Citations Affected:
IC 12-7-2
; IC 12-10;
IC 12-15-8.5-0.5.
Synopsis: Home and community based services. Establishes the
CHOICE account for the purpose of providing services under the
community and home options to institutional care for the elderly and
disabled program (CHOICE). Requires the office of the secretary of
family and social services to establish a home and community based
long term care service program and establishes eligibility for the
program. Requires the office of Medicaid policy and planning (OMPP)
to apply for: (1) a waiver to exempt individuals using Medicaid home
and community based waiver services from lien recovery; (2) a waiver
to amend the aged and disabled waiver to include any service offered
by the community and home options to institutional care for the elderly
and disabled (CHOICE) program; (3) a waiver to amend Medicaid
waivers to include spousal impoverishment protection provisions that
are at least at the level of those offered to health facility residents; (4)
a waiver to amend the state Medicaid plan to include personal care
services; and (5) a waiver to have funds follow an individual
transitioning from a health facility to home and community based
services. Specifies protections an individual receiving Medicaid waiver
services must have. Requires the office of the secretary of family and
social services to have self-directed care options available for CHOICE
individuals and Medicaid waiver individuals who choose self-directed
care services. Requires the area agencies on aging to determine
CHOICE eligibility for individuals on the CHOICE waiting list and
establishes time frames for the determinations. Requires an individual
eligible for CHOICE, beginning July 1, 2005, to receive CHOICE
services within 60 days. Establishes the home and community based
long term care transition account.
Effective: Upon passage; July 1, 2003.
January 23, 2003, read first time and referred to Committee on Health and Provider
Services.
A BILL FOR AN ACT to amend the Indiana Code concerning
human services and to make an appropriation.
SECTION 1.
IC 12-7-2-1.3
IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 1.3. "Activities of daily
living", for purposes of
IC 12-10-10
and
IC 12-10-11.5
, has the
meaning set forth in
IC 12-10-10-1.5.
SECTION 2.
IC 12-7-2-118.8
IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 118.8. "Institution", for purposes
of
IC 12-10-11.5
, has the meaning set forth in
IC 12-10-11.5-1.
SECTION 3.
IC 12-10-10-12
IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 12. (a) The CHOICE account
within the state general fund is established for the purpose of
providing services under this chapter. The account shall be
administered by the office of the secretary of family and social
services.
(b) Money in the account is annually appropriated for the
purposes of the account.
(c) The expenses of administering the account shall be paid from
money in the account.
(d) Money in the account at the end of a state fiscal year does
not revert to the state general fund.
(e) Money appropriated to this account:
(1) may be used only to provide services for the program
under this chapter; and
(2) may not be used to fund a Medicaid waiver.
SECTION 4.
IC 12-10-11.5
IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2003]:
Chapter 11.5. Long Term Care Services
Sec. 1. As used in this chapter, "institution" means any of the
following:
(1) A health facility licensed under IC 16-28.
(2) An intermediate care facility for the mentally retarded.
Sec. 2. (a) The office of the secretary of family and social
services shall establish a comprehensive program of home and
community based long term care services to provide eligible
individuals with care that is not more costly than services provided
to similarly situated individuals who reside in institutions.
(b) The program of home and community based long term care
services must insure the availability of appropriate and cost
effective alternatives to institutional care that an individual is
entitled to under the federal Medicaid program.
Sec. 3. An individual who has resided in the state for at least
ninety (90) days shall be eligible for the home and community
based long term care services program if the individual:
(1) participates in the community and home options to
institutional care for the elderly and disabled program
established by
IC 12-10-10-6
; or
(2) meets the following requirements:
(A) Has an income of not more than three hundred percent
(300%) of the federal Supplemental Security Income level.
(B) Is unable to perform at least three (3) activities of daily
living determined by an assessment conducted by an area
agency on aging case manager or any other agency the
state has contracted with to perform assessments.
(C) Is at risk of being placed in an institution.
