) As used in this section, "prosthetic device" means an
161	161	25 artificial leg or arm, or any component part of the device.
162	162	26 (d) This section applies to a managed care provider that
163	163	27 provides orthotic devices or prosthetic devices, including repairs
164	164	28 or replacements, that are:
165	165	29 (1) provided or performed by a person that is:
166	166	30 (A) accredited as required under 42 U.S.C. 1395m(a)(20);
167	167	31 or
168	168	32 (B) a qualified practitioner (as defined in 42 U.S.C.
169	169	33 1395m(h)(1)(F)(iii));
170	170	34 (2) determined by the enrollee's physician to be medically
171	171	35 necessary to restore or maintain the enrollee's ability to
172	172	36 perform activities of daily living or essential job related
173	173	37 activities and may include the appropriate model determined
174	174	38 to meet the enrollee's medical needs; and
175	175	39 (3) not solely for comfort or convenience.
176	176	40 However, if the enrollee is less than eighteen (18) years of age, the
177	177	41 managed care provider may specify an appropriate model that
178	178	42 meets the enrollee's medical needs as well as maximizes the
179	179	2024 IN 1428—LS 7066/DI 147 5
180	180	1 enrollee's ability to move and engage in recreational activities,
181	181	2 including biking, swimming, and maximizing upper limb function.
182	182	3 (e) If the enrollee is less than eighteen (18) years of age and
183	183	4 supporting documentation is provided by the enrollee's managed
184	184	5 care provider, reimbursement under this section for replacement
185	185	6 of an orthotic device or a prosthetic device must be allowed for any
186	186	7 of the following reasons:
187	187	8 (1) The orthotic device or prosthetic device has been lost or
188	188	9 stolen.
189	189	10 (2) The orthotic device or prosthetic device has suffered
190	190	11 irreparable damage.
191	191	12 (3) The orthotic device or prosthetic device has suffered
192	192	13 irreparable wear and tear beyond repair.
193	193	14 (4) The enrollee had a change in condition necessitating a
194	194	15 replacement, including:
195	195	16 (A) growth of the enrollee;
196	196	17 (B) change in the enrollee's anatomical presentation,
197	197	18 including weight gain, weight loss, or change in anatomy;
198	198	19 (C) change in the enrollee's condition; or
199	199	20 (D) change in the enrollee's functional activity level.
200	200	21 Except as provided in this chapter for an enrollee who is less than
201	201	22 eighteen (18) years of age, coverage is not required under this
202	202	23 section for a prosthetic device that is designed exclusively for an
203	203	24 athletic purpose.
204	204	2024 IN 1428—LS 7066/DI 147