Indiana 2024 Regular Session

Indiana Senate Bill SB0192 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~SB0192.1~~
2		-	~~January 26, 2024~~
	1	+
	2	+	Introduced Version
3	3		SENATE BILL No. 192
4	4		_____
5		-	DIGEST OF SB 192 (Updated January 24, 2024 12:52 pm - DI 104)
6		-	Citations Affected: IC 12-15; IC 16-27; IC 25-26; IC 34-30.
7		-	Synopsis: Various health care matters. Provides that if a physician has
8		-	entered into a provider agreement with the office of Medicaid policy
9		-	and planning (office) or a managed care organization and the physician,
10		-	subject to the provider agreement, provides emergency medical
11		-	services to individuals participating in the state Medicaid program, the
12		-	office or the managed care organization shall promptly compensate the
13		-	physician for the services in accordance with an autopay list published
14		-	by the office. Prohibits any delay in or denial of compensation to the
	5	+	DIGEST OF INTRODUCED BILL
	6	+	Citations Affected: IC 4-21.5; IC 12-15; IC 16-27; IC 16-51-1-1;
	7	+	IC 25-26-13-31.2; IC 27-1-37.7; IC 34-30-2.1-207.4.
	8	+	Synopsis: Various health care matters. Makes changes to the law
	9	+	governing administrative adjudication and to provisions related to
	10	+	managed care organizations. Provides that if a physician has entered
	11	+	into a provider agreement with the office of Medicaid policy and
	12	+	planning (office) or a managed care organization and the physician,
	13	+	subject to the provider agreement, provides professional services to
	14	+	individuals participating in the state Medicaid program, the office or
	15	+	the managed care organization shall promptly compensate the
	16	+	physician for the professional services in accordance with the provider
	17	+	agreement. Prohibits any delay in or denial of compensation to the
15	18		physician unless the cause of the delay or denial is specifically
16	19		provided for in: (1) the Medicaid managed care law; (2) an
17	20		administrative rule adopted under the Medicaid managed care law; (3)
18	21		the federal administrative rules on Medicaid managed care; or (4) the
19		-	provider agreement. States that a home health agency is not required to
	22	+	provider agreement. Defines "antiretroviral" as a drug used to prevent
	23	+	a retrovirus, such as the human immunodeficiency virus (HIV), from
	24	+	replicating. Provides, for purposes of the Medicaid program and the
	25	+	children's health insurance program, that an FDA approved drug that
	26	+	is prescribed for the treatment or prevention of HIV or acquired
	27	+	immunodeficiency syndrome (AIDS), including antiretrovirals, shall
	28	+	not be subject to: (1) prior authorization; (2) a step therapy protocol; or
	29	+	(3) any other protocol that could restrict or delay the dispensing of the
	30	+	drug. Prohibits a health plan (including a policy of accident and
	31	+	sickness insurance, a health maintenance organization contract, the
	32	+	state employee self-insurance program and prepaid health care delivery
	33	+	plan, and a Medicaid risk based managed care program) from imposing
	34	+	(Continued next page)
	35	+	Effective: July 1, 2024.
	36	+	Johnson T
	37	+	January 9, 2024, read first time and referred to Committee on Health and Provider
	38	+	Services.
	39	+	2024 IN 192—LS 6838/DI 92 Digest Continued
	40	+	or enforcing: (1) a prior authorization requirement; (2) a step therapy
	41	+	protocol requirement; or (3) any other protocol requirement; if
	42	+	imposing or enforcing the requirement could restrict or delay the
	43	+	dispensing to a covered individual of an FDA approved drug, including
	44	+	an antiretroviral, that is prescribed for the treatment or prevention of
	45	+	HIV or AIDS. States that a home health agency is not required to
20	46		conduct a tuberculosis test on a job applicant before the individual has
21	47		contact with a patient. Repeals a statute that requires certain personal
22	48		services agency employees or agents to complete a tuberculosis test.
23	49		Authorizes the establishment of home health agency cooperative
24		-	(Continued next page)
25		-	Effective: July 1, 2024.
26		-	Johnson T, Becker, Bohacek,
27		-	Ford J.D.
28		-	January 9, 2024, read first time and referred to Committee on Health and Provider
29		-	Services.
30		-	January 25, 2024, amended, reported favorably — Do Pass; reassigned to Committee on
31		-	Appropriations.
32		-	SB 192—LS 6838/DI 92 Digest Continued
33	50		agreements. (A similar law enacted in 2022 expired on July 1, 2023.)
34	51		Makes statements and findings of the general assembly concerning
35	52		home health agency cooperative agreements. Specifies that a home
36	53		health agency may contract directly or indirectly through a network of
37		-	home health agencies. Allows a pharmacist to administer an
38		-	immunization that is recommended by the federal Centers for Disease
39		-	Control and Prevention Advisory Committee on Immunization
40		-	Practices to a group of individuals under a drug order, under a
41		-	prescription, or according to a protocol approved by a physician if
42		-	certain conditions are met. (Current law allows a pharmacist to
43		-	administer specified immunizations to a group of individuals under a
44		-	drug order, under a prescription, or according to a protocol approved
45		-	by a physician if certain conditions are met.) Removes a provision
46		-	allowing a pharmacist to administer pneumonia immunizations to
47		-	individuals who are at least 50 years of age.
48		-	SB 192—LS 6838/DI 92SB 192—LS 6838/DI 92 January 26, 2024
	54	+	home health agencies. Exempts: (1) a remote location of a hospital; and
	55	+	(2) a free standing emergency department or other provider-based
	56	+	entity; from health care billing requirements. Allows a pharmacist to
	57	+	administer an immunization that is recommended by the federal
	58	+	Centers for Disease Control and Prevention Advisory Committee on
	59	+	Immunization Practices to a group of individuals under a drug order,
	60	+	under a prescription, or according to a protocol approved by a
	61	+	physician if certain conditions are met. (Current law allows a
	62	+	pharmacist to administer specified immunizations to a group of
	63	+	individuals under a drug order, under a prescription, or according to a
	64	+	protocol approved by a physician if certain conditions are met.)
	65	+	Removes a provision allowing a pharmacist to administer pneumonia
	66	+	immunizations to individuals who are at least 50 years of age.
	67	+	2024 IN 192—LS 6838/DI 922024 IN 192—LS 6838/DI 92 Introduced
49	68		Second Regular Session of the 123rd General Assembly (2024)
50	69		PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
51	70		Constitution) is being amended, the text of the existing provision will appear in this style type,
52	71		additions will appear in this style type, and deletions will appear in this style type.
53	72		Additions: Whenever a new statutory provision is being enacted (or a new constitutional
54	73		provision adopted), the text of the new provision will appear in this style type. Also, the
55	74		word NEW will appear in that style type in the introductory clause of each SECTION that adds
56	75		a new provision to the Indiana Code or the Indiana Constitution.
57	76		Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
58	77		between statutes enacted by the 2023 Regular Session of the General Assembly.
59	78		SENATE BILL No. 192
60	79		A BILL FOR AN ACT to amend the Indiana Code concerning
61	80		health.
62	81		Be it enacted by the General Assembly of the State of Indiana:
63		-	1 SECTION 1. IC 12-15-12-24 IS ADDED TO THE INDIANA
64		-	2 CODE AS A NEW SECTION TO READ AS FOLLOWS
65		-	3 [EFFECTIVE JULY 1, 2024]: Sec. 24. (a) If:
66		-	4 (1) a physician has entered into a provider agreement with:
67		-	5 (A) the office; or
68		-	6 (B) a managed care organization;
69		-	7 under IC 12-15-11-4(a) for the provision of emergency
70		-	8 services; and
71		-	9 (2) the physician, subject to the provider agreement referred
72		-	10 to in subdivision (1), provides emergency services to
73		-	11 individuals participating in the state Medicaid program;
74		-	12 the office or the managed care organization shall promptly
75		-	13 compensate the physician for the emergency services in accordance
76		-	14 with the provider agreement. A managed care organization shall
77		-	15 reimburse the physician in accordance with an autopay list
78		-	SB 192—LS 6838/DI 92 2
79		-	1 published by the office.
80		-	2 (b) A physician's compensation under subsection (a) shall not be
81		-	3 delayed due to the retrospective review of the medical services
82		-	4 provided or for any other reason unless the cause of the delay is
83		-	5 specifically provided for in:
84		-	6 (1) this article;
85		-	7 (2) a rule adopted under this article;
86		-	8 (3) 42 CFR 438; or
87		-	9 (4) the provider agreement referred to in subsection (a)(1).
88		-	10 (c) A physician shall not be denied compensation for emergency
89		-	11 services to which subsection (a) applies unless the cause of the
90		-	12 denial is specifically provided for in:
91		-	13 (1) this article;
92		-	14 (2) a rule adopted under this article;
93		-	15 (3) 42 CFR 438; or
94		-	16 (4) the provider agreement referred to in subsection (a)(1).
95		-	17 (d) A managed care organization:
96		-	18 (1) may not deny a claim solely because the claim code is not
97		-	19 included on the office's autopay list; and
98		-	20 (2) shall consider each claim based on the prudent layperson
99		-	21 standard.
