Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is
being amended, the text of the existing provision will appear in this style type, additions
will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that
adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles
conflicts between statutes enacted by the 2006 Regular Session of the General Assembly.
AN ACT to amend the Indiana Code concerning health and to make an appropriation.
Be it enacted by the General Assembly of the State of Indiana:
and planning under IC 12-15-41-15 or IC 12-15-44-19(b).
(22) An emergency rule adopted by the Indiana state board of
animal health under IC 15-2.1-18-21.
(23) An emergency rule adopted by the board of directors of the
Indiana education savings authority under IC 21-9-4-7.
(24) An emergency rule adopted by the Indiana board of tax
review under IC 6-1.1-4-34 (repealed).
(25) An emergency rule adopted by the department of local
government finance under IC 6-1.1-4-33 (repealed).
(26) An emergency rule adopted by the boiler and pressure vessel
rules board under IC 22-13-2-8(c).
(27) An emergency rule adopted by the Indiana board of tax
review under IC 6-1.1-4-37(l) (repealed) or an emergency rule
adopted by the department of local government finance under
IC 6-1.1-4-36(j) (repealed) or IC 6-1.1-22.5-20.
(28) An emergency rule adopted by the board of the Indiana
economic development corporation under IC 5-28-5-8.
(29) A rule adopted by the department of financial institutions
under IC 34-55-10-2.5.
(30) A rule adopted by the Indiana finance authority:
(A) under IC 8-15.5-7 approving user fees (as defined in
IC 8-15.5-2-10) provided for in a public-private agreement
under IC 8-15.5;
(B) under IC 8-15-2-17.2(a)(10):
(i) establishing enforcement procedures; and
(ii) making assessments for failure to pay required tolls;
(C) under IC 8-15-2-14(a)(3) authorizing the use of and
establishing procedures for the implementation of the
collection of user fees by electronic or other nonmanual
means; or
(D) to make other changes to existing rules related to a toll
road project to accommodate the provisions of a
public-private agreement under IC 8-15.5.
(b) The following do not apply to rules described in subsection (a):
(1) Sections 24 through 36 of this chapter.
(2) IC 13-14-9.
(c) After a rule described in subsection (a) has been adopted by the
agency, the agency shall submit the rule to the publisher for the
assignment of a document control number. The agency shall submit the
rule in the form required by section 20 of this chapter and with the
documents required by section 21 of this chapter. The publisher shall
determine the number of copies format of the rule and other documents
to be submitted under this subsection.
(d) After the document control number has been assigned, the
agency shall submit the rule to the secretary of state publisher for
filing. The agency shall submit the rule in the form required by section
20 of this chapter and with the documents required by section 21 of this
chapter. The secretary of state publisher shall determine the number
of copies format of the rule and other documents to be submitted under
this subsection.
(e) Subject to section 39 of this chapter, the secretary of state
publisher shall:
(1) accept the rule for filing; and
(2) file stamp and indicate electronically record the date and time
that the rule is accepted. on every duplicate original copy
submitted.
(f) A rule described in subsection (a) takes effect on the latest of the
following dates:
(1) The effective date of the statute delegating authority to the
agency to adopt the rule.
(2) The date and time that the rule is accepted for filing under
subsection (e).
(3) The effective date stated by the adopting agency in the rule.
(4) The date of compliance with every requirement established by
law as a prerequisite to the adoption or effectiveness of the rule.
(g) Subject to subsection (h), IC 14-10-2-5, IC 14-22-2-6,
IC 22-8-1.1-16.1, and IC 22-13-2-8(c), and except as provided in
subsections (j), and (k), and (l), a rule adopted under this section
expires not later than ninety (90) days after the rule is accepted for
filing under subsection (e). Except for a rule adopted under subsection
(a)(13), (a)(24), (a)(25), or (a)(27), the rule may be extended by
adopting another rule under this section, but only for one (1) extension
period. The extension period for a rule adopted under subsection
(a)(28) may not exceed the period for which the original rule was in
effect. A rule adopted under subsection (a)(13) may be extended for
two (2) extension periods. Subject to subsection (j), a rule adopted
under subsection (a)(24), (a)(25), or (a)(27) may be extended for an
unlimited number of extension periods. Except for a rule adopted under
subsection (a)(13), for a rule adopted under this section to be effective
after one (1) extension period, the rule must be adopted under:
(1) sections 24 through 36 of this chapter; or
(2) IC 13-14-9;
(100) papers, a tax of one cent ($0.01).
(3) On more than one hundred (100) papers, one-half cent
($0.005) for each fifty (50) papers or fractional part thereof.
(4) On tubes, one cent ($0.01) for each fifty (50) tubes or
fractional part thereof.
SECTION 3. IC 6-7-1-17 IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 17. (a) Distributors who hold
certificates and retailers shall be agents of the state in the collection of
the taxes imposed by this chapter and the amount of the tax levied,
assessed, and imposed by this chapter on cigarettes sold, exchanged,
bartered, furnished, given away, or otherwise disposed of by
distributors or to retailers. Distributors who hold certificates shall be
agents of the department to affix the required stamps and shall be
entitled to purchase the stamps from the department at a discount of
one and two-tenths percent (1.2%) of the amount of the tax stamps
purchased, one and two-tenths cents ($0.012) per individual
package of cigarettes as compensation for their labor and expense.
(b) The department may permit distributors who hold certificates
and who are admitted to do business in Indiana to pay for revenue
stamps within thirty (30) days after the date of purchase. However, the
privilege is extended upon the express condition that:
(1) except as provided in subsection (c), a bond or letter of credit
satisfactory to the department, in an amount not less than the sales
price of the stamps, is filed with the department; and
(2) proof of payment is made of all local property, state income,
and excise taxes for which any such distributor may be liable. The
bond or letter of credit, conditioned to secure payment for the
stamps, shall be executed by the distributor as principal and by a
corporation duly authorized to engage in business as a surety
company or financial institution in Indiana.
(c) If a distributor has at least five (5) consecutive years of good
credit standing with the state, the distributor shall not be required to
post a bond or letter of credit under subsection (b).
SECTION 4. IC 6-7-1-28.1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE AUGUST 1, 2007]: Sec. 28.1. The taxes,
registration fees, fines, or penalties collected under this chapter shall
be deposited in the following manner:
(1) Six Four and six-tenths twenty-two hundredths percent
(6.6%) (4.22%) of the money shall be deposited in a fund to be
known as the cigarette tax fund.
(2) Ninety-four hundredths Six-tenths percent (0.94%) (0.6%) of
the money shall be deposited in a fund to be known as the mental
health centers fund.
(3) Eighty-three Fifty-three and ninety-seven sixty-eight
hundredths percent (83.97%) (53.68%) of the money shall be
deposited in the state general fund.
(4) Eight Five and forty-nine forty-three hundredths percent
(8.49%) (5.43%) of the money shall be deposited into the pension
relief fund established in IC 5-10.3-11.
(5) Twenty-seven and five hundredths percent (27.05%) of the
money shall be deposited in the Indiana check-up plan trust
fund established by IC 12-15-44-17.
(6) Two and forty-six hundredths percent (2.46%) of the
money shall be deposited in the state general fund for the
purpose of paying appropriations for Medicaid_Current
Obligations, for provider reimbursements.
(7) Four and one-tenth percent (4.1%) of the money shall be
deposited in the state general fund for the purpose of paying
any appropriation for a health initiative.
(8) Two and forty-six hundredths percent (2.46%) of the
money shall be deposited in the state general fund for the
purpose of reimbursing the state general fund for a tax credit
provided under IC 6-3.1-31.
The money in the cigarette tax fund, the mental health centers fund, the
Indiana check-up plan trust fund, or the pension relief fund at the
end of a fiscal year does not revert to the state general fund. However,
if in any fiscal year, the amount allocated to a fund under subdivision
(1) or (2) is less than the amount received in fiscal year 1977, then that
fund shall be credited with the difference between the amount allocated
and the amount received in fiscal year 1977, and the allocation for the
fiscal year to the fund under subdivision (3) shall be reduced by the
amount of that difference. Money deposited under subdivisions (6)
through (8) may not be used for any purpose other than the
purpose stated in the subdivision.