Sec. 4. The state shall provide access to the following long term
care services that are appropriate and needed for an individual
who is eligible for these services under this chapter:
(1) Any home and community based service that is available
through:
(A) the community and home options to institutional care
for the elderly and disabled program; or
(B) any state Medicaid waiver.
(2) Personal care services.
(3) Self-directed care.
(4) Assisted living.
(5) Adult foster care.
(6) Adult day care services.
(7) The provision of durable medical equipment or devices.
(8) Housing modifications.
(9) Adaptive medical equipment and devices.
(10) Adaptive nonmedical equipment and devices.
(11) Any other service that is necessary to maintain an
individual in a home and community based setting, including
the following:
(A) Transportation services.
(B) Housing.
(C) Education.
(D) Workforce development.
Sec. 5. (a) The office of the secretary of family and social
services shall annually determine any state savings generated by
home and community based services under this chapter by
reducing the use of institutional care.
(b) Savings determined under subsection (a) shall be used to
fund the state's share of additional home and community based
Medicaid waiver slots.
SECTION 5.
IC 12-15-8.5-0.5
IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2003]: Sec. 0.5. (a) Except as provided in
subsection (b), this chapter does not apply to an individual who
receives home and community based services under a Medicaid
waiver that allows a lien exemption.
(b) The office may apply a lien to an individual who
fraudulently received home and community based services under
a Medicaid waiver.
SECTION 6. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "board" refers to the community and home options to
institutional care for the elderly and disabled board established by
IC 12-10-11-1.
(b) As used in this SECTION, "office" refers to the office of
Medicaid policy and planning established by
IC 12-8-6-1.
(c) As used in this SECTION, "waiver" refers to the aged and
disabled Medicaid waiver.
(d) Before September 1, 2003, the office shall discuss and review
any amendment to the waiver required under this SECTION with
the board.
(e) Before October 1, 2003, the office shall apply to the United
States Department of Health and Human Services to amend the
waiver to include in the waiver any service that is offered under the
community and home options to institutional care for the elderly
and disabled (CHOICE) program established by
IC 12-10-10-6.
A
service provided under this subsection may not be more restrictive
than the corresponding service provided under
IC 12-10-10.
(f) The office may not implement the waiver until the office files
an affidavit with the governor attesting that the amendment to the
waiver applied for under this SECTION is in effect. The office shall
file the affidavit under this subsection not later than five (5) days
after the office is notified that the waiver is approved.
(g) If the office receives approval for the amendment to the
waiver under this SECTION from the United States Department
of Health and Human Services and the governor receives the
affidavit filed under subsection (f), the office shall implement the
waiver not more than sixty (60) days after the governor receives
the affidavit.
(h) Before January 1, 2004, the office shall meet with the board
to discuss any changes to other state Medicaid waivers that are
necessary to provide services that may not be more restrictive than
the services provided under the CHOICE program. The office shall
recommend the changes determined necessary by this subsection
to the governor.
(i) The office may adopt rules under
IC 4-22-2
necessary to
implement this SECTION.
(j) This SECTION expires December 31, 2008.
SECTION 7. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning established by
IC 12-8-6-1.
(b) As used in this SECTION, "waiver" refers to a Medicaid
waiver approved by the United States Department of Health and
Human Services (42 U.S.C. 1396 et seq.).
(c) Before September 1, 2003, the office shall seek approval from
the United States Department of Health and Human Services to
amend the waiver to modify income eligibility requirements to
include spousal impoverishment protection provisions under 42
U.S.C. 1396r-5 that are at least at the level of the spousal
impoverishment protections afforded to individuals who reside in
health facilities licensed under IC 16-28.
(d) The office may not implement the waiver amendments until
the office files an affidavit with the governor attesting that the
federal waiver amendment applied for under this SECTION is in
effect. The office shall file the affidavit under this subsection not
later than five (5) days after the office is notified that the waiver
amendment is approved.
(e) If the United States Department of Health and Human
Services approves the waiver amendment requested under this
SECTION and the governor receives the affidavit filed under
subsection (d), the office shall implement the waiver amendments
not more than sixty (60) days after the governor receives the
affidavit.