100		-	22 SECTION 2. IC 16-27-1-19, AS ADDED BY P.L.117-2023,
101		-	23 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
102		-	24 JULY 1, 2024]: Sec. 19. A home health agency is not required to
103		-	25 conduct a preemployment physical or a tuberculosis test on a job
104		-	26 applicant before the individual has contact with a home health agency
105		-	27 patient.
106		-	28 SECTION 3. IC 16-27-4-15 IS REPEALED [EFFECTIVE JULY 1,
107		-	29 2024]. Sec. 15. An employee or agent of a personal services agency
108		-	30 who will have direct client contact must complete a tuberculosis test in
109		-	31 the same manner as required by the state department for licensed home
110		-	32 health agency employees and agents.
111		-	33 SECTION 4. IC 16-27-6 IS ADDED TO THE INDIANA CODE AS
112		-	34 A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY
113		-	35 1, 2024]:
114		-	36 Chapter 6. Home Health Agency Cooperative Agreements
115		-	37 Sec. 0.5. (a) The general assembly recognizes the importance
116		-	38 and necessity of home health services and home health agencies to
117		-	39 promote and protect the public's general health, safety, and
118		-	40 welfare.
119		-	41 (b) The general assembly finds it necessary and appropriate to
120		-	42 encourage home health agencies to cooperate, take certain actions,
121		-	SB 192—LS 6838/DI 92 3
122		-	1 and enter into agreements that will facilitate improved quality of
123		-	2 care and increase access to home health services even if the
124		-	3 cooperation or actions may:
125		-	4 (1) be characterized as anticompetitive;
126		-	5 (2) result in the acquisition, maintenance, or use of market
127		-	6 power within the meaning of federal and state antitrust laws;
128		-	7 or
129		-	8 (3) otherwise have the effect of displacing competition.
130		-	9 (c) The general assembly believes that it is in the state's best
131		-	10 interest to supplant state and federal antitrust laws with:
132		-	11 (1) the process provided in this chapter; and
133		-	12 (2) active supervision from the secretary as set forth in this
134		-	13 chapter.
135		-	14 (d) It is the intent of the general assembly that this chapter
136		-	15 immunize, to the fullest extent possible, a person from all federal
137		-	16 and state antitrust laws for any cooperation or action approved
138		-	17 and supervised under this chapter. This intent is within the public
139		-	18 policy of the state to facilitate the provision of quality and cost
140		-	19 efficient health care services to patients.
141		-	20 Sec. 1. The definitions in IC 16-27-1 apply throughout this
142		-	21 chapter.
143		-	22 Sec. 2. As used in this chapter, "office" refers to the office of the
144		-	23 secretary of family and social services established by IC 12-8-1.5-1.
145		-	24 Sec. 3. As used in this chapter, "secretary" refers to the
146		-	25 secretary of family and social services appointed under
147		-	26 IC 12-8-1.5-2.
148		-	27 Sec. 4. Home health agencies may enter into cooperative
149		-	28 agreements to carry out the following activities:
150		-	29 (1) To form and operate, either directly or indirectly, one (1)
151		-	30 or more networks of home health agencies to arrange for the
152		-	31 provision of health care services through such networks,
153		-	32 including to contract either directly or indirectly through a
154		-	33 network.
155		-	34 (2) To contract, either directly or through such networks, with
156		-	35 the office, or the office's contractors, to provide:
157		-	36 (A) services to Medicaid beneficiaries; and
158		-	37 (B) health care services in an efficient and cost effective
159		-	38 manner on a prepaid, capitation, or other reimbursement
160		-	39 basis.
161		-	40 (3) To undertake other managed health care activities.
162		-	41 Sec. 5. (a) Any health care provider licensed under this title or
163		-	42 IC 25 may apply to become a participating provider in the
164		-	SB 192—LS 6838/DI 92 4
165		-	1 networks described in this chapter provided the services the
166		-	2 provider contracts for are within the lawful scope of the provider's
167		-	3 practice.
168		-	4 (b) This section does not require a plan or network to provide
169		-	5 coverage for any specific health care service.
170		-	6 Sec. 6. A home health agency may authorize any of the
171		-	7 following, or any combination of the following, to undertake or
172		-	8 effectuate any of the activities identified in this chapter:
173		-	9 (1) The Indiana Association for Home and Hospice Care, Inc.
174		-	10 (2) Any subsidiary of the corporation named in subdivision
175		-	11 (1).
176		-	12 Sec. 7. The secretary or the secretary's designee shall supervise
177		-	13 and oversee the activities described in this chapter and may take
178		-	14 the following actions:
179		-	15 (1) Gather relevant facts, collect data, conduct public
180		-	16 hearings, invite and receive public comments, investigate
181		-	17 market conditions, conduct studies, and review documentary
182		-	18 evidence or require the home health agencies or their third
183		-	19 party designee to do the same.
184		-	20 (2) Evaluate the substantive merits of any action to be taken
185		-	21 by the home health agencies and assess whether the action
186		-	22 comports with the standards established by the general
187		-	23 assembly.
188		-	24 (3) Issue written decisions approving, modifying, or
189		-	25 disapproving the recommended action, and explaining the
190		-	26 reasons and rationale for the decision.
191		-	27 (4) Require home health agencies or their third party
192		-	28 designees to report annually on the extent of the benefits
193		-	29 realized by the actions taken under this chapter.
194		-	30 Sec. 8. The secretary may adopt rules under IC 4-22-2 to
195		-	31 implement this chapter.
196		-	32 SECTION 5. IC 25-26-13-31.2, AS AMENDED BY P.L.56-2023,
197		-	33 SECTION 239, IS AMENDED TO READ AS FOLLOWS
198		-	34 [EFFECTIVE JULY 1, 2024]: Sec. 31.2. (a) A pharmacist may
199		-	35 administer an immunization to an individual under a drug order or
200		-	36 prescription.
201		-	37 (b) Subject to subsection (c), a pharmacist may administer
202		-	38 immunizations for the following an immunization that is
203		-	39 recommended by the federal Centers for Disease Control and
204		-	40 Prevention Advisory Committee on Immunization Practices to a
205		-	41 group of individuals under a drug order, under a prescription, or
206		-	42 according to a protocol approved by a physician.
207		-	SB 192—LS 6838/DI 92 5
208		-	1 (1) Influenza.
209		-	2 (2) Shingles (herpes zoster).
210		-	3 (3) Pneumonia.
211		-	4 (4) Tetanus, diphtheria, and acellular pertussis (whooping cough).
212		-	5 (5) Human papillomavirus (HPV) infection.
213		-	6 (6) Meningitis.
214		-	7 (7) Measles, mumps, and rubella.
215		-	8 (8) Varicella.
216		-	9 (9) Hepatitis A.
217		-	10 (10) Hepatitis B.
218		-	11 (11) Haemophilus influenzae type b (Hib).
219		-	12 (12) Coronavirus disease.
220		-	13 (c) A pharmacist may administer an immunization under subsection
221		-	14 (b) if the following requirements are met:
222		-	15 (1) The physician specifies in the drug order, prescription, or
223		-	16 protocol the group of individuals to whom the immunization may
224		-	17 be administered.
225		-	18 (2) The physician who writes the drug order, prescription, or
226		-	19 protocol is licensed and actively practicing with a medical office
227		-	20 in Indiana and not employed by a pharmacy.
228		-	21 (3) The pharmacist who administers the immunization is
229		-	22 responsible for notifying, not later than fourteen (14) days after
230		-	23 the pharmacist administers the immunization, the physician who
231		-	24 authorized the immunization and the individual's primary care
232		-	25 physician that the individual received the immunization.
233		-	26 (4) If the physician uses a protocol, the protocol may apply only
234		-	27 to an individual or group of individuals who
235		-	28 (A) except as provided in clause (B), are at least eleven (11)
236		-	29 years of age. or
237		-	30 (B) for the pneumonia immunization under subsection (b)(3),
238		-	31 are at least fifty (50) years of age.
239		-	32 (5) Before administering an immunization to an individual
240		-	33 according to a protocol approved by a physician, the pharmacist
241		-	34 must receive the consent of one (1) of the following:
242		-	35 (A) If the individual to whom the immunization is to be
243		-	36 administered is at least eleven (11) years of age but less than
244		-	37 eighteen (18) years of age, the parent or legal guardian of the
245		-	38 individual.
246		-	39 (B) If the individual to whom the immunization is to be
247		-	40 administered is at least eighteen (18) years of age but has a
248		-	41 legal guardian, the legal guardian of the individual.
249		-	42 (C) If the individual to whom the immunization is to be
250		-	SB 192—LS 6838/DI 92 6
251		-	1 administered is at least eighteen (18) years of age but has no
252		-	2 legal guardian, the individual.
253		-	3 A parent or legal guardian who is required to give consent under
254		-	4 this subdivision must be present at the time of immunization.
255		-	5 (d) If the Indiana department of health or the department of
256		-	6 homeland security determines that an emergency exists, subject to
257		-	7 IC 16-41-9-1.7(a)(2), a pharmacist may administer any immunization
258		-	8 in accordance with:
259		-	9 (1) the requirements of subsection (c)(1) through (c)(3); and
260		-	10 (2) any instructions in the emergency determination.