SECTION 5. IC 6-3.1-31 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2007 (RETROACTIVE)]:
Chapter 31. Credit for Offering Health Benefit Plans
Sec. 1. This chapter applies to an employer that does not offer
coverage for health care services under a self-funded health benefit
plan that complies with the federal Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1001 et seq.).
Sec. 2. As used in this chapter, "eligible taxpayer" means a
taxpayer that did not provide health insurance to the taxpayer's
employees in the taxable year immediately preceding the first
taxable year for which the taxpayer claims a credit under this
chapter.
Sec. 3. As used in this chapter, "full-time employee" means an
employee who is normally scheduled to work at least thirty (30)
hours each week.
Sec. 4. (a) As used in this chapter, "health benefit plan" means
coverage for health care services provided under:
(1) an insurance policy that provides one (1) or more of the
types of insurance described in Class 1(b) or Class 2(a) of
IC 27-1-5-1; or
(2) a contract with a health maintenance organization for
coverage of basic health care services under IC 27-13;
that satisfies the requirements of Section 125 of the Internal
Revenue Code.
(b) The term does not include the following:
(1) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Automobile medical payment insurance.
(4) A specified disease policy issued as an individual policy.
(5) A limited benefit health insurance policy issued as an
individual policy.
(6) A short term insurance plan that:
(A) may not be renewed; and
(B) has a duration of not more than six (6) months.
(7) A policy that provides a stipulated daily, weekly, or
monthly payment to an insured during hospital confinement,
without regard to the actual expense of the confinement.
(8) Worker's compensation or similar insurance.
(9) A student health insurance policy.
Sec. 5. As used in this chapter, "pass through entity" means a:
(1) corporation that is exempt from the adjusted gross income
tax under IC 6-3-2-2.8(2);
(2) partnership;
(3) limited liability company; or
(4) limited liability partnership.
Sec. 6. As used in this chapter, "state tax liability" means a
taxpayer's total tax liability that is incurred under:
(1) IC 6-3-1 through IC 6-3-7 (adjusted gross income tax);
(2) IC 6-5.5 (financial institutions tax); and
(3) IC 27-1-18-2 (insurance premiums tax);
as computed after the application of the credits that under
IC 6-3.1-1-2 are to be applied before the credit provided by this
chapter.
Sec. 7. As used in this chapter, "taxpayer" means an individual
or entity that has state tax liability.
Sec. 8. (a) An eligible taxpayer that, after December 31, 2006,
makes health insurance available to the eligible taxpayer's
employees and their dependents through at least one (1) health
benefit plan is entitled to a credit against the taxpayer's state tax
liability for the first two (2) taxable years in which the taxpayer
makes the health benefit plan available if the following
requirements are met:
(1) An employee's participation in the health benefit plan is at
the employee's election.
(2) If an employee chooses to participate in the health benefit
plan, the employee may pay the employee's share of the cost
of the plan using a wage assignment authorized under
IC 22-2-6-2.
(b) The credit allowed in each of the first two (2) taxable years
described in subsection (a) equals the lesser of:
(1) two thousand five hundred dollars ($2,500); or
(2) fifty dollars ($50) multiplied by the number of employees
enrolled in the health benefit plan during the taxable year.
Sec. 9. (a) An employer may pay or provide reimbursement for
all or part of the cost of a health benefit plan made available under
section 8 of this chapter.
(b) An employer that pays or provides reimbursement under
subsection (a) shall pay or provide reimbursement on an equal
basis for all full-time employees who elect to participate in the
health benefit plan.
Sec. 10. (a) If the amount determined under section 8 of this
chapter for a taxpayer in a taxable year exceeds the taxpayer's
state tax liability for that taxable year, the taxpayer may carry the
excess over to the following taxable years. The amount of the credit
carryover from a taxable year shall be reduced to the extent that
the carryover is used by the taxpayer to obtain a credit under this
chapter for any subsequent taxable year. A taxpayer is not entitled
to a carryback.
(b) A taxpayer is not entitled to a refund of any unused credit.
Sec. 11. If a pass through entity does not have state income tax
liability against which the tax credit may be applied, a shareholder
or partner of the pass through entity is entitled to a tax credit equal
to:
(1) the tax credit determined for the pass through entity for
the taxable year; multiplied by
(2) the percentage of the pass through entity's distributive
income to which the shareholder or partner is entitled.
Sec. 12. To receive the credit provided by this chapter, a
taxpayer must claim the credit on the taxpayer's state tax return
or returns in the manner prescribed by the department. The
taxpayer must submit to the department all information that the
department determines is necessary to calculate the credit
provided by this chapter and to determine the taxpayer's eligibility
for the credit.
Sec. 13. (a) A taxpayer claiming a credit under this chapter shall
continue to make health insurance available to the taxpayer's
employees through a health benefit plan for at least twenty-four
(24) consecutive months beginning on the day after the last day of
the taxable year in which the taxpayer first offers the health benefit
plan.
(b) If the taxpayer terminates the health benefit plan before the
expiration of the period required under subsection (a), the
taxpayer shall repay the department the amount of the credit
received under section 8 of this chapter.
SECTION 6. IC 6-3.1-31.2 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2007](RETROACTIVE)]:
Chapter 31.2. Small Employer Qualified Wellness Program Tax
Credit
Sec. 1. As used in this chapter, "pass through entity" means:
(1) a corporation that is exempt from the adjusted gross
income tax under IC 6-3-2-2.8(2);
(2) a partnership;
(3) a limited liability company; or
(4) a limited liability partnership.
Sec. 2. As used in this chapter, "qualified wellness program"
means a wellness program that is certified by the state department
of health under IC 16-46-13.
Sec. 3. (a) As used in this chapter, "small employer" means an
employer that:
(1) is actively engaged in business;
(2) on at least fifty percent (50%) of the working days of the
employer during the preceding calendar year, employed at
least two (2) but not more than one hundred (100) eligible
employees, the majority of whom work in Indiana.
(b) In determining the number of eligible employees for
purposes of subsection (a), employers that are affiliated employers
or that are eligible to file a combined tax return for purposes of
state taxation are considered one (1) employer.
Sec. 4. As used in this chapter, "state tax liability" means a
taxpayer's total tax liability that is incurred under:
(1) IC 6-3-1 through IC 6-3-7 (the adjusted gross income tax);
(2) IC 6-5.5 (the financial institutions tax); and
(3) IC 27-1-18-2 (the insurance premiums tax);
as computed after the application of the credits that under
IC 6-3.1-1-2 are to be applied before the credit provided by this
chapter.
Sec. 5. As used in this chapter, "taxpayer" means a small
employer that has any state tax liability.
Sec. 6. A taxpayer is entitled to a credit against the taxpayer's
state tax liability for a taxable year in an amount equal to fifty
percent (50%) of the costs incurred by the taxpayer during the
taxable year for providing a qualified wellness program for the
taxpayer's employees during the taxable year.
Sec. 7. If a pass through entity is entitled to a credit under
section 6 of this chapter but does not have state tax liability against
which the tax credit may be applied, a shareholder, partner, or
member of the pass through entity is entitled to a tax credit equal
to:
(1) the tax credit determined for the pass through entity for
the taxable year; multiplied by
(2) the percentage of the pass through entity's distributive
income to which the shareholder, partner, or member is
entitled.
Sec. 8. (a) If the credit provided by this chapter exceeds the
taxpayer's state tax liability for the taxable year for which the
credit is first claimed, the excess may be carried forward to
succeeding taxable years and used as a credit against the
taxpayer's state tax liability during those taxable years. Each time
that the credit is carried forward to a succeeding taxable year, the
credit is to be reduced by the amount that was used as a credit
during the immediately preceding taxable year.
(b) A taxpayer is not entitled to any carryback or refund of any
unused credit.
Sec. 9. To receive the credit provided by this chapter, a taxpayer
must:
(1) submit to the department with the taxpayer's state tax
return or returns a copy of the certificate received from the
state department of health under IC 16-46-13; and
(2) claim the credit on the taxpayer's state tax return or
returns in the manner prescribed by the department.
The taxpayer shall submit to the department all information that
the department determines is necessary for the calculation of the
credit provided by this chapter.