(f) The office may adopt rules under
IC 4-22-2
necessary to
implement this SECTION.
(g) This SECTION expires December 31, 2008.
SECTION 8. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning established by
IC 12-8-6-1.
(b) An individual who receives Medicaid services through a
Medicaid waiver shall receive the following:
(1) The development of a care plan addressing the individual's
needs.
(2) Advocacy on behalf of the individual's interests.
(3) The monitoring of the quality of community and home
care services provided to the individual.
(4) Information and referral services on community and home
care services if the individual is eligible for these services.
(c) The use by or on behalf of an individual receiving Medicaid
waiver services of any of the following services or devices does not
make the individual ineligible for services under a Medicaid
waiver:
(1) Skilled nursing assistance.
(2) Supervised community and home care services, including
skilled nursing supervision.
(3) Adaptive medical equipment and devices.
(4) Adaptive nonmedical equipment and devices.
(d) If necessary to implement this SECTION, the office shall
apply to the United States Department of Health and Human
Services for an amendment to a Medicaid waiver to comply with
this SECTION.
(e) If the office applies for a waiver amendment under
subsection (d), the office may not implement the waiver
amendment until the office files an affidavit with the governor
attesting that the federal waiver applied for under this SECTION
is in effect. The office shall file the affidavit under this subsection
not later than five (5) days after the office is notified that the
waiver is approved.
(f) If the office receives a waiver amendment under this
SECTION from the United States Department of Health and
Human Services and the governor receives the affidavit filed under
subsection (e), the office shall implement the waiver not more than
sixty (60) days after the governor receives the affidavit.
(g) The office may adopt rules under
IC 4-22-2
necessary to
implement this SECTION.
SECTION 9. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning established by
IC 12-8-6-1.
(b) As used in this SECTION, "personal care services" has the
meaning set forth in 42 CFR 440.167.
(c) Before July 1, 2004, the office shall apply to the United States
Department of Health and Human Services for approval to amend
the state Medicaid plan to include personal care services.
(d) The office may not implement the amended state Medicaid
plan until the office files an affidavit with the governor attesting
that the proposed amendment to the state Medicaid plan applied
for under this SECTION was approved. The office shall file the
affidavit under this subsection not later than five (5) days after the
office is notified that the proposed amendment is approved.
(e) If the office receives approval of the proposed amendment to
the state Medicaid plan under this SECTION from the United
States Department of Health and Human Services and the
governor receives the affidavit filed under subsection (d), the office
shall implement the amendment not more than sixty (60) days after
the governor receives the affidavit.
(f) The office may adopt rules under
IC 4-22-2
necessary to
implement this SECTION.
(g) This SECTION expires December 31, 2008.
SECTION 10. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "office" refers to the office of the secretary of family
and social services established by
IC 12-8-1-1.
(b) Before July 1, 2004, the office shall have self-directed care
options services available for:
(1) the community and home options to institutional care for
the elderly and disabled program established by
IC 12-10-10-6
; and
(2) a Medicaid waiver;
for an eligible individual who chooses self-directed care services.
(c) This SECTION expires December 31, 2006.
SECTION 11. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "CHOICE program" refers to the community and
home options to institutional care for the elderly and disabled
program established by
IC 12-10-10-6.
(b) Before December 31, 2003, the area agencies on aging shall
determine the eligibility for the CHOICE program of an individual
who has been on the waiting list for the program before November
1, 2003 and who has not received an eligibility determination for
the CHOICE program.
(c) Beginning November 1, 2003, the area agencies on aging
shall determine whether an individual who is applying for the
CHOICE program and placed on the waiting list for the CHOICE
program is eligible for the CHOICE program not more than sixty
(60) days after the individual is placed on the waiting list.
(d) Beginning July 1, 2005, an eligible individual under the
CHOICE program shall not:
(1) wait on a waiting list for services for more than ninety (90)
days; and
(2) be denied services because of funding shortages for the
program.