261		-	11 (e) A pharmacist or pharmacist's designee shall provide
262		-	12 immunization data to the immunization data registry (IC 16-38-5) in a
263		-	13 manner prescribed by the Indiana department of health unless:
264		-	14 (1) the individual receiving the immunization;
265		-	15 (2) the parent of the individual receiving the immunization, if the
266		-	16 individual receiving the immunization is less than eighteen (18)
267		-	17 years of age; or
268		-	18 (3) the legal guardian of the individual receiving the
269		-	19 immunization, if a legal guardian has been appointed;
270		-	20 has completed and filed with the pharmacist or pharmacist's designee
271		-	21 a written immunization data exemption form, as provided in
272		-	22 IC 16-38-5-2.
273		-	23 (f) If an immunization is administered under a protocol, then the
274		-	24 name, license number, and contact information of the physician who
275		-	25 wrote the protocol must be posted in the location where the
276		-	26 immunization is administered. A copy of the protocol must be available
277		-	27 for inspection by the individual receiving the immunization.
278		-	28 (g) A pharmacist may administer an immunization that is provided
279		-	29 according to a standing order, prescription, or protocol issued under
280		-	30 this section or IC 16-19-4-11 by the state health commissioner or the
281		-	31 commissioner's designated public health authority who is a licensed
282		-	32 prescriber. If a pharmacist has received a protocol to administer an
283		-	33 immunization from a physician and that specific immunization is
284		-	34 covered by a standing order, prescription, or protocol issued by the
285		-	35 state health commissioner or the commissioner's designated public
286		-	36 health authority, the pharmacist must administer the immunization
287		-	37 according to the standing order, prescription, or protocol issued by the
288		-	38 state health commissioner or the commissioner's designated public
289		-	39 health authority.
290		-	40 SECTION 6. IC 34-30-2.1-207.4 IS ADDED TO THE INDIANA
291		-	41 CODE AS A NEW SECTION TO READ AS FOLLOWS
292		-	42 [EFFECTIVE JULY 1, 2024]: Sec. 207.4. IC 16-27-6-0.5 (Concerning
293		-	SB 192—LS 6838/DI 92 7
294		-	1 federal and state antitrust laws for certain activities under the
295		-	2 home health agency cooperative agreement law).
296		-	SB 192—LS 6838/DI 92 8
297		-	COMMITTEE REPORT
298		-	Madam President: The Senate Committee on Health and Provider
299		-	Services, to which was referred Senate Bill No. 192, has had the same
300		-	under consideration and begs leave to report the same back to the
301		-	Senate with the recommendation that said bill be AMENDED as
302		-	follows:
303		-	Page 1, delete lines 1 through 15.
304		-	Delete pages 2 through 8.
305		-	Page 9, delete lines 1 through 23.
306		-	Page 9, line 30, delete "physician" and insert "emergency".
307		-	Page 9, line 33, delete "professional" and insert "emergency".
308		-	Page 9, line 36, delete "professional" and insert "emergency".
309		-	Page 9, line 37, after "." insert "A managed care organization shall
310		-	reimburse the physician in accordance with an autopay list
311		-	published by the office.".
312		-	Page 10, line 5, delete "professional" and insert "emergency".
313		-	Page 10, between lines 10 and 11, begin a new paragraph and insert:
314		-	"(d) A managed care organization:
315		-	(1) may not deny a claim solely because the claim code is not
316		-	included on the office's autopay list; and
317		-	(2) shall consider each claim based on the prudent layperson
318		-	standard.".
319		-	Page 10, delete lines 11 through 42.
320		-	Delete pages 11 through 12.
321		-	Page 13, delete lines 1 through 33.
322		-	Page 16, delete lines 2 through 42.
323		-	Page 19, delete lines 9 through 42.
324		-	Page 20, delete lines 1 through 23.
325		-	Renumber all SECTIONS consecutively.
326		-	and when so amended that said bill do pass and be reassigned to the
327		-	Senate Committee on Appropriations.
328		-	(Reference is to SB 192 as introduced.)
329		-	CHARBONNEAU, Chairperson
330		-	Committee Vote: Yeas 9, Nays 0.
331		-	SB 192—LS 6838/DI 92
	82	+	1 SECTION 1. IC 4-21.5-1-4 IS AMENDED TO READ AS
	83	+	2 FOLLOWS [EFFECTIVE JULY 1, 2024]: Sec. 4. "Agency action"
	84	+	3 means any of the following:
	85	+	4 (1) The whole or a part of an order.
	86	+	5 (2) The failure to issue an order.
	87	+	6 (3) An agency's performance of, or failure to perform, any other
	88	+	7 duty, function, or activity under this article.
	89	+	8 (4) A final action taken by a managed care organization.
	90	+	9 SECTION 2. IC 4-21.5-1-8.2 IS ADDED TO THE INDIANA
	91	+	10 CODE AS A NEW SECTION TO READ AS FOLLOWS
	92	+	11 [EFFECTIVE JULY 1, 2024]: Sec. 8.2. "Managed care
	93	+	12 organization" has the meaning set forth in IC 12-7-2-126.9.
	94	+	13 SECTION 3. IC 4-21.5-2-6, AS AMENDED BY P.L.53-2018,
	95	+	14 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	96	+	15 JULY 1, 2024]: Sec. 6. This article does not apply to the formulation,
	97	+	2024 IN 192—LS 6838/DI 92 2
	98	+	1 issuance, or administrative review (but does apply to the judicial
	99	+	2 review and civil enforcement) of any of the following:
	100	+	3 (1) Except as provided in IC 12-17.2-3.5-17, IC 12-17.2-4-18.7,
	101	+	4 IC 12-17.2-5-18.7, and IC 12-17.2-6-20, determinations by the
	102	+	5 division of family resources and the department of child services.
	103	+	6 (2) Determinations by the alcohol and tobacco commission.
	104	+	7 (3) Determinations by the office of Medicaid policy and planning
	105	+	8 concerning recipients and applicants of Medicaid. However, this
	106	+	9 article does apply to determinations agency actions by the office
	107	+	10 of Medicaid policy and planning or a managed care
	108	+	11 organization concerning providers.
	109	+	12 SECTION 4. IC 4-21.5-2-9 IS ADDED TO THE INDIANA CODE
	110	+	13 AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
	111	+	14 1, 2024]: Sec. 9. The amendments made to IC 4-21.5-1-4,
	112	+	15 IC 4-21.5-1-8.2, IC 4-21.5-2-6, IC 4-21.5-3-6, IC 4-21.5-3-7,
	113	+	16 IC 4-21.5-3-8, IC 4-21.5-3-17, IC 4-21.5-3-27, and IC 4-21.5-3-32 in
	114	+	17 the 2024 session of the general assembly apply only to agency
	115	+	18 actions commenced under IC 4-21.5-3 after June 30, 2024.
	116	+	19 SECTION 5. IC 4-21.5-3-6, AS AMENDED BY P.L.241-2023,
	117	+	20 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	118	+	21 JULY 1, 2024]: Sec. 6. (a) Notice shall be given under this section
	119	+	22 concerning the following:
	120	+	23 (1) A safety order under IC 22-8-1.1.
	121	+	24 (2) Any order that:
	122	+	25 (A) imposes a sanction on a person or terminates a legal right,
	123	+	26 duty, privilege, immunity, or other legal interest of a person;
	124	+	27 (B) is not described in section 4 or 5 of this chapter or
	125	+	28 IC 4-21.5-4; and
	126	+	29 (C) by statute becomes effective without a proceeding under
	127	+	30 this chapter if there is no request for a review of the order
	128	+	31 within a specified period after the order is issued or served.
	129	+	32 (3) A notice of program reimbursement or equivalent
	130	+	33 determination or other notice regarding a hospital's
	131	+	34 reimbursement issued by the office of Medicaid policy and
	132	+	35 planning, or by a contractor of the office of Medicaid policy and
	133	+	36 planning, or a managed care organization regarding a hospital's
	134	+	37 year end cost settlement.
	135	+	38 (4) A determination of audit findings or an equivalent
	136	+	39 determination by the office of Medicaid policy and planning, or
	137	+	40 by a contractor of the office of Medicaid policy and planning, or
	138	+	41 a managed care organization arising from a Medicaid
	139	+	42 postpayment or concurrent audit of a hospital's Medicaid claims.
	140	+	2024 IN 192—LS 6838/DI 92 3
	141	+	1 (5) A license suspension or revocation under:
	142	+	2 (A) IC 24-4.4-2;
	143	+	3 (B) IC 24-4.5-3;
	144	+	4 (C) IC 28-1-29;
	145	+	5 (D) IC 28-7-5;
	146	+	6 (E) IC 28-8-4.1; or
	147	+	7 (F) IC 28-8-5.
	148	+	8 (6) An order issued by the secretary or the secretary's designee
	149	+	9 against providers regulated by the division of aging or the bureau
	150	+	10 of disabilities services and not licensed by the Indiana department
	151	+	11 of health under IC 16-27 or IC 16-28.
	152	+	12 (b) When an agency issues an order described by subsection (a), the
	153	+	13 agency shall give notice to the following persons:
	154	+	14 (1) Each person to whom the order is specifically directed.
	155	+	15 (2) Each person to whom a law requires notice to be given.
	156	+	16 A person who is entitled to notice under this subsection is not a party
	157	+	17 to any proceeding resulting from the grant of a petition for review
	158	+	18 under section 7 of this chapter unless the person is designated as a
	159	+	19 party in the record of the proceeding.
	160	+	20 (c) The notice must include the following:
	161	+	21 (1) A brief description of the order.