Sec. 10. Beginning in 2009, the department shall, not later than
December 31 of each odd-numbered year, report to the legislative
council in an electronic format under IC 5-14-6 concerning use of
the credit provided by this chapter. A report required by this
section must include:
(1) the number of taxpayers claiming and receiving the credit;
(2) any reports of abuse of the credit; and
(3) other information the department considers necessary
concerning the use and effectiveness of the credit;
during the preceding reporting period.
SECTION 7. IC 12-7-2-140.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 140.5. "Plan", for purposes of
IC 12-15-44, has the meaning set forth in IC 12-15-44-1.
SECTION 8. IC 12-7-2-144.3 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 144.3. "Preventative care
services", for purposes of IC 12-15-44, has the meaning set forth in
IC 12-15-44-2.
SECTION 9. IC 12-15-2-13 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 13. (a) A pregnant
woman:
(1) who is not described in 42 U.S.C. 1396a(a)(10)(A)(i); and
(2) whose family income does not exceed the income level
established in subsection (b);
is eligible to receive Medicaid.
(b) A pregnant woman described in this section is eligible to receive
Medicaid, subject to subsections (c) and (d) and 42 U.S.C. 1396a et
seq., if her family income does not exceed one two hundred fifty
percent (150%) (200%) of the federal income poverty level for the
same size family.
(c) Medicaid made available to a pregnant woman described in this
section is limited to medical assistance for services related to
pregnancy, including prenatal, delivery, and postpartum services, and
to other conditions that may complicate pregnancy.
(d) Medicaid is available to a pregnant woman described in this
section for the duration of the pregnancy and for the sixty (60) day
postpartum period that begins on the last day of the pregnancy, without
regard to any change in income of the family of which she is a member
during that time.
(e) The office may apply a resource standard in determining the
eligibility of a pregnant woman described in this section.
SECTION 10. IC 12-15-2-15.8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 15.8. After an individual who is
less than three (3) years of age is determined to be eligible for
Medicaid under section 14 of this chapter, the individual is not
required to submit eligibility information more frequently than
once in a twelve (12) month period until the child becomes three (3)
years of age.
SECTION 11. IC 12-15-15-1.1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 1.1. (a) This section
applies to a hospital that is:
(1) licensed under IC 16-21; and
(2) established and operated under IC 16-22-2, IC 16-22-8, or
IC 16-23.
(b) For a state fiscal year ending after June 30, 2003, in addition to
reimbursement received under section 1 of this chapter, a hospital is
entitled to reimbursement in an amount calculated as follows:
STEP ONE: The office shall identify the aggregate inpatient
hospital services, reimbursable under this article and under the
state Medicaid plan, that were provided during the state fiscal
year by hospitals established and operated under IC 16-22-2,
IC 16-22-8, or IC 16-23.
STEP TWO: For the aggregate inpatient hospital services
identified under STEP ONE, the office shall calculate the
aggregate payments made under this article and under the state
Medicaid plan to hospitals established and operated under
IC 16-22-2, IC 16-22-8, or IC 16-23, excluding payments under
IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate of
the amount that would have been paid in the aggregate by the
office for the inpatient hospital services described in STEP ONE
under Medicare payment principles.
STEP FOUR: Subtract the amount calculated under STEP TWO
from the amount calculated under STEP THREE.
STEP FIVE: Subject to subsection (g), from the amount
calculated under STEP FOUR, allocate to a hospital established
and operated under IC 16-22-8 an amount equal to not to exceed
one hundred percent (100%) of the difference between:
(A) the total cost for the hospital's provision of inpatient
services covered under this article for the hospital's fiscal year
ending during the state fiscal year; and
(B) the total payment to the hospital for its provision of
inpatient services covered under this article for the hospital's
fiscal year ending during the state fiscal year, excluding
payments under IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP SIX: Subtract the amount calculated under STEP FIVE
from the amount calculated under STEP FOUR.
STEP SEVEN: Distribute an amount equal to the amount
calculated under STEP SIX to the eligible hospitals established
and operated under IC 16-22-2 or IC 16-23 described in
subsection (c) in proportion to an amount not to exceed each
hospital's Medicaid shortfall as defined in subsection (f).
(c) Subject to subsection (e), reimbursement for a state fiscal year
under this section consists of payments made after the close of each
state fiscal year. Payment for a state fiscal year ending after June 30,
2003, shall be made before December 31 following the state fiscal
year's end. A hospital is not eligible for a payment described in this
subsection unless an intergovernmental transfer or certification of
expenditures is made under subsection (d).
(d) Subject to subsection (e):
(1) a hospital may make an intergovernmental transfer under this
subsection, or an intergovernmental transfer may be made by or
on behalf of the hospital; or
(2) a certification of expenditures as eligible for federal
financial participation may be made;
after the close of each state fiscal year. An intergovernmental transfer
under this subsection must be made to the Medicaid indigent care trust
fund in an amount equal to a percentage, as determined by the office,
of the amount to be distributed to the hospital under STEP SEVEN of
subsection (b). In determining the percentage, the office shall apply the
same percentage of not more than eighty-five percent (85%) to all
hospitals eligible for reimbursement under STEP SEVEN of subsection
(b). this section. The office shall use the intergovernmental transfer to
fund payments made under this section. and as otherwise provided
under IC 12-15-20-2(8).
(e) A hospital making that makes a certification of expenditures
or makes or has an intergovernmental transfer made on the hospital's
behalf under subsection (d) this section may appeal under IC 4-21.5
the amount determined by the office to be paid the hospital under STEP
SEVEN of subsection (b). The periods described in subsections (c) and
(d) for the hospital or another entity to make an intergovernmental
transfer or certification of expenditures are tolled pending the
administrative appeal and any judicial review initiated by the hospital
under IC 4-21.5. The distribution to other hospitals under STEP
SEVEN of subsection (b) may not be delayed due to an administrative
appeal or judicial review instituted by a hospital under this subsection.
If necessary, the office may make a partial distribution to the other
eligible hospitals under STEP SEVEN of subsection (b) pending the
completion of a hospital's administrative appeal or judicial review, at
which time the remaining portion of the payments due to the eligible
hospitals shall be made. A partial distribution may be based upon
estimates and trends calculated by the office.
(f) For purposes of this section:
(1) the Medicaid shortfall of a hospital established and operated
under IC 16-22-2 or IC 16-23 is calculated as follows:
STEP ONE: The office shall identify the inpatient hospital
services, reimbursable under this article and under the state
Medicaid plan, that were provided during the state fiscal year
by the hospital.
STEP TWO: For the inpatient hospital services identified
under STEP ONE, the office shall calculate the payments
made under this article and under the state Medicaid plan to
the hospital, excluding payments under IC 12-15-16,
IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate
of the amount that would have been paid by the office for the
inpatient hospital services described in STEP ONE under
Medicare payment principles; and
the amount determined by the office to be paid by the hospital under
STEP SEVEN of subsection (b). The periods described in subsections
(c) and (d) for the hospital or other entity to make an
intergovernmental transfer or certification of expenditures are tolled
pending the administrative appeal and any judicial review initiated by
the hospital under IC 4-21.5. The distribution to other hospitals under
STEP SEVEN of subsection (b) may not be delayed due to an
administrative appeal or judicial review instituted by a hospital under
this subsection. If necessary, the office may make a partial distribution
to the other eligible hospitals under STEP SEVEN of subsection (b)
pending the completion of a hospital's administrative appeal or judicial
review, at which time the remaining portion of the payments due to the
eligible hospitals must be made. A partial distribution may be
calculated by the office based upon estimates and trends.
(f) For purposes of this section:
(1) the Medicaid shortfall of a hospital established and operated
under IC 16-22-2 or IC 16-23 is calculated as follows:
STEP ONE: The office shall identify the outpatient hospital
services, reimbursable under this article and under the state
Medicaid plan, that were provided during the state fiscal year
by the hospital.
STEP TWO: For the outpatient hospital services identified
under STEP ONE, the office shall calculate the payments
made under this article and under the state Medicaid plan to
the hospital, excluding payments under IC 12-15-16,
IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate
of the amount that would have been paid by the office for the
outpatient hospital services described in STEP ONE under
Medicare payment principles; and
(2) a hospital's Medicaid shortfall is equal to the amount by which
the amount calculated in STEP THREE of subdivision (1) is
greater than the amount calculated in STEP TWO of subdivision
(1).