SECTION 12. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "waiver" refers to an Indiana Medicaid waiver
approved by the United States Department of Health and Human
Services.
(b) Before July 1, 2005, the office shall seek approval from the
United States Department of Health and Human Services to amend
any Medicaid waiver for home and community based services so
that an eligible individual receives services within ninety (90) days
after being determined eligible for the services.
(c) The office may not implement the waiver amendment until
the office files an affidavit with the governor attesting that the
federal waiver amendments applied for under this SECTION are
in effect. The office shall file the affidavit under this subsection not
later than five (5) days after the office is notified that the waiver
amendments are approved.
(d) If the United States Department of Health and Human
Services approves the waiver amendments requested under this
SECTION and the governor receives the affidavit filed under
subsection (c), the office shall implement the waiver amendments
not more than sixty (60) days after the governor receives the
affidavit.
SECTION 13. [EFFECTIVE JULY 1, 2003] (a) The home and
community based long term care transition account within the
state general fund is established for the purpose of reducing the
overutilization of institutional care and transitioning eligible
individuals who would not otherwise receive home and community
based long term care services into these services.
(b) The account shall be administered by the office of the
secretary of family and social services established by
IC 12-8-1-1.
(c) The expenses of administering the account shall be paid from
money in the account.
(d) The treasurer of state shall invest the money in the account
not currently needed to meet the obligations of the account in the
same manner as other public money may be invested. Interest that
accrues from these investments shall be deposited in the state
general fund.
(e) Money in the home and community based long term care
transition account is annually appropriated for the purposes of the
account. The account must be used for the following:
(1) Case management costs incurred by either the office or the
area agencies on aging in moving individuals to home and
community based care, including eligibility determination
costs.
(2) The cost of identifying and screening individuals in health
facilities licensed under IC 16-28 who may be eligible and
appropriate for home and community based services.
(3) The cost of placing an individual who is:
(A) a resident of a health facility; and
(B) determined by the screening process to be eligible and
appropriate for home and community based services;
into home and community based care, including housing and
transportation costs.
(f) Money in the account at the end of a state fiscal year does not
revert for use for any other purpose in the state general fund.
However, any unencumbered amount in the account on July 1,
2007, reverts to the state general fund for use for any
governmental purpose.
(g) The funds appropriated to this account under subsection (e)
are in addition to any funds provided to existing programs for
home and community based services.
(h) Before December 31 of each year, the office of the secretary
of family and social services shall submit a report to the governor
and the legislative council on the impact of the account in reducing
the state's use of publicly financed institutional care by a health
facility licensed under IC 16-28.
(i) Before December 31, 2003, the office of the secretary of
family and social services shall recommend to the governor, the
budget committee, and the budget agency the amount of money
needed in the account in order to meet the account's purposes set
forth in this SECTION for the following fiscal years:
(1) July 1, 2004, through June 30, 2005.
(2) July 1, 2005, through June 30, 2006.
(3) July 1, 2006, through June 30, 2007.
(j) Before December 31 of each year, the office of the secretary
of family and social services shall submit to the governor, the
budget committee, and the budget agency any recommended
adjustments to the amount determined in subsection (i) in the
amount of money needed for the account to meet the account's
purposes for the following fiscal year.
(k) The budget director may approve, after review by the
budget committee, the annual amount recommended for the
account in subsection (j).
(l) The auditor of state shall transfer the approved amount into
the account.
(m) This SECTION expires July 1, 2007.
SECTION 14. [EFFECTIVE UPON PASSAGE] (a) Before
December 31, 2003, the secretary of family and social services
(
IC 12-8-1-2)
shall discuss with the community and home options
to institutional care for the elderly and disabled (CHOICE) board
established by
IC 12-10-11-1
, and with any other agency or
individual that the secretary considers appropriate, the
establishment of a system of integrated services, including:
(1) transportation;
(2) housing;
(3) education; and
(4) workforce development;
to enhance the viability and availability of home and community
based care.