	162	+	22 (2) A brief explanation of the available procedures and the time
	163	+	23 limit for seeking administrative review of the order under section
	164	+	24 7 of this chapter.
	165	+	25 (3) Any other information required by law.
	166	+	26 (d) An order described in subsection (a) is effective fifteen (15) days
	167	+	27 after the order is served, unless a statute other than this article specifies
	168	+	28 a different date or the agency specifies a later date in its order. This
	169	+	29 subsection does not preclude an agency from issuing, under
	170	+	30 IC 4-21.5-4, an emergency or other temporary order concerning the
	171	+	31 subject of an order described in subsection (a).
	172	+	32 (e) If a petition for review of an order described in subsection (a) is
	173	+	33 filed within the period set by section 7 of this chapter and a petition for
	174	+	34 stay of effectiveness of the order is filed by a party or another person
	175	+	35 who has a pending petition for intervention in the proceeding, an
	176	+	36 administrative law judge shall, as soon as practicable, conduct a
	177	+	37 preliminary hearing to determine whether the order should be stayed in
	178	+	38 whole or in part. The burden of proof in the preliminary hearing is on
	179	+	39 the person seeking the stay. The administrative law judge may stay the
	180	+	40 order in whole or in part. The order concerning the stay may be issued
	181	+	41 after an order described in subsection (a) becomes effective. The
	182	+	42 resulting order concerning the stay shall be served on the parties and
	183	+	2024 IN 192—LS 6838/DI 92 4
	184	+	1 any person who has a pending petition for intervention in the
	185	+	2 proceeding. It must include a statement of the facts and law on which
	186	+	3 it is based.
	187	+	4 SECTION 6. IC 4-21.5-3-7, AS AMENDED BY P.L.205-2019,
	188	+	5 SECTION 7, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	189	+	6 JULY 1, 2024]: Sec. 7. (a) To qualify for review of a personnel action
	190	+	7 to which IC 4-15-2.2 applies, a person must comply with
	191	+	8 IC 4-15-2.2-42. To qualify for review of any other order described in
	192	+	9 section 4, 5, or 6 of this chapter, a person must petition for review in a
	193	+	10 writing that does the following:
	194	+	11 (1) States facts demonstrating that:
	195	+	12 (A) the petitioner is a person to whom the order is specifically
	196	+	13 directed;
	197	+	14 (B) the petitioner is aggrieved or adversely affected by the
	198	+	15 order; or
	199	+	16 (C) the petitioner is entitled to review under any law.
	200	+	17 (2) Includes, with respect to determinations of notice of program
	201	+	18 reimbursement and audit findings described in section 6(a)(3) and
	202	+	19 6(a)(4) of this chapter, a statement of issues that includes:
	203	+	20 (A) the specific findings, action, or determination of the office
	204	+	21 of Medicaid policy and planning, or of a contractor of the
	205	+	22 office of Medicaid policy and planning, or a managed care
	206	+	23 organization from which the provider is appealing;
	207	+	24 (B) the reason the provider believes that the finding, action, or
	208	+	25 determination of the office of Medicaid policy and planning,
	209	+	26 or of a contractor of the office of Medicaid policy and
	210	+	27 planning, or a managed care organization was in error; and
	211	+	28 (C) with respect to each finding, action, or determination of
	212	+	29 the office of Medicaid policy and planning or of a contractor
	213	+	30 of the office of Medicaid policy and planning, the statutes or
	214	+	31 rules that support the provider's contentions of error.
	215	+	32 Not more than thirty (30) days after filing a petition for review
	216	+	33 under this section, At any point in the proceeding, and upon a
	217	+	34 finding of good cause by the administrative law judge, a person
	218	+	35 may amend the statement of issues contained in a petition for
	219	+	36 review to add one (1) or more additional issues.
	220	+	37 (3) Is filed:
	221	+	38 (A) with respect to an order described in section 4, 5, 6(a)(1),
	222	+	39 6(a)(2), or 6(a)(5) of this chapter, with the ultimate authority
	223	+	40 for the agency issuing the order office of administrative law
	224	+	41 proceedings within fifteen (15) days after the person is given
	225	+	42 notice of the order or any longer period set by statute; or
	226	+	2024 IN 192—LS 6838/DI 92 5
	227	+	1 (B) with respect to a determination described in section 6(a)(3)
	228	+	2 or 6(a)(4) of this chapter, with the office of Medicaid policy
	229	+	3 and planning administrative law proceedings not more than
	230	+	4 one hundred eighty (180) days after the hospital is provided
	231	+	5 notice of the determination.
	232	+	6 The issuance of an amended notice of program reimbursement by
	233	+	7 the office of Medicaid policy and planning does not extend the
	234	+	8 time within which a hospital must file a petition for review from
	235	+	9 the original notice of program reimbursement under clause (B),
	236	+	10 except for matters that are the subject of the amended notice of
	237	+	11 program reimbursement.
	238	+	12 If the petition for review is denied, the petition shall be treated as a
	239	+	13 petition for intervention in any review initiated under subsection (d).
	240	+	14 (b) If an agency denies a petition for review under subsection (a) is
	241	+	15 denied and the petitioner is not allowed to intervene as a party in a
	242	+	16 proceeding resulting from the grant of the petition for review of another
	243	+	17 person, the agency office of administrative proceedings shall serve
	244	+	18 a written notice on the petitioner that includes the following:
	245	+	19 (1) A statement that the petition for review is denied.
	246	+	20 (2) A brief explanation of the available procedures and the time
	247	+	21 limit for seeking administrative review of the denial under
	248	+	22 subsection (c).
	249	+	23 (c) An agency shall assign an administrative law judge, or after June
	250	+	24 30, 2020, if the proceeding is subject to the jurisdiction of the office of
	251	+	25 administrative law proceedings, an agency shall request assignment of
	252	+	26 an administrative law judge by the office of administrative law
	253	+	27 proceedings, to Upon a person's written request, the administrative
	254	+	28 law judge shall conduct a preliminary hearing on the issue of whether
	255	+	29 a person is qualified under subsection (a) to obtain review of an order.
	256	+	30 when a person requests reconsideration of the denial of review in a
	257	+	31 writing that: The written request is valid if the request:
	258	+	32 (1) states facts demonstrating that the person filed a petition for
	259	+	33 review of an order described in section 4, 5, or 6 of this chapter;
	260	+	34 (2) states facts demonstrating that the person was denied review
	261	+	35 without an evidentiary hearing; relevant to the denial and any
	262	+	36 supporting laws, rules, or regulations; and
	263	+	37 (3) is filed with the ultimate authority for the agency denying the
	264	+	38 review administrative law judge within fifteen (15) days after
	265	+	39 the notice required by subsection (b) was served on the petitioner.
	266	+	40 Notice of the preliminary hearing shall be given to the parties, each
	267	+	41 person who has a pending petition for intervention in the proceeding,
	268	+	42 and any other person described by section 5(d) of this chapter. The
	269	+	2024 IN 192—LS 6838/DI 92 6
	270	+	1 resulting order must be served on the persons to whom notice of the
	271	+	2 preliminary hearing must be given and include a statement of the facts
	272	+	3 and law on which it is based.
	273	+	4 (d) If a petition for review is granted, the petitioner becomes a party
	274	+	5 to the proceeding. and:
	275	+	6 (1) the agency shall assign the matter to an administrative law
	276	+	7 judge or, after June 30, 2020, if the proceeding is subject to the
	277	+	8 jurisdiction of the office of administrative law proceedings,
	278	+	9 request assignment of an administrative law judge by the office of
	279	+	10 administrative law proceedings; or
	280	+	11 (2) The administrative law judge may certify the matter to
	281	+	12 another agency for the assignment of an administrative law judge
	282	+	13 (if a statute transfers responsibility for a hearing on the matter to
	283	+	14 another agency).
	284	+	15 The agency granting the administrative review or the agency to which
	285	+	16 the matter is transferred may conduct informal proceedings to settle the
	286	+	17 matter to the extent allowed by law.
	287	+	18 SECTION 7. IC 4-21.5-3-8 IS AMENDED TO READ AS
	288	+	19 FOLLOWS [EFFECTIVE JULY 1, 2024]: Sec. 8. (a) An agency may
	289	+	20 issue a sanction or terminate a legal right, duty, privilege, immunity, or
	290	+	21 other legal interest not described by section 4, 5, or 6 of this chapter
	291	+	22 only after conducting a proceeding under this chapter. However, this
	292	+	23 subsection does not preclude an agency from issuing, under
	293	+	24 IC 4-21.5-4, an emergency or other temporary order concerning the
	294	+	25 subject of the proceeding. Orders to which this subsection applies
	295	+	26 include any order that suspends Medicaid payments, as determined
	296	+	27 by the office of Medicaid policy and planning.
	297	+	28 (b) When an agency seeks to issue an order that is described by
	298	+	29 subsection (a), the agency shall serve a complaint upon:
	299	+	30 (1) each person to whom any resulting order will be specifically
	300	+	31 directed; and
	301	+	32 (2) any other person required by law to be notified.
	302	+	33 A person notified under this subsection is not a party to the proceeding
	303	+	34 unless the person is a person against whom any resulting order will be
	304	+	35 specifically directed or the person is designated by the agency as a
	305	+	36 party in the record of the proceeding.