(g) The actual distribution of the amount calculated under STEP
FIVE of subsection (b) to a hospital established and operated under
IC 16-22-8 shall be made under the terms and conditions provided for
the hospital in the state plan for medical assistance. Payment to a
hospital under STEP FIVE of subsection (b) is not a condition
precedent to the tender of payments to hospitals under STEP SEVEN
of subsection (b).
IC 12-15-20-2(8)(D) to serve as the non-federal share of such
payments, the remaining amount calculated under STEP
FOUR for a state fiscal year shall be paid to all hospitals
described in subsection (a). The payments shall be made on a
pro rata basis based on the hospitals' Medicaid inpatient days
or other payment methodology approved by the Centers for
Medicare and Medicaid Services. For purposes of this
clause, a hospital's Medicaid inpatient days are the
hospital's in-state and paid Medicaid fee for service and
managed care days for the state fiscal year for which
services are identified under STEP ONE, as determined by
the office.
(C) Subject to IC 12-15-20.7, in the event the entirety of the
amount calculated under STEP FOUR is not distributed
following the payments made under clauses (A) and (B), the
remaining amount may be paid to hospitals described in
subsection (a) that are eligible under this clause. A hospital is
eligible for a payment under this clause only if the non-federal
share of the hospital's payment is provided by or on behalf of
the hospital. The remaining amount shall be paid to those
eligible hospitals:
(i) on a pro rata basis in relation to all hospitals eligible
under this clause based on the hospitals' Medicaid inpatient
days; or
(ii) other payment methodology determined by the office
and approved by the Centers for Medicare and Medicaid
Services.
(D) For purposes of the clauses (A), (B) and (C), a hospital's
Medicaid inpatient days are based on the Medicaid inpatient
days allowed for the hospital by the office for purposes of the
office's most recent determination of eligibility for the
Medicaid disproportionate payment program under
IC 12-15-16.
(c) Reimbursement for a state fiscal year under this section consists
of payments made after the close of each state fiscal year. Payment for
a state fiscal year ending after June 30, 2003, shall be made before
December 31 following the end of the state fiscal year. As used in this
subsection, "Medicaid supplemental payments" means Medicaid
payments for hospitals that are in addition to Medicaid
fee-for-service payments, Medicaid risk-based managed care
payments, and Medicaid disproportionate share payments, and
that are included in the Medicaid state plan, including Medicaid
safety-net payments, and payments made under sections 1.1, 1.3,
1.5, 9, and 9.5 of this chapter. For a state fiscal year ending after
June 30, 2007, in addition to the reimbursement received under
section 1 of this chapter, a hospital eligible under this section is
entitled to reimbursement in an amount calculated as follows:
STEP ONE: The office shall identify the total inpatient
hospital services and the total outpatient hospital services
reimbursable under this article and under the state Medicaid
plan that were provided during the state fiscal year for all
hospitals described in subsection (a).
STEP TWO: For the total inpatient hospital services and the
total outpatient hospital services identified in STEP ONE, the
office shall calculate the total payments made under this
article and under the state Medicaid plan to all hospitals
described in subsection (a). A calculation under this STEP
excludes a payment made under the following:
(A) IC 12-15-16.
(B) IC 12-15-17.
(C) IC 12-15-19.
STEP THREE: The office shall calculate, under Medicare
payment principles, a reasonable estimate of the total amount
that would have been paid by the office for the inpatient
hospital services and the outpatient hospital services
identified in STEP ONE.
STEP FOUR: Subtract the amount calculated under STEP
TWO from the amount calculated under STEP THREE.
STEP FIVE: Distribute an amount equal to the amount
calculated under STEP FOUR to the eligible hospitals
described in subsection (a) as follows:
(A) As used in this clause, "Medicaid inpatient days" are
the hospital's in-state paid Medicaid fee for service and
risk-based managed care days for the state fiscal year for
which services are identified under STEP ONE, as
determined by the office. Subject to the availability of
funds transferred to the Medicaid indigent care trust fund
under STEP FOUR of IC 12-16-7.5-4.5(c) and remaining
in the Medicaid indigent care trust fund under
IC 12-15-20-2(8)(G) to serve as the non-federal share of the
payments, the amount calculated under STEP FOUR for
a state fiscal year shall be paid to all hospitals described in
subsection (a). The payments shall be made on a pro rata
basis, based on the hospitals' Medicaid inpatient days or in
accordance with another payment methodology
determined by the office and approved by the Centers for
Medicare and Medicaid Services.
(B) Subject to IC 12-15-20.7, if the entire amount
calculated under STEP FOUR is not distributed following
the payments made under clause (A), the remaining
amount shall be paid as described in clauses (C) and (D) to
a hospital that is described in subsection (a) and that is
described as eligible under this clause. A hospital is eligible
for a payment under clause (C) only if the hospital:
(i) has less than sixty thousand (60,000) Medicaid
inpatient days annually;
(ii) was eligible for Medicaid disproportionate share
hospital payments in the state fiscal year ending June 30,
1998, or the hospital met the office's Medicaid
disproportionate share payment criteria based upon
state fiscal year 1998 data and received a Medicaid
disproportionate share payment for the state fiscal year
ending June 30, 2001; and
(iii) received a Medicaid disproportionate share payment
under IC 12-15-19-2.1 for state fiscal years 2001, 2002,
2003, and 2004.
The payment amount under clause (C) for an eligible
hospital is subject to the availability of the non-federal
share of the hospital's payment being provided by the
hospital or on behalf of the hospital.
(C) For state fiscal years ending after June 30, 2007, but
before July 1, 2009, payments to eligible hospitals
described in clause (B) shall be made as follows:
(i) The payment to an eligible hospital that merged two
(2) hospitals under a single Medicaid provider number
effective January 1, 2004, shall equal one hundred
percent (100%) of the hospital's hospital-specific limit
for the state fiscal year ending June 30, 2005, when the
payment is combined with any Medicaid
disproportionate share payment made under
IC 12-15-19-2.1, Medicaid, and other Medicaid
supplemental payments, paid or to be paid to the hospital
for a state fiscal year.
(ii) The payment to an eligible hospital described in
clause (B) other than a hospital described in item (i) shall
equal one hundred percent (100%) of the hospital's
hospital specific limit for the state fiscal year ending
June 30, 2004, when the payment is combined with any
Medicaid disproportionate share payment made under
IC 12-15-19-2.1, Medicaid, and other Medicaid
supplemental payments, paid or to be paid to the hospital
for a state fiscal year.
(D) For state fiscal years beginning after June 30, 2009,
payments to an eligible hospital described in clause (B)
shall be made in a manner determined by the office.
(E) Subject to IC 12-15-20.7, if the entire amount
calculated under STEP FOUR is not distributed following
the payments made under clause (A), and clauses (C) or
(D), the remaining amount may be paid as described in
clause (F) to a hospital described in subsection (a) that is
described as eligible under this clause. A hospital is eligible
for a payment for a state fiscal year under clause (F) if the
hospital:
(i) is eligible to receive Medicaid disproportionate share
payments for the state fiscal year for which the Medicaid
disproportionate share payment is attributable under
IC 12-15-19-2.1, for a state fiscal year ending after June
30, 2007; and
(ii) does not receive a payment under clauses (C) or (D)
for the state fiscal year.
A payment to a hospital under this clause is subject to the
availability of non-federal matching funds.
(F) Payments to eligible hospitals described in clause (E)
shall be made:
(i) to best use federal matching funds available for
hospitals that are eligible for Medicaid disproportionate
share payments under IC 12-15-19-2.1; and
(ii) by using a methodology that allocates available
funding under this clause, Medicaid supplemental
payments, and payments under IC 12-15-19-2.1, in a
manner in which all hospitals eligible under clause (E)
receive payments in a manner that takes into account the
situation of eligible hospitals that have historically
qualified for Medicaid disproportionate share payments
and ensures that payments for eligible hospitals are
equitable.
(G) If the Centers for Medicare and Medicaid Services
does not approve the payment methodologies in clauses (A)
through (F), the office may implement alternative payment
methodologies, that are eligible for federal financial
participation, to implement a program consistent with the
payments for hospitals described in clauses (A) through
(F).