(b) The secretary shall report to the governor and the budget
committee any recommendations for funding these services.
(c) This SECTION expires December 31, 2004.
SECTION 15. [EFFECTIVE UPON PASSAGE] (a) Before
December 31, 2003, the secretary of family and social services
(
IC 12-8-1-2)
and the area agencies on aging shall calculate the
number of individuals who may reasonably need care under this
act, including the following individuals:
(1) An individual receiving home and community based
services under the community and home options to
institutional care for the elderly and disabled (CHOICE)
program established by
IC 12-10-10-6.
(2) An individual on the waiting list to receive home and
community based services under the CHOICE program.
(3) An individual receiving home and community based
services under a state Medicaid waiver.
(4) An individual on a Medicaid waiver waiting list to receive
home and community based services.
(5) An individual who receives assisted living services or adult
foster care services under a Medicaid waiver.
(6) An individual residing in a health facility licensed under
IC 16-28 who may be appropriately served in a home and
community based setting.
(b) Before December 31, 2003, the secretary shall report the
findings under subsection (a) to the governor, the budget
committee, and the budget agency.
(c) This SECTION expires December 31, 2004.
SECTION 16. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning established by
IC 12-8-6-1.
(b) As used in this SECTION, "waiver" refers to any state
Medicaid waiver approved by the United States Department of
Health and Human Services under 42 U.S.C. 1396 et seq.
(c) Except as provided in subsection (d) and before September
1, 2003, the office shall apply to the United States Department of
Health and Human Services for approval of a waiver to exempt
any individual who receives home and community based services
under a Medicaid waiver from a lien and estate recovery action
filed by the office under 42 U.S.C. 1396p and
IC 12-15-8.5.
(d) The office may file a lien and estate recovery action against
an individual described in subsection (c) if the office obtains
evidence that the individual provided fraudulent information
concerning eligibility for Medicaid services.
(e) The office may not implement the waiver until the office files
an affidavit with the governor attesting that the federal waiver
applied for under this SECTION is in effect. The office shall file the
affidavit under this subsection not later than five (5) days after the
office is notified that the waiver is approved.
(f) If the office receives a waiver under this SECTION from the
United States Department of Health and Human Services and the
governor receives the affidavit filed under subsection (e), the office
shall implement the waiver not more than sixty (60) days after the
governor receives the affidavit.
(g) The office may adopt rules under
IC 4-22-2
necessary to
implement this SECTION.
(h) This SECTION expires December 31, 2008.
SECTION 17. [EFFECTIVE JULY 1, 2003] (a) As used in this
SECTION, "health facility" refers to a facility licensed under
IC 16-28.
(b) As used in this SECTION, "office" refers to the office of
Medicaid policy and planning established by
IC 12-8-6-1.
(c) As used in this SECTION, "waiver" refers to a home and
community based Medicaid waiver approved by the United States
Department of Health and Human Services under 42 U.S.C. 1396
et seq.
(d) Before December 31, 2003, the office shall apply to the
United States Department of Health and Human Services for a
waiver to allow Medicaid funds used by an individual in a health
facility setting to follow the individual if the individual moves from
the health facility and transitions into home and community based
services provided by a Medicaid waiver.
(e) The office may not implement the waiver until the office files
an affidavit with the governor attesting that the federal waiver
applied for under this SECTION is in effect. The office shall file the
affidavit under this subsection not later than five (5) days after the
office is notified that the waiver is approved.
(f) If the office receives a waiver under this SECTION from the
United States Department of Health and Human Services and the
governor receives the affidavit filed under subsection (e), the office
shall implement the waiver not more than sixty (60) days after the
governor receives the affidavit.
(g) The office shall report the estimated fiscal impact of the
waiver applied for under this SECTION to the governor, the
budget committee, and the budget agency. The information in the
report shall be included in the office's calculations of the funds
needed for the home and community based long term care
transition account established by this act.
(h) This SECTION expires December 31, 2009.
SECTION 18. An emergency is declared for this act.