	306	+	37 (c) The complaint required by subsection (b) must include the
	307	+	38 following:
	308	+	39 (1) A short, plain statement showing that the pleader is entitled to
	309	+	40 an order.
	310	+	41 (2) A demand for the order that the pleader seeks.
	311	+	42 (d) The administrative law judge conducting a proceeding under
	312	+	2024 IN 192—LS 6838/DI 92 7
	313	+	1 this section concerning a Medicaid payment suspension may
	314	+	2 consider the factors under 42 CFR 455.23(e) or 42 CFR 455.23(f).
	315	+	3 The administrative law judge's decision to halt a Medicaid
	316	+	4 payment suspension does not prohibit the office of Medicaid policy
	317	+	5 and planning from referring the provider to the Medicaid fraud
	318	+	6 control unit.
	319	+	7 SECTION 8. IC 4-21.5-3-17 IS AMENDED TO READ AS
	320	+	8 FOLLOWS [EFFECTIVE JULY 1, 2024]: Sec. 17. (a) The
	321	+	9 administrative law judge, at appropriate stages of a proceeding, shall
	322	+	10 give all parties full opportunity to file pleadings, amendments to
	323	+	11 pleadings or initial filings, motions, and objections and submit offers
	324	+	12 of settlement.
	325	+	13 (b) The administrative law judge, at appropriate stages of a
	326	+	14 proceeding, may give all parties full opportunity to file briefs, proposed
	327	+	15 findings of fact, and proposed orders.
	328	+	16 (c) A party shall serve copies of any filed item on all parties.
	329	+	17 (d) The administrative law judge shall serve copies of all notices,
	330	+	18 orders, and other papers generated by the administrative law judge on
	331	+	19 all parties. The administrative law judge shall give notice of
	332	+	20 preliminary hearings, prehearing conferences, hearings, stays, and
	333	+	21 orders disposing of the proceeding to persons described by section 5(d)
	334	+	22 of this chapter.
	335	+	23 SECTION 9. IC 4-21.5-3-27 IS AMENDED TO READ AS
	336	+	24 FOLLOWS [EFFECTIVE JULY 1, 2024]: Sec. 27. (a) If the
	337	+	25 administrative law judge is the ultimate authority for the agency, the
	338	+	26 ultimate authority's order disposing of a proceeding is a final order. If
	339	+	27 the administrative law judge is not the ultimate authority, the
	340	+	28 administrative law judge's order disposing of the proceeding becomes
	341	+	29 a final order when affirmed under section 29 of this chapter. Regardless
	342	+	30 of whether the order is final, it must comply with this section.
	343	+	31 (b) This subsection applies only to an order not subject to subsection
	344	+	32 (c). The order must include, separately stated, findings of fact for all
	345	+	33 aspects of the order, including the remedy prescribed and, if applicable,
	346	+	34 the action taken on a petition for stay of effectiveness. Findings of
	347	+	35 ultimate fact must be accompanied by a concise statement of the
	348	+	36 underlying basic facts of record to support the findings. The order must
	349	+	37 also include a statement of the available procedures and time limit for
	350	+	38 seeking administrative review of the order (if administrative review is
	351	+	39 available). The administrative law judge shall apply the standards
	352	+	40 of review described in IC 4-21.5-5-14 when evaluating an agency
	353	+	41 action or order.
	354	+	42 (c) This subsection applies only to an order of the ultimate authority
	355	+	2024 IN 192—LS 6838/DI 92 8
	356	+	1 entered under IC 13, IC 14, or IC 25. The order must include separately
	357	+	2 stated findings of fact and, if a final order, conclusions of law for all
	358	+	3 aspects of the order, including the remedy prescribed and, if applicable,
	359	+	4 the action taken on a petition for stay of effectiveness. Findings of
	360	+	5 ultimate fact must be accompanied by a concise statement of the
	361	+	6 underlying basic facts of record to support the findings. Conclusions of
	362	+	7 law must consider prior final orders (other than negotiated orders) of
	363	+	8 the ultimate authority under the same or similar circumstances if those
	364	+	9 prior final orders are raised on the record in writing by a party and must
	365	+	10 state the reasons for deviations from those prior orders. The order must
	366	+	11 also include a statement of the available procedures and time limit for
	367	+	12 seeking administrative review of the order (if administrative review is
	368	+	13 available). The ultimate authority shall apply the standards of
	369	+	14 review described under this section when evaluating an agency
	370	+	15 action or order.
	371	+	16 (d) Findings must be based exclusively upon the evidence of record
	372	+	17 in the proceeding and on matters officially noticed in that proceeding.
	373	+	18 Findings must be based upon the kind of evidence that is substantial
	374	+	19 and reliable. The administrative law judge's experience, technical
	375	+	20 competence, and specialized knowledge may be used in evaluating
	376	+	21 evidence.
	377	+	22 (e) Conclusions of law must be based upon duly enacted laws,
	378	+	23 agency rules, or judicial opinions. An administrative law judge or
	379	+	24 ultimate authority shall invalidate any agency action or order that
	380	+	25 is based upon a policy or other publication that does not comply
	381	+	26 with IC 4-22-2 and may order the agency to pay attorney's fees
	382	+	27 under section 27.5 of this chapter.
	383	+	28 (e) (f) A substitute administrative law judge may issue the order
	384	+	29 under this section upon the record that was generated by a previous
	385	+	30 administrative law judge.
	386	+	31 (f) (g) The administrative law judge may allow the parties a
	387	+	32 designated amount of time after conclusion of the hearing for the
	388	+	33 submission of proposed findings.
	389	+	34 (g) (h) An order under this section shall be issued in writing within
	390	+	35 ninety (90) days after conclusion of the hearing or after submission of
	391	+	36 proposed findings in accordance with subsection (f), (g), unless this
	392	+	37 period is waived or extended with the written consent of all parties. or
	393	+	38 for good cause shown.
	394	+	39 (h) (i) The administrative law judge shall have copies of the order
	395	+	40 under this section delivered to each party and to the ultimate authority
	396	+	41 for the agency (if it is not rendered by the ultimate authority).
	397	+	42 SECTION 10. IC 4-21.5-3-32 IS AMENDED TO READ AS
	398	+	2024 IN 192—LS 6838/DI 92 9
	399	+	1 FOLLOWS [EFFECTIVE JULY 1, 2024]: Sec. 32. (a) Each agency
	400	+	2 shall make all written final orders available for public inspection and
	401	+	3 copying under IC 5-14-3. The agency shall index final orders that are
	402	+	4 issued after June 30, 1987, by name and subject. An agency shall index
	403	+	5 an order issued before July 1, 1987, if a person submits a written
	404	+	6 request to the agency that the order be indexed. An agency shall delete
	405	+	7 from these orders identifying details to the extent required by IC 5-14-3
	406	+	8 or other law. In each case, the justification for the deletion must be
	407	+	9 explained in writing and attached to the order. The office of
	408	+	10 administrative law proceedings shall create a data base that
	409	+	11 contains all final orders in a searchable format and that is
	410	+	12 accessible to the public. The public shall not be charged a fee to
	411	+	13 access the data base. Not more than sixty (60) calendar days after
	412	+	14 the issuance of the final order, the agency shall prepare final
	413	+	15 orders for publication in the data base, including redacting private,
	414	+	16 protected information, or other confidential information in
	415	+	17 accordance with state or federal law.
	416	+	18 (b) An agency may not rely on a written final order as precedent to
	417	+	19 the detriment of any person until the order has been made available for
	418	+	20 to the public inspection and indexed in the manner described in
	419	+	21 subsection (a). However, this subsection does not apply to any person
	420	+	22 who has actual timely knowledge of the order. The burden of proving
	421	+	23 that knowledge is on the agency.
	422	+	24 SECTION 11. IC 12-15-12-24 IS ADDED TO THE INDIANA
	423	+	25 CODE AS A NEW SECTION TO READ AS FOLLOWS
	424	+	26 [EFFECTIVE JULY 1, 2024]: Sec. 24. (a) If:
	425	+	27 (1) a physician has entered into a provider agreement with:
	426	+	28 (A) the office; or
	427	+	29 (B) a managed care organization;
	428	+	30 under IC 12-15-11-4(a) for the provision of physician services;
	429	+	31 and
	430	+	32 (2) the physician, subject to the provider agreement referred
	431	+	33 to in subdivision (1), provides professional services to
	432	+	34 individuals participating in the state Medicaid program;
	433	+	35 the office or the managed care organization shall promptly
	434	+	36 compensate the physician for the professional services in
	435	+	37 accordance with the provider agreement.
	436	+	38 (b) A physician's compensation under subsection (a) shall not be
	437	+	39 delayed due to the retrospective review of the medical services
	438	+	40 provided or for any other reason unless the cause of the delay is
	439	+	41 specifically provided for in:
	440	+	42 (1) this article;
	441	+	2024 IN 192—LS 6838/DI 92 10
	442	+	1 (2) a rule adopted under this article;
	443	+	2 (3) 42 CFR 438; or
	444	+	3 (4) the provider agreement referred to in subsection (a)(1).
	445	+	4 (c) A physician shall not be denied compensation for
	446	+	5 professional services to which subsection (a) applies unless the
	447	+	6 cause of the denial is specifically provided for in:
	448	+	7 (1) this article;
	449	+	8 (2) a rule adopted under this article;
	450	+	9 (3) 42 CFR 438; or
	451	+	10 (4) the provider agreement referred to in subsection (a)(1).