(d) A hospital described in subsection (a) may appeal under
IC 4-21.5 the amount determined by the office to be paid to the hospital
under STEP FIVE of subsection subsections (b) or (c). The
distribution to other hospitals under STEP FIVE of subsection (b) or
(c) may not be delayed due to an administrative appeal or judicial
review instituted by a hospital under this subsection. If necessary, the
office may make a partial distribution to the other eligible hospitals
under STEP FIVE of subsection (b) or (c) pending the completion of
a hospital's administrative appeal or judicial review, at which time the
remaining portion of the payments due to the eligible hospitals shall be
made. A partial distribution may be based on estimates and trends
calculated by the office.
SECTION 14. IC 12-15-15-9 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 9. (a) For purposes of
this section and IC 12-16-7.5-4.5, a payable claim is attributed to a
county if the payable claim is submitted to the division by a hospital
licensed under IC 16-21-2 for payment under IC 12-16-7.5 for care
provided by the hospital to an individual who qualifies for the hospital
care for the indigent program under IC 12-16-3.5-1 or IC 12-16-3.5-2
and:
(1) who is a resident of the county;
(2) who is not a resident of the county and for whom the onset of
the medical condition that necessitated the care occurred in the
county; or
(3) whose residence cannot be determined by the division and for
whom the onset of the medical condition that necessitated the care
occurred in the county.
(b) For each state fiscal year ending after June 30, 2003, and before
July 1, 2007, a hospital licensed under IC 16-21-2 that submits to the
division during the state fiscal year a payable claim under IC 12-16-7.5
is entitled to a payment under this section. subsection (c).
(c) Except as provided in section 9.8 of this chapter and subject to
section 9.6 of this chapter, for a state fiscal year, the office shall pay to
a hospital referred to in subsection (b) an amount equal to the amount,
based on information obtained from the division and the calculations
and allocations made under IC 12-16-7.5-4.5, that the office determines
for the hospital under STEP SIX of the following STEPS:
STEP ONE: Identify:
(A) each hospital that submitted to the division one (1) or
more payable claims under IC 12-16-7.5 during the state fiscal
year; and
(B) the county to which each payable claim is attributed.
STEP TWO: For each county identified in STEP ONE, identify:
(A) each hospital that submitted to the division one (1) or
more payable claims under IC 12-16-7.5 attributed to the
county during the state fiscal year; and
(B) the total amount of all hospital payable claims submitted
to the division under IC 12-16-7.5 attributed to the county
during the state fiscal year.
STEP THREE: For each county identified in STEP ONE, identify
the amount of county funds transferred to the Medicaid indigent
care trust fund under STEP FOUR of IC 12-16-7.5-4.5(b).
IC 12-16-7.5-4.5.
STEP FOUR: For each hospital identified in STEP ONE, with
respect to each county identified in STEP ONE, calculate the
hospital's percentage share of the county's funds transferred to the
Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b). IC 12-16-7.5-4.5. Each hospital's percentage
share is based on the total amount of the hospital's payable claims
submitted to the division under IC 12-16-7.5 attributed to the
county during the state fiscal year, calculated as a percentage of
the total amount of all hospital payable claims submitted to the
division under IC 12-16-7.5 attributed to the county during the
state fiscal year.
STEP FIVE: Subject to subsection (j), for each hospital identified
in STEP ONE, with respect to each county identified in STEP
ONE, multiply the hospital's percentage share calculated under
STEP FOUR by the amount of the county's funds transferred to
the Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b). IC 12-16-7.5-4.5.
STEP SIX: Determine the sum of all amounts calculated under
STEP FIVE for each hospital identified in STEP ONE with
respect to each county identified in STEP ONE.
a Medicaid enrollee; and
(2) a payable hospital claim under IC 12-16-7.5 includes a
payable claim under IC 12-16-7.5 for the hospital's care submitted
by an individual or entity other than the hospital, to the extent
permitted under the hospital care for the indigent program.
(j) (k) The amount calculated under STEP FIVE of subsection (c)
for a hospital with respect to a county may not exceed the total amount
of the hospital's payable claims attributed to the county during the state
fiscal year.
SECTION 15. IC 12-15-15-9.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 9.5. (a) For purposes
of this section and IC 12-16-7.5-4.5, a payable claim is attributed to a
county if the payable claim is submitted to the division by a hospital
licensed under IC 16-21-2 for payment under IC 12-16-7.5 for care
provided by the hospital to an individual who qualifies for the hospital
care for the indigent program under IC 12-16-3.5-1 or IC 12-16-3.5-2
and;
(1) who is a resident of the county;
(2) who is not a resident of the county and for whom the onset of
the medical condition that necessitated the care occurred in the
county; or
(3) whose residence cannot be determined by the division and for
whom the onset of the medical condition that necessitated the care
occurred in the county.
(b) For each state fiscal year ending after June 30, 2003, but before
July 1, 2007, a hospital licensed under IC 16-21-2:
(1) that submits to the division during the state fiscal year a
payable claim under IC 12-16-7.5; and
(2) whose payment under section 9(c) of this chapter was less
than the total amount of the hospital's payable claims under
IC 12-16-7.5 submitted by the hospital to the division during the
state fiscal year;
is entitled to a payment under this section. subsection (c).
(c) Except as provided in section 9.8 of this chapter and subject to
section 9.6 of this chapter, for a state fiscal year, the office shall pay to
a hospital referred to in subsection (b) an amount equal to the amount,
based on information obtained from the division and the calculations
and allocations made under IC 12-16-7.5-4.5, that the office determines
for the hospital under STEP EIGHT of the following STEPS:
STEP ONE: Identify each county whose transfer of funds to the
Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b) IC 12-16-7.5-4.5 for the state fiscal year was
less than the total amount of all hospital payable claims attributed
to the county and submitted to the division during the state fiscal
year.
STEP TWO: For each county identified in STEP ONE, calculate
the difference between the amount of funds of the county
transferred to the Medicaid indigent care trust fund under STEP
FOUR of IC 12-16-7.5-4.5(b) IC 12-16-7.5-4.5 and the total
amount of all hospital payable claims attributed to the county and
submitted to the division during the state fiscal year.
STEP THREE: Calculate the sum of the amounts calculated for
the counties under STEP TWO.
STEP FOUR: Identify each hospital whose payment under section
9(c) of this chapter was less than the total amount of the hospital's
payable claims under IC 12-16-7.5 submitted by the hospital to
the division during the state fiscal year.
STEP FIVE: Calculate for each hospital identified in STEP FOUR
the difference between the hospital's payment under section 9(c)
of this chapter and the total amount of the hospital's payable
claims under IC 12-16-7.5 submitted by the hospital to the
division during the state fiscal year.
STEP SIX: Calculate the sum of the amounts calculated for each
of the hospitals under STEP FIVE.
STEP SEVEN: For each hospital identified in STEP FOUR,
calculate the hospital's percentage share of the amount calculated
under STEP SIX. Each hospital's percentage share is based on the
amount calculated for the hospital under STEP FIVE calculated
as a percentage of the sum calculated under STEP SIX.
STEP EIGHT: For each hospital identified in STEP FOUR,
multiply the hospital's percentage share calculated under STEP
SEVEN by the sum calculated under STEP THREE. The amount
calculated under this STEP for a hospital may not exceed the
amount by which the hospital's total payable claims under
IC 12-16-7.5 submitted during the state fiscal year exceeded the
amount of the hospital's payment under section 9(c) of this
chapter.
(d) For state fiscal years beginning after June 30, 2007, a
hospital that received a payment determined under STEP EIGHT
of subsection (c) for the state fiscal year ending June 30, 2007, shall
be paid an amount equal to the amount determined for the hospital
under STEP EIGHT of subsection (c) for the state fiscal year
ending June 30, 2007.
(d) (e) A hospital's payment under subsection (c) or (d) is in the
form of a Medicaid add-on supplemental payment. The amount of the
hospital's add-on payment is subject to the availability of funding for
the non-federal share of the payment under subsection (e). (f). The
office shall make the payments under subsection (c) or (d) before
December 15 that next succeeds the end of the state fiscal year.