	452	+	11 SECTION 12. IC 12-15-12-25 IS ADDED TO THE INDIANA
	453	+	12 CODE AS A NEW SECTION TO READ AS FOLLOWS
	454	+	13 [EFFECTIVE JULY 1, 2024]: Sec. 25. Any action, order, or decision
	455	+	14 by a managed care organization that adversely affects a provider
	456	+	15 under contract with that entity is subject to administrative review
	457	+	16 under IC 4-21.5. An agency's final order is binding on the managed
	458	+	17 care organization.
	459	+	18 SECTION 13. IC 12-15-12-26 IS ADDED TO THE INDIANA
	460	+	19 CODE AS A NEW SECTION TO READ AS FOLLOWS
	461	+	20 [EFFECTIVE JULY 1, 2024]: Sec. 26. (a) For purposes of this
	462	+	21 section, the term "prepayment review" means any action by a
	463	+	22 managed care organization or a contractor, assignee, agent, or
	464	+	23 entity acting on the behalf of a managed care organization
	465	+	24 requiring a provider to provide medical record documentation in
	466	+	25 conjunction with or after the submission of a claim for payment for
	467	+	26 medical services rendered, but before the claim has been
	468	+	27 adjudicated by the managed care organization.
	469	+	28 (b) A managed care organization or a contractor, assignee,
	470	+	29 agent, or entity acting on the behalf of a managed care
	471	+	30 organization shall be prohibited from requiring any enrolled
	472	+	31 provider to be subject to prepayment review unless the
	473	+	32 requirement is implemented directly by the office.
	474	+	33 (c) Nothing in this section shall prohibit a managed care
	475	+	34 organization from notifying the office of providers suspected of
	476	+	35 committing fraud and abuse or prohibit the office from requiring
	477	+	36 managed care organizations to coordinate efforts to combat and
	478	+	37 prevent fraud and abuse pursuant to federal or state law or
	479	+	38 regulation.
	480	+	39 (d) When authorized by the office under this section, a managed
	481	+	40 care organization's prepayment review is subject to all of the
	482	+	41 following conditions:
	483	+	42 (1) During the prepayment review period, the managed care
	484	+	2024 IN 192—LS 6838/DI 92 11
	485	+	1 organization shall give detailed reports to the provider on a
	486	+	2 weekly basis that includes, at a minimum, the claim or claims
	487	+	3 that were denied, the requirement or requirements that must
	488	+	4 be followed, the reason any claim or claims did not comply
	489	+	5 with such requirement or requirements, and the name and
	490	+	6 phone number of the reviewer.
	491	+	7 (2) The managed care organization must designate a reviewer
	492	+	8 to be responsible for reviewing and discussing all prepayment
	493	+	9 review findings with the provider. The reviewer must have
	494	+	10 knowledge of the provider's claims and the resulting findings.
	495	+	11 The reviewer shall meet with a provider at least on a monthly
	496	+	12 basis during the term of the prepayment review.
	497	+	13 (3) The managed care organization must allow the provider
	498	+	14 to challenge the managed care organization's findings during
	499	+	15 the term of prepayment review. The provider shall be allowed
	500	+	16 to appeal the managed care organization's findings to the
	501	+	17 office. Any decision by the office shall be binding on the
	502	+	18 managed care organization.
	503	+	19 (4) The managed care organization shall deliver a final report
	504	+	20 to the provider within thirty (30) days of the end of the
	505	+	21 prepayment review term summarizing the findings and
	506	+	22 providing educational materials to the provider.
	507	+	23 (5) The prepayment period cannot last more than six (6)
	508	+	24 months. The office may authorize an extension of payment
	509	+	25 review if the managed care organization demonstrates that
	510	+	26 the provider willfully or recklessly ignored the managed care
	511	+	27 organization directives during the prepayment review period.
	512	+	28 (6) The provider shall be deemed to be released from
	513	+	29 prepayment review if the managed care organization fails to
	514	+	30 meet any obligations under this section.
	515	+	31 (7) The managed care organization shall not use prepayment
	516	+	32 review to retaliate against a provider for exercising the
	517	+	33 provider's statutory or contractual rights.
	518	+	34 SECTION 14. IC 12-15-13-6, AS AMENDED BY P.L.152-2017,
	519	+	35 SECTION 22, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	520	+	36 JULY 1, 2024]: Sec. 6. (a) Except as provided by IC 12-15-35-50, a
	521	+	37 notice or bulletin that is issued by:
	522	+	38 (1) the office;
	523	+	39 (2) a contractor of the office; or
	524	+	40 (3) a managed care organization;
	525	+	41 concerning a change to the Medicaid program, including a change to
	526	+	42 prior authorization, claims processing, payment rates, and medical
	527	+	2024 IN 192—LS 6838/DI 92 12
	528	+	1 policies, that does not require use of the rulemaking process under
	529	+	2 IC 4-22-2 may not become effective until thirty (30) days after the date
	530	+	3 the notice or bulletin is communicated to the parties affected by the
	531	+	4 notice or bulletin.
	532	+	5 (b) The office must provide a written notice or bulletin described in
	533	+	6 subsection (a) within five (5) business days after the date on the notice
	534	+	7 or bulletin.
	535	+	8 (c) If the office, a contractor of the office, or a managed care
	536	+	9 organization does not comply with the requirements in subsections (a)
	537	+	10 and (b):
	538	+	11 (1) the notice or bulletin is void;
	539	+	12 (2) a claim may not be denied because the claim does not comply
	540	+	13 with the void notice or bulletin; and
	541	+	14 (3) the office, a contractor of the office, or a managed care
	542	+	15 organization may not reissue the bulletin or notice for thirty (30)
	543	+	16 days unless the change is required by the federal government to
	544	+	17 be implemented earlier.
	545	+	18 (d) Any notice or bulletin issued under this section does not have
	546	+	19 the force and effect of law under IC 4-22-2.
	547	+	20 SECTION 15. IC 12-15-23-1 IS AMENDED TO READ AS
	548	+	21 FOLLOWS [EFFECTIVE JULY 1, 2024]: Sec. 1. Except as provided
	549	+	22 in section 2 of this chapter, if the administrator of the office determines
	550	+	23 that there are reasonable grounds to suspect that a provider has
	551	+	24 received payments that the provider is not entitled to under Medicaid,
	552	+	25 the administrator shall certify the evidence of the suspected activity to
	553	+	26 the state Medicaid fraud control unit established under IC 4-6-10. (a)
	554	+	27 Subject to the procedures in this section, the office may suspend
	555	+	28 Medicaid payments to a provider on the basis of a credible
	556	+	29 allegation of fraud and refer its findings to the Medicaid fraud
	557	+	30 control unit for investigation pursuant to 42 CFR 455.23.
	558	+	31 (b) The office's process for determination of a credible
	559	+	32 allegation of fraud shall include the administrative hearing
	560	+	33 conducted under IC 4-21.5-3-8. This subsection does not apply
	561	+	34 when the office bases its decision to suspend Medicaid payments on
	562	+	35 verified proof of fraud.
	563	+	36 (c) The office shall not suspend a provider's payments if an
	564	+	37 administrative law judge determines that there is no credible
	565	+	38 allegation of fraud. Nothing in this subsection precludes the agency
	566	+	39 from referring the matter to the Medicaid fraud control unit for an
	567	+	40 investigation.
	568	+	41 (d) The office shall suspend a provider's Medicaid payments if
	569	+	42 an administrative law judge agrees that there is a credible
	570	+	2024 IN 192—LS 6838/DI 92 13
	571	+	1 allegation of fraud. In such cases, the office may proceed pursuant
	572	+	2 to 42 CFR 455.23.
	573	+	3 (e) To ensure that a Medicaid payment suspension is temporary,
	574	+	4 the office shall reexamine the facts, circumstances, laws, and any
	575	+	5 new evidence every ninety (90) days to determine whether the
	576	+	6 credible allegation of fraud continues. The office shall solicit
	577	+	7 information from the provider that is the subject of the sanction as
	578	+	8 part of its reevaluation. If the Medicaid fraud control unit, or any
	579	+	9 prosecuting authorities, have not certified to the office that there
	580	+	10 is evidence of fraud within six (6) months after receiving the
	581	+	11 referral, the office shall deem the legal proceedings completed and
	582	+	12 lift the Medicaid payment suspension.
	583	+	13 SECTION 16. IC 12-15-35.5-10 IS ADDED TO THE INDIANA
	584	+	14 CODE AS A NEW SECTION TO READ AS FOLLOWS
	585	+	15 [EFFECTIVE JULY 1, 2024]: Sec. 10. (a) As used in this section,
	586	+	16 "antiretroviral" means a drug used to prevent a retrovirus, such
	587	+	17 as the human immunodeficiency virus (HIV), from replicating.
	588	+	18 (b) As used in this section, "prior authorization" has the
	589	+	19 meaning set forth in 405 IAC 5-2-20.
	590	+	20 (c) As used in this section, "step therapy protocol" means a
	591	+	21 protocol that specifies, as a condition of coverage, the order in
	592	+	22 which certain prescription drugs must be used to treat a covered
	593	+	23 individual's condition.
	594	+	24 (d) A drug that is covered under a program described in section
	595	+	25 1 of this chapter, that has been approved by the federal Food and
	596	+	26 Drug Administration, and that is prescribed for the treatment or
	597	+	27 prevention of the human immunodeficiency virus (HIV) or
	598	+	28 acquired immunodeficiency syndrome (AIDS), including
	599	+	29 antiretrovirals, shall not be subject to:
	600	+	30 (1) prior authorization;
	601	+	31 (2) a step therapy protocol; or
	602	+	32 (3) any other protocol that could restrict or delay the
	603	+	33 dispensing of the drug.
	604	+	34 SECTION 17. IC 16-27-1-19, AS ADDED BY P.L.117-2023,
	605	+	35 SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	606	+	36 JULY 1, 2024]: Sec. 19. A home health agency is not required to
	607	+	37 conduct a preemployment physical or a tuberculosis test on a job
	608	+	38 applicant before the individual has contact with a home health agency
	609	+	39 patient.
	610	+	40 SECTION 18. IC 16-27-4-15 IS REPEALED [EFFECTIVE JULY
	611	+	41 1, 2024]. Sec. 15. An employee or agent of a personal services agency
	612	+	42 who will have direct client contact must complete a tuberculosis test in
	613	+	2024 IN 192—LS 6838/DI 92 14
	614	+	1 the same manner as required by the state department for licensed home
	615	+	2 health agency employees and agents.
	616	+	3 SECTION 19. IC 16-27-6 IS ADDED TO THE INDIANA CODE
	617	+	4 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
	618	+	5 JULY 1, 2024]:
	619	+	6 Chapter 6. Home Health Agency Cooperative Agreements
	620	+	7 Sec. 0.5. (a) The general assembly recognizes the importance
	621	+	8 and necessity of home health services and home health agencies to
	622	+	9 promote and protect the public's general health, safety, and
	623	+	10 welfare.
	624	+	11 (b) The general assembly finds it necessary and appropriate to
	625	+	12 encourage home health agencies to cooperate, take certain actions,
	626	+	13 and enter into agreements that will facilitate improved quality of
	627	+	14 care and increase access to home health services even if the
	628	+	15 cooperation or actions may:
	629	+	16 (1) be characterized as anticompetitive;
	630	+	17 (2) result in the acquisition, maintenance, or use of market
	631	+	18 power within the meaning of federal and state antitrust laws;
	632	+	19 or
	633	+	20 (3) otherwise have the effect of displacing competition.
	634	+	21 (c) The general assembly believes that it is in the state's best
	635	+	22 interest to supplant state and federal antitrust laws with:
	636	+	23 (1) the process provided in this chapter; and
	637	+	24 (2) active supervision from the secretary as set forth in this
	638	+	25 chapter.
	639	+	26 (d) It is the intent of the general assembly that this chapter
	640	+	27 immunize, to the fullest extent possible, a person from all federal
	641	+	28 and state antitrust laws for any cooperation or action approved
	642	+	29 and supervised under this chapter. This intent is within the public
	643	+	30 policy of the state to facilitate the provision of quality and cost
	644	+	31 efficient health care services to patients.
	645	+	32 Sec. 1. The definitions in IC 16-27-1 apply throughout this
	646	+	33 chapter.
	647	+	34 Sec. 2. As used in this chapter, "office" refers to the office of the
	648	+	35 secretary of family and social services established by IC 12-8-1.5-1.
	649	+	36 Sec. 3. As used in this chapter, "secretary" refers to the
	650	+	37 secretary of family and social services appointed under
	651	+	38 IC 12-8-1.5-2.
	652	+	39 Sec. 4. Home health agencies may enter into cooperative
	653	+	40 agreements to carry out the following activities:
	654	+	41 (1) To form and operate, either directly or indirectly, one (1)
	655	+	42 or more networks of home health agencies to arrange for the
	656	+	2024 IN 192—LS 6838/DI 92 15
	657	+	1 provision of health care services through such networks,
	658	+	2 including to contract either directly or indirectly through a
	659	+	3 network.
	660	+	4 (2) To contract, either directly or through such networks, with
	661	+	5 the office, or the office's contractors, to provide:
	662	+	6 (A) services to Medicaid beneficiaries; and
	663	+	7 (B) health care services in an efficient and cost effective
	664	+	8 manner on a prepaid, capitation, or other reimbursement
	665	+	9 basis.
	666	+	10 (3) To undertake other managed health care activities.
	667	+	11 Sec. 5. (a) Any health care provider licensed under this title or
	668	+	12 IC 25 may apply to become a participating provider in the
	669	+	13 networks described in this chapter provided the services the
	670	+	14 provider contracts for are within the lawful scope of the provider's
	671	+	15 practice.
	672	+	16 (b) This section does not require a plan or network to provide
	673	+	17 coverage for any specific health care service.
	674	+	18 Sec. 6. A home health agency may authorize any of the
	675	+	19 following, or any combination of the following, to undertake or
	676	+	20 effectuate any of the activities identified in this chapter:
	677	+	21 (1) The Indiana Association for Home and Hospice Care, Inc.
	678	+	22 (2) Any subsidiary of the corporation named in subdivision
	679	+	23 (1).
	680	+	24 Sec. 7. The secretary or the secretary's designee shall supervise
	681	+	25 and oversee the activities described in this chapter and may take
	682	+	26 the following actions:
	683	+	27 (1) Gather relevant facts, collect data, conduct public
	684	+	28 hearings, invite and receive public comments, investigate
	685	+	29 market conditions, conduct studies, and review documentary
	686	+	30 evidence or require the home health agencies or their third
	687	+	31 party designee to do the same.
	688	+	32 (2) Evaluate the substantive merits of any action to be taken
	689	+	33 by the home health agencies and assess whether the action
	690	+	34 comports with the standards established by the general
	691	+	35 assembly.
	692	+	36 (3) Issue written decisions approving, modifying, or
	693	+	37 disapproving the recommended action, and explaining the
	694	+	38 reasons and rationale for the decision.
	695	+	39 (4) Require home health agencies or their third party
	696	+	40 designees to report annually on the extent of the benefits
	697	+	41 realized by the actions taken under this chapter.
	698	+	42 Sec. 8. The secretary may adopt rules under IC 4-22-2 to
	699	+	2024 IN 192—LS 6838/DI 92 16
	700	+	1 implement this chapter.
	701	+	2 SECTION 20. IC 16-51-1-1, AS ADDED BY P.L.203-2023,
	702	+	3 SECTION 18, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	703	+	4 JULY 1, 2024]: Sec. 1. (a) This chapter applies to an Indiana nonprofit
	704	+	5 hospital system.
	705	+	6 (b) This chapter does not apply to the following:
	706	+	7 (1) A hospital licensed under IC 16-21-2 that is operated by:
	707	+	8 (A) a county;
	708	+	9 (B) a city pursuant to IC 16-23; or
	709	+	10 (C) the health and hospital corporation established under
	710	+	11 IC 16-22-8.
	711	+	12 (2) A critical access hospital that meets the criteria under 42 CFR
	712	+	13 485.601 through 42 CFR 485.647.
	713	+	14 (3) Any of the following hospitals licensed under IC 16-21-2:
	714	+	15 (A) A remote location of a hospital (as defined in 42 CFR
	715	+	16 413.65(a)(2)).
	716	+	17 (B) A free standing emergency department or other
	717	+	18 provider-based entity (as defined in 42 CFR 413.65(a)(2))
	718	+	19 that:
	719	+	20 (i) complies with requirements of 42 CFR 413.65; and
	720	+	21 (ii) has the provider-based entity's location listed on the
	721	+	22 hospital's license.
	722	+	23 (3) (4) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)).
	723	+	24 (4) (5) A federally qualified health center (as defined in 42 U.S.C.
	724	+	25 1396d(l)(2)(B)).
	725	+	26 (5) (6) An oncology treatment facility, even if owned or operated
	726	+	27 by a hospital.
	727	+	28 (6) (7) A health facility licensed under IC 16-28.
	728	+	29 (7) (8) A community mental health center certified under
	729	+	30 IC 12-21-2-3(5)(C).
	730	+	31 (8) (9) A private mental health institution licensed under
	731	+	32 IC 12-25, including a service facility location for a private mental
	732	+	33 health institution and reimbursed as a hospital-based outpatient
	733	+	34 service site.
	734	+	35 (9) (10) Services provided for the treatment of individuals with
	735	+	36 psychiatric disorders or chronic addiction disorders in:
	736	+	37 (A) any part of a hospital, whether or not a distinct part; or
	737	+	38 (B) an outpatient off campus site that is within thirty-five (35)
	738	+	39 miles of a hospital.
	739	+	40 (10) (11) Billing under the Medicare program or a Medicare
	740	+	41 advantage plan.
	741	+	42 (11) (12) Billing under the Medicaid program.
	742	+	2024 IN 192—LS 6838/DI 92 17
	743	+	1 SECTION 21. IC 25-26-13-31.2, AS AMENDED BY P.L.56-2023,
	744	+	2 SECTION 239, IS AMENDED TO READ AS FOLLOWS
	745	+	3 [EFFECTIVE JULY 1, 2024]: Sec. 31.2. (a) A pharmacist may
	746	+	4 administer an immunization to an individual under a drug order or
	747	+	5 prescription.
	748	+	6 (b) Subject to subsection (c), a pharmacist may administer
	749	+	7 immunizations for the following an immunization that is
	750	+	8 recommended by the federal Centers for Disease Control and
	751	+	9 Prevention Advisory Committee on Immunization Practices to a
	752	+	10 group of individuals under a drug order, under a prescription, or
	753	+	11 according to a protocol approved by a physician.
	754	+	12 (1) Influenza.
	755	+	13 (2) Shingles (herpes zoster).
	756	+	14 (3) Pneumonia.
	757	+	15 (4) Tetanus, diphtheria, and acellular pertussis (whooping cough).
	758	+	16 (5) Human papillomavirus (HPV) infection.
	759	+	17 (6) Meningitis.
	760	+	18 (7) Measles, mumps, and rubella.
	761	+	19 (8) Varicella.
	762	+	20 (9) Hepatitis A.
	763	+	21 (10) Hepatitis B.
	764	+	22 (11) Haemophilus influenzae type b (Hib).
	765	+	23 (12) Coronavirus disease.
	766	+	24 (c) A pharmacist may administer an immunization under subsection
	767	+	25 (b) if the following requirements are met:
	768	+	26 (1) The physician specifies in the drug order, prescription, or
	769	+	27 protocol the group of individuals to whom the immunization may
	770	+	28 be administered.
	771	+	29 (2) The physician who writes the drug order, prescription, or
	772	+	30 protocol is licensed and actively practicing with a medical office
	773	+	31 in Indiana and not employed by a pharmacy.
	774	+	32 (3) The pharmacist who administers the immunization is
	775	+	33 responsible for notifying, not later than fourteen (14) days after
	776	+	34 the pharmacist administers the immunization, the physician who
	777	+	35 authorized the immunization and the individual's primary care
	778	+	36 physician that the individual received the immunization.
	779	+	37 (4) If the physician uses a protocol, the protocol may apply only
	780	+	38 to an individual or group of individuals who
	781	+	39 (A) except as provided in clause (B), are at least eleven (11)
	782	+	40 years of age. or
	783	+	41 (B) for the pneumonia immunization under subsection (b)(3),
	784	+	42 are at least fifty (50) years of age.
	785	+	2024 IN 192—LS 6838/DI 92 18
	786	+	1 (5) Before administering an immunization to an individual
	787	+	2 according to a protocol approved by a physician, the pharmacist
	788	+	3 must receive the consent of one (1) of the following:
	789	+	4 (A) If the individual to whom the immunization is to be
	790	+	5 administered is at least eleven (11) years of age but less than
	791	+	6 eighteen (18) years of age, the parent or legal guardian of the
	792	+	7 individual.
	793	+	8 (B) If the individual to whom the immunization is to be
	794	+	9 administered is at least eighteen (18) years of age but has a
	795	+	10 legal guardian, the legal guardian of the individual.
	796	+	11 (C) If the individual to whom the immunization is to be
	797	+	12 administered is at least eighteen (18) years of age but has no
	798	+	13 legal guardian, the individual.
	799	+	14 A parent or legal guardian who is required to give consent under
	800	+	15 this subdivision must be present at the time of immunization.
	801	+	16 (d) If the Indiana department of health or the department of
	802	+	17 homeland security determines that an emergency exists, subject to
	803	+	18 IC 16-41-9-1.7(a)(2), a pharmacist may administer any immunization
	804	+	19 in accordance with:
	805	+	20 (1) the requirements of subsection (c)(1) through (c)(3); and
	806	+	21 (2) any instructions in the emergency determination.
	807	+	22 (e) A pharmacist or pharmacist's designee shall provide
	808	+	23 immunization data to the immunization data registry (IC 16-38-5) in a
	809	+	24 manner prescribed by the Indiana department of health unless:
	810	+	25 (1) the individual receiving the immunization;
	811	+	26 (2) the parent of the individual receiving the immunization, if the
	812	+	27 individual receiving the immunization is less than eighteen (18)
	813	+	28 years of age; or
	814	+	29 (3) the legal guardian of the individual receiving the
	815	+	30 immunization, if a legal guardian has been appointed;
	816	+	31 has completed and filed with the pharmacist or pharmacist's designee
	817	+	32 a written immunization data exemption form, as provided in
	818	+	33 IC 16-38-5-2.
	819	+	34 (f) If an immunization is administered under a protocol, then the
	820	+	35 name, license number, and contact information of the physician who
	821	+	36 wrote the protocol must be posted in the location where the
	822	+	37 immunization is administered. A copy of the protocol must be available
	823	+	38 for inspection by the individual receiving the immunization.
	824	+	39 (g) A pharmacist may administer an immunization that is provided
	825	+	40 according to a standing order, prescription, or protocol issued under
	826	+	41 this section or IC 16-19-4-11 by the state health commissioner or the
	827	+	42 commissioner's designated public health authority who is a licensed
	828	+	2024 IN 192—LS 6838/DI 92 19
	829	+	1 prescriber. If a pharmacist has received a protocol to administer an
	830	+	2 immunization from a physician and that specific immunization is
	831	+	3 covered by a standing order, prescription, or protocol issued by the
	832	+	4 state health commissioner or the commissioner's designated public
	833	+	5 health authority, the pharmacist must administer the immunization
	834	+	6 according to the standing order, prescription, or protocol issued by the
	835	+	7 state health commissioner or the commissioner's designated public
	836	+	8 health authority.
	837	+	9 SECTION 22. IC 27-1-37.7 IS ADDED TO THE INDIANA CODE
	838	+	10 AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
	839	+	11 JULY 1, 2024]:
	840	+	12 Chapter 37.7. Coverage for Prescription Drugs to Treat or
	841	+	13 Prevent HIV or AIDS
	842	+	14 Sec. 1. As used in this chapter, "antiretroviral" means a drug
	843	+	15 used to prevent a retrovirus, such as the human immunodeficiency
	844	+	16 virus (HIV), from replicating.
	845	+	17 Sec. 2. (a) As used in this chapter, "health plan" means any of
	846	+	18 the following that provides coverage for health care services:
	847	+	19 (1) A policy of accident and sickness insurance, as defined in
	848	+	20 IC 27-8-5-1(a), excluding the types of insurance and plans set
	849	+	21 forth in IC 27-8-5-2.5(a).
	850	+	22 (2) A contract with a health maintenance organization (as
	851	+	23 defined in IC 27-13-1-19) that provides coverage for basic
	852	+	24 health care services (as defined in IC 27-13-1-4).
	853	+	25 (3) A self-insurance program established under
	854	+	26 IC 5-10-8-7(b).
	855	+	27 (4) A prepaid health care delivery plan entered into under
	856	+	28 IC 5-10-8-7(c).
	857	+	29 (5) A Medicaid risk based managed care program operated
	858	+	30 under IC 12-15.
	859	+	31 (b) The term includes a person that administers any of the
	860	+	32 following:
	861	+	33 (1) A policy described in subsection (a)(1).
	862	+	34 (2) A contract described in subsection (a)(2).
	863	+	35 (3) A self-insurance program described in subsection (a)(3).
	864	+	36 (4) A prepaid health care delivery plan described in
	865	+	37 subsection (a)(4).
	866	+	38 (5) A Medicaid risk based managed care program described
	867	+	39 in subsection (a)(5).
	868	+	40 Sec. 3. As used in this chapter, "prior authorization" means a
	869	+	41 practice implemented by a health plan under which a covered
	870	+	42 individual or the covered individual's health care provider must
	871	+	2024 IN 192—LS 6838/DI 92 20
	872	+	1 obtain approval from the health plan for a prescription for the
	873	+	2 covered individual as a prerequisite to the health plan covering the
	874	+	3 prescription.
	875	+	4 Sec. 4. As used in this chapter, "step therapy protocol" means
	876	+	5 a protocol under which a health plan specifies that certain
	877	+	6 prescription drugs must be used to treat a covered individual's
	878	+	7 condition before the health plan will cover other prescription drugs
	879	+	8 for the treatment of the covered individual's condition.
	880	+	Sec. 5. (a) This section applies 9 to a health plan's coverage of a
	881	+	10 drug that:
	882	+	11 (1) has been approved by the federal Food and Drug
	883	+	12 Administration; and
	884	+	13 (2) is prescribed for the treatment or prevention of the human
	885	+	14 immunodeficiency virus (HIV) or acquired immunodeficiency
	886	+	15 syndrome (AIDS).
	887	+	16 The term includes antiretrovirals.
	888	+	17 (b) A health plan shall not impose or enforce:
	889	+	18 (1) a prior authorization requirement;
	890	+	19 (2) a step therapy protocol requirement; or
	891	+	20 (3) any other protocol requirement;
	892	+	21 if imposing or enforcing the requirement could restrict or delay the
	893	+	22 dispensing to a covered individual of a prescription drug to which
	894	+	23 this section applies.
	895	+	24 SECTION 23. IC 34-30-2.1-207.4 IS ADDED TO THE INDIANA
	896	+	25 CODE AS A NEW SECTION TO READ AS FOLLOWS
	897	+	26 [EFFECTIVE JULY 1, 2024]: Sec. 207.4. IC 16-27-6-0.5 (Concerning
	898	+	27 federal and state antitrust laws for certain activities under the
	899	+	28 home health agency cooperative agreement law).
	900	+	2024 IN 192—LS 6838/DI 92