(e) (f) The non-federal share of a payment to a hospital under
subsection (c) or (d) is derived from funds transferred to the Medicaid
indigent care trust fund under STEP FOUR of IC 12-16-7.5-4.5(b)
IC 12-16-7.5-4.5 and not expended under section 9 of this chapter. To
the extent possible, the funds shall be derived on a proportional basis
from the funds transferred by each county identified in subsection (c),
STEP ONE:
(1) to which at least one (1) payable claim submitted by the
hospital to the division during the state fiscal year is attributed;
and
(2) whose funds transferred to the Medicaid indigent care trust
fund under STEP FOUR of IC 12-16-7.5-4.5(b) were not
completely expended under section 9 of this chapter.
The amount available to be derived from the remaining funds
transferred to the Medicaid indigent care trust fund under STEP FOUR
of IC 12-16-7.5-4.5(b) to serve as the non-federal share of the payment
to a hospital under subsection (c) is an amount that bears the same
proportion to the total amount of funds transferred by all the counties
identified in subsection (c), STEP ONE, that the amount calculated for
the hospital under subsection (c), STEP FIVE, bears to the amount
calculated under subsection (c), STEP SIX.
(f) (g) Except as provided in subsection (g), (h), the office may not
make a payment under this section until the payments due under
section 9 of this chapter for the state fiscal year have been made.
(g) (h) If a hospital appeals a decision by the office regarding the
hospital's payment under section 9 of this chapter, the office may make
payments under this section before all payments due under section 9 of
this chapter are made if:
(1) a delay in one (1) or more payments under section 9 of this
chapter resulted from the appeal; and
(2) the office determines that making payments under this section
while the appeal is pending will not unreasonably affect the
interests of hospitals eligible for a payment under this section.
(h) (i) Any funds transferred to the Medicaid indigent care trust fund
under STEP FOUR of IC 12-16-7.5-4.5(b) IC 12-16-7.5-4.5 remaining
after payments are made under this section shall be used as provided
in IC 12-15-20-2(8)(D). IC 12-15-20-2(8).
(i) For purposes of this section: subsection (c):
(1) "payable claim" has the meaning set forth in
IC 12-16-7.5-2.5(b);
(2) the amount of a payable claim is an amount equal to the
amount the hospital would have received under the state's
fee-for-service Medicaid reimbursement principles for the
hospital care for which the payable claim is submitted under
IC 12-16-7.5 if the individual receiving the hospital care had been
a Medicaid enrollee; and
(3) a payable hospital claim under IC 12-16-7.5 includes a
payable claim under IC 12-16-7.5 for the hospital's care submitted
by an individual or entity other than the hospital, to the extent
permitted under the hospital care for the indigent program.
SECTION 16. IC 12-15-15-9.6 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 9.6. For state fiscal
years beginning after June 30, 2007, the total amount of payments to
hospitals under sections 9 and 9.5 of this chapter may not exceed the
amount transferred to the Medicaid indigent care trust fund under
STEP FOUR of IC 12-16-7.5-4.5(b). paid to hospitals under sections
9 and 9.5 of this chapter for the state fiscal year ending June 30,
2007.
SECTION 17. IC 12-15-15-10 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 10. (a) This section
applies to a hospital that:
(1) is licensed under IC 16-21; and
(2) qualifies as a provider under IC 12-15-16, IC 12-15-17, or
IC 12-15-19 of the Medicaid disproportionate share provider
program.
(b) The office may, after consulting with affected providers, do one
(1) or more of the following:
(1) Expand the payment program established under section 1.1(b)
of this chapter to include all hospitals described in subsection (a).
(2) (1) Establish a nominal charge hospital payment program.
(3) (2) Establish any other permissible payment program.
(c) A program expanded or established under this section is subject
to the availability of:
(1) intergovernmental transfers; or
(2) funds certified as being eligible for federal financial
participation; or
(3) other permissible sources of non-federal share dollars.
(d) The office may not implement a program under this section until
the federal Centers for Medicare and Medicaid Services approves the
provisions regarding the program in the amended state plan for medical
assistance.
(e) The office may determine not to continue to implement a
program established under this section if federal financial participation
is not available.
SECTION 18. IC 12-15-19-2.1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 2.1. (a) For each state
fiscal year ending on or after June 30, 2000, the office shall develop a
disproportionate share payment methodology that ensures that each
hospital qualifying for disproportionate share payments under
IC 12-15-16-1(a) timely receives total disproportionate share payments
that do not exceed the hospital's hospital specific limit provided under
42 U.S.C. 1396r-4(g). The payment methodology as developed by the
office must:
(1) maximize disproportionate share hospital payments to
qualifying hospitals to the extent practicable;
(2) take into account the situation of those qualifying hospitals
that have historically qualified for Medicaid disproportionate
share payments; and
(3) ensure that payments net of intergovernmental transfers made
by or on behalf of for qualifying hospitals are equitable.
(b) Total disproportionate share payments to a hospital under this
chapter shall not exceed the hospital specific limit provided under 42
U.S.C. 1396r-4(g). The hospital specific limit for a state fiscal year
shall be determined by the office taking into account data provided by
each hospital that is considered reliable by the office based on a system
of periodic audits, the use of trending factors, and an appropriate base
year determined by the office. The office may require independent
certification of data provided by a hospital to determine the hospital's
hospital specific limit.
(c) The office shall include a provision in each amendment to the
state plan regarding Medicaid disproportionate share payments that the
office submits to the federal Centers for Medicare and Medicaid
Services that, as provided in 42 CFR 447.297(d)(3), allows the state to
make additional disproportionate share expenditures after the end of
each federal fiscal year that relate back to a prior federal fiscal year.
However, the total disproportionate share payments to:
under this subdivision, and Medicaid supplemental payments
as defined in IC 12-15-15-1.5, in a manner that all hospitals
eligible for Medicaid disproportionate share payments under
IC 12-15-19-2.1 receive payments using a methodology that:
(A) takes into account the situation of the eligible hospitals
that have historically qualified for Medicaid
disproportionate share payments; and
(B) ensures that payments for eligible hospitals are
equitable.
(d) The percentage reduction shall be sufficient to ensure that
payments do not exceed the statewide Medicaid disproportionate
share allocation or the amounts that can be financed with:
(1) the state share that is in the amount transferred from the
hospital care for the indigent trust fund;
(2) other intergovernmental transfers;
(3) certifications of public expenditures; or
(4) any other permissible sources of non-federal match.
SECTION 20. IC 12-15-20-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 2. The Medicaid
indigent care trust fund is established to pay the non-federal share of
the following:
(1) Enhanced disproportionate share payments to providers under
IC 12-15-19-1.
(2) Subject to subdivision (8), disproportionate share payments to
providers under IC 12-15-19-2.1.
(3) Medicaid payments for pregnant women described in
IC 12-15-2-13 and infants and children described in
IC 12-15-2-14.
(4) Municipal disproportionate share payments to providers under
IC 12-15-19-8.
(5) Payments to hospitals under IC 12-15-15-9.
(6) Payments to hospitals under IC 12-15-15-9.5.
(7) Payments, funding, and transfers as otherwise provided in
clauses (8)(D), and (8)(F), and (8)(G).
(8) Of the intergovernmental transfers deposited into the
Medicaid indigent care trust fund, the following apply:
(A) The entirety of the intergovernmental transfers deposited
into the Medicaid indigent care trust fund for state fiscal years
ending on or before June 30, 2000, shall be used to fund the
state's share of the disproportionate share payments to
providers under IC 12-15-19-2.1.
Medicaid indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(b) for the state fiscal year ending after June
30, 2003;
shall be used, to fund the non-federal share of disproportionate
share payments to providers under IC 12-15-19-2.1. The
remainder of the intergovernmental transfers, if any, for the
state fiscal years shall be used to fund, in descending order of
priority, the non-federal share of payments to hospitals under
IC 12-15-15-9, the non-federal share of payments to hospitals
under IC 12-15-15-9.5, the amount to be transferred under
clause (F), and the non-federal share of payments under
clauses (A) and (B) of STEP FIVE of IC 12-15-15-1.5(b). in
descending order of priority, as follows:
(i) As provided in clause (B) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) and clause (B) of STEP THREE of
IC 12-16-7.5-4.5(b)(2), to fund the amount to be
transferred to the office.
(ii) As provided in clause (C) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) and clause (C) of STEP THREE of
IC 12-16-7.5-4.5(b)(2), to fund the non-federal share of
the payments made under IC 12-15-15-9 and
IC 12-15-15-9.5.
(iii) To fund the non-federal share of the payments made
under IC 12-15-15-1.1, IC 12-15-15-1.3, and
IC 12-15-19-8.
(iv) As provided under clause (A) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) and clause (A) of STEP THREE of
IC 12-16-7.5-4.5(b)(2), for the payment to be made under
clause (A) of STEP FIVE of IC 12-15-15-1.5(b).
(v) As provided under STEP FOUR of
IC 12-16-7.5-4.5(b)(1) and STEP FOUR of
IC 12-16-7.5-4.5(b)(2), to fund the payments to be made
under clause (B) of STEP FIVE of IC 12-15-15-1.5(b).
(vi) To fund, in an order of priority determined by the
office to best use the available non-federal share, the
programs listed in clause (H).
(E) For state fiscal years ending after June 30, 2007, the
total amount of intergovernmental transfers used to fund the
non-federal share of payments to hospitals under
IC 12-15-15-9 and IC 12-15-15-9.5 shall not exceed the
amount calculated under STEP TWO of the following formula:
hospital is eligible under this item if the hospital was
eligible for Medicaid disproportionate share hospital
payments for the state fiscal year ending June 30, 1998,
the hospital received a Medicaid disproportionate share
payment under IC 12-15-19-2.1 for state fiscal years
2001, 2002, 2003, and 2004, and the hospital merged two
(2) hospitals under a single Medicaid provider number,
effective January 1, 2004.
(ii) An amount equal to the non-federal share of
payments to hospitals that are eligible under this item,
for payments made under clause (C) of STEP FIVE of
IC 12-15-15-1.5(b) under an agreement with the office,
Medicaid safety-net payments, and any payment made
under IC 12-15-19-2.1. The amount of payments to each
hospital under this item shall be equal to one hundred
percent (100%) of the hospital's hospital-specific limit
for state fiscal year 2004, when the payments are
combined with payments made to the hospital under
IC 12-15-15-9, IC 12-15-15-9.5, and clause (B) of STEP
FIVE of IC 12-15-15-1.5(b) for a state fiscal year. A
hospital is eligible under this item if the hospital did not
receive a payment under item (i), the hospital has less
than sixty thousand (60,000) Medicaid inpatient days
annually, the hospital either was eligible for Medicaid
disproportionate share hospital payments for the state
fiscal year ending June 30, 1998 or the hospital met the
office's Medicaid disproportionate share payment
criteria based on state fiscal year 1998 data and received
a Medicaid disproportionate share payment for the state
fiscal year ending June 30, 2001, and the hospital
received a Medicaid disproportionate share payment
under IC 12-15-19-2.1 for state fiscal years 2001, 2002,
2003, and 2004.
(iii) Subject to IC 12-15-19-6, an amount not less than the
non-federal share of Medicaid safety-net payments in
accordance with the Medicaid state plan.
(iv) An amount not less than the non-federal share of
payments made under clause (C) of STEP FIVE of
IC 12-15-15-1.5(b) under an agreement with the office to
a hospital having sixty thousand (60,000) Medicaid
inpatient days annually.
check-up plan established by section 3 of this chapter.
Sec. 2. As used in this chapter, "preventative care services"
means care that is provided to an individual to prevent disease,
diagnose disease, or promote good health.
Sec. 3. (a) The Indiana check-up plan is established.
(b) The office shall administer the plan.
(c) The department of insurance and the office of the secretary
shall provide oversight of the marketing practices of the plan.
(d) The office shall promote the plan and provide information
to potential eligible individuals who live in medically underserved
rural areas of Indiana.
(e) The office shall, to the extent possible, ensure that enrollment
in the plan is distributed throughout Indiana in proportion to the
number of individuals throughout Indiana who are eligible for
participation in the plan.
(f) The office shall establish standards for consumer protection,
including the following:
(1) Quality of care standards.
(2) A uniform process for participant grievances and appeals.
(3) Standardized reporting concerning provider performance,
consumer experience, and cost.
(g) A health care provider that provides care to an individual
who receives health insurance coverage under the plan shall
participate in the Medicaid program under IC 12-15.
(h) The office of the secretary may refer an individual who:
(1) has applied for health insurance coverage under the plan;
and
(2) is at high risk of chronic disease;
to the Indiana comprehensive health insurance association for
administration of the individual's plan benefits under IC 27-8-10.1.
(i) The following do not apply to the plan:
(1) IC 12-15-6.
(2) IC 12-15-12.
(3) IC 12-15-13.
(4) IC 12-15-14.
(5) IC 12-15-15.
(6) IC 12-15-21.
(7) IC 12-15-26.
(8) IC 12-15-31.1.
(9) IC 12-15-34.
(10) IC 12-15-35.
requirements on the coverage of mental health care services or
substance abuse services if similar limitations or requirements are
not imposed on the coverage of services for other medical or
surgical conditions.
Sec. 5. (a) The office shall provide to an individual who
participates in the plan a list of health care services that qualify as
preventative care services for the age, gender, and preexisting
conditions of the individual. The office shall consult with the
federal Centers for Disease Control and Prevention for a list of
recommended preventative care services.
(b) The plan shall, at no cost to the individual, provide payment
for not more than five hundred dollars ($500) of qualifying
preventative care services per year for an individual who
participates in the plan. Any additional preventative care services
covered under the plan and received by the individual during the
year are subject to the deductible and payment requirements of the
plan.
Sec. 6. The plan has the following per participant coverage
limitations:
(1) An annual individual maximum coverage limitation of
three hundred thousand dollars ($300,000).
(2) A lifetime individual maximum coverage limitation of one
million dollars ($1,000,000).
Sec. 7. The following requirements apply to funds appropriated
by the general assembly to the plan:
(1) At least eighty-five percent (85%) of the funds must be
used to fund payment for health care services.
(2) An amount determined by the office of the secretary to
fund:
(A) administrative costs of; and
(B) any profit made by;
an insurer or a health maintenance organization under a
contract with the office to provide health insurance coverage
under the plan. The amount determined under this
subdivision may not exceed fifteen percent (15%) of the funds.
Sec. 8. The plan is not an entitlement program. The maximum
enrollment of individuals who may participate in the plan is
dependent on funding appropriated for the plan.
Sec. 9. (a) An individual is eligible for participation in the plan
if the individual meets the following requirements:
(1) The individual is at least eighteen (18) years of age and less
than sixty-five (65) years of age.
(2) The individual is a United States citizen and has been a
resident of Indiana for at least twelve (12) months.
(3) The individual has an annual household income of not
more than two hundred percent (200%) of the federal income
poverty level.
(4) The individual is not eligible for health insurance coverage
through the individual's employer.
(5) The individual has not had health insurance coverage for
at least six (6) months.
(b) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare
program (42 U.S.C. 1395 et seq.).
(2) A pregnant woman for purposes of pregnancy related
services.
(3) An individual who is eligible for the Medicaid program as
a disabled person.
(c) The eligibility requirements specified in subsection (a) are
subject to approval for federal financial participation by the
United States Department of Health and Human Services.
Sec. 10. (a) An individual who participates in the plan must have
a health care account to which payments may be made for the
individual's participation in the plan only by the following:
(1) The individual.
(2) An employer.
(3) The state.
(b) The minimum funding amount for a health care account is
the amount required under section 11 of this chapter.
(c) An individual's health care account must be used to pay the
individual's deductible for health care services under the plan.
(d) An individual may make payments to the individual's health
care account as follows:
(1) An employer withholding or causing to be withheld from
an employee's wages or salary, after taxes are deducted from
the wages or salary, the individual's contribution under this
chapter and distributed equally throughout the calendar year.
(2) Submission of the individual's contribution under this
chapter to the office to deposit in the individual's health care
account in a manner prescribed by the office.
(3) Another method determined by the office.
(e) An employer may make, from funds not payable by the
employer to the employee, not more than fifty percent (50%) of an
individual's required payment to the individual's health care
account.
Sec. 11. (a) An individual's participation in the plan does not
begin until an initial payment is made for the individual's
participation in the plan. A required payment to the plan for the
individual's participation may not exceed one-twelfth (1/12) of the
annual payment required under subsection (b).
(b) To participate in the plan, an individual shall do the
following:
(1) Apply for the plan on a form prescribed by the office. The
office may develop and allow a joint application for a
household.
(2) If the individual is approved by the office to participate in
the plan, contribute to the individual's health care account the
lesser of the following:
(A) One thousand one hundred dollars ($1,100) per year,
less any amounts paid by the individual under the:
(i) Medicaid program under IC 12-15;
(ii) children's health insurance program under
IC 12-17.6; and
(iii) Medicare program (42 U.S.C. 1395 et seq.);
as determined by the office.
(B) Not more than the following applicable percentage of
the individual's annual household income per year, less any
amounts paid by the individual under the Medicaid
program under IC 12-15, the children's health insurance
program under IC 12-17.6, and the Medicare program (42
U.S.C. 1395 et seq.) as determined by the office:
(i) two percent (2%) of the individual's annual household
income per year if the individual has an annual
household income of not more than one hundred percent
(100%);
(ii) three percent (3%) of the individual's annual
household income per year if the individual has an
annual household income of more than one hundred
percent (100%) and not more than one hundred
twenty-five percent (125%);
(iii) four percent (4%) of the individual's annual
household income per year if the individual has an
annual household income of more than one hundred
twenty-five percent (125%) and not more than one
hundred fifty percent (150%); or
(iv) five percent (5%) of the individual's annual
household income per year if the individual has an
annual household income of more than one hundred fifty
percent (150%) and not more than two hundred percent
(200%);
of the federal income poverty level.
(c) The state shall contribute the difference to the individual's
account if the individual's payment required under subsection
(b)(2) is less than one thousand one hundred dollars ($1,100).
(d) If an individual's required payment to the plan is not made
within sixty (60) days after the required payment date, the
individual may be terminated from participation in the plan. The
individual must receive written notice before the individual is
terminated from the plan.
(e) After termination from the plan under subsection (d), the
individual may not reapply to participate in the plan for twelve
(12) months.
Sec. 12. (a) An individual who is approved to participate in the
plan is eligible for a twelve (12) month plan period. An individual
who participates in the plan may not be refused renewal of
participation in the plan for the sole reason that the plan has
reached the plan's maximum enrollment.
(b) If the individual chooses to renew participation in the plan,
the individual shall complete a renewal application and any
necessary documentation, and submit to the office the
documentation and application on a form prescribed by the office.
(c) If the individual chooses not to renew participation in the
plan, the individual may not reapply to participate in the plan for
at least twelve (12) months.
(d) Any funds remaining in the health care account of an
individual who renews participation in the plan at the end of the
individual's twelve (12) month plan period must be used to reduce
the individual's payments for the subsequent plan period.
However, if the individual did not, during the plan period, receive
all qualified preventative services recommended as provided in
section 5 of this chapter, the state's contribution to the health care
account may not be used to reduce the individual's payments for
the subsequent plan period.
(e) If an individual is no longer eligible for the plan, does not
renew participation in the plan at the end of the plan period, or is
terminated from the plan for nonpayment of a required payment,
the office shall, not more than sixty (60) days after the last date of
participation in the plan, refund to the individual the amount
determined under subsection (f) of any funds remaining in the
individual's health care account as follows:
(1) An individual who is no longer eligible for the plan or does
not renew participation in the plan at the end of the plan
period shall receive the amount determined under STEP
FOUR of subsection (f).
(2) An individual who is terminated from the plan due to
nonpayment of a required payment shall receive the amount
determined under STEP FIVE of subsection (f).
(f) The office shall determine the amount payable to an
individual described in subsection (e) as follows:
STEP ONE: Determine the total amount paid into the
individual's health care account under section 10(d) of this
chapter.
STEP TWO: Determine the total amount paid into the
individual's health care account from all sources.
STEP THREE: Divide STEP ONE by STEP TWO.
STEP FOUR: Multiply the ratio determined in STEP THREE
by the total amount remaining in the individual's health care
account.
STEP FIVE: Multiply the amount determined under STEP
FOUR by seventy-five hundredths (0.75).
Sec. 13. Subject to appeal to the office, an individual may be
held responsible under the plan for receiving nonemergency
services in an emergency room setting, including prohibiting the
individual from using funds in the individual's health care account
to pay for the nonemergency services. However, an individual may
not be prohibited from using funds in the individual's health care
account to pay for nonemergency services provided in an
emergency room setting for a medical condition that arises
suddenly and unexpectedly and manifests itself by acute symptoms
of such severity, including severe pain, that the absence of
immediate medical attention could reasonably be expected by a
prudent lay person who possesses an average knowledge of health
and medicine to:
(1) place an individual's health in serious jeopardy;
(2) result in serious impairment to the individual's bodily
functions; or
(3) result in serious dysfunction of a bodily organ or part of
the individual.
Sec. 14. (a) An insurer or health maintenance organization that
contracts with the office to provide health insurance coverage,
dental coverage, or vision coverage to an individual that
participates in the plan:
(1) is responsible for the claim processing for the coverage;
(2) shall reimburse providers at a reimbursement rate of:
(A) not less than the federal Medicare reimbursement rate
for the service provided; or
(B) at a rate of one hundred thirty percent (130%) of the
Medicaid reimbursement rate for a service that does not
have a Medicare reimbursement rate; and
(3) may not deny coverage to an eligible individual who has
been approved by the office to participate in the plan, unless
the individual has met the coverage limitations described in
section 6 of this chapter.
(b) An insurer or a health maintenance organization that
contracts with the office to provide health insurance coverage
under the plan must incorporate cultural competency standards
established by the office. The standards must include standards for
non-English speaking, minority, and disabled populations.
Sec. 15. (a) An insurer or a health maintenance organization
that contracts with the office to provide health insurance coverage
under the plan or an affiliate of an insurer or a health maintenance
organization that contracts with the office to provide health
insurance coverage under the plan shall offer to provide the same
health insurance coverage to an individual who:
(1) has not had health insurance coverage during the previous
six (6) months; and
(2) meets the eligibility requirements specified in section 9 of
this chapter for participation in the plan but is not enrolled
because the plan has reached maximum enrollment.
(b) The insurance underwriting and rating practices applied to
health insurance coverage offered under subsection (a) must not be
different from underwriting and rating practices used for the
health insurance coverage provided under the plan.
(c) The state does not provide funding for health insurance
coverage received under this section.
Sec. 16. (a) An insurer or a health maintenance organization
that contracts with the office to provide health insurance coverage
under the plan or an affiliate of an insurer or a health maintenance
organization that contracts with the office to provide health
insurance coverage under the plan shall offer to provide the same
health insurance coverage to an individual who:
(1) has not had health insurance coverage during the previous
six (6) months; and
(2) does not meet the eligibility requirements specified in
section 9 of this chapter for participation in the plan.
(b) An insurer, a health maintenance organization, or an
affiliate described in subsection (a) may apply to health insurance
coverage offered under subsection (a) the insurer's, health
maintenance organization's, or affiliate's standard individual or
small group insurance underwriting and rating practices.
(c) The state does not provide funding for health insurance
coverage received under this section.
Sec. 17. (a) The Indiana check-up plan trust fund is established
for the following purposes:
(1) Administering a plan created by the general assembly to
provide health insurance coverage for low income residents of
the state under this chapter.
(2) Providing copayments, preventative care services, and
premiums for individuals enrolled in the plan.
(3) Funding tobacco use prevention and cessation programs,
childhood immunization programs, and other health care
initiatives designed to promote the general health and well
being of Indiana residents.
The fund is separate from the state general fund.
(b) The fund shall be administered by the office of the secretary
of family and social services.
(c) The expenses of administering the fund shall be paid from
money in the fund.
(d) The fund shall consist of the following:
(1) Cigarette tax revenues designated by the general assembly
to be part of the fund.
(2) Other funds designated by the general assembly to be part
of the fund.
(3) Federal funds available for the purposes of the fund.
(4) Gifts or donations to the fund.
(e) The treasurer of state shall invest the money in the fund not
currently needed to meet the obligations of the fund in the same
manner as other public money may be invested.
(f) Money must be appropriated before funds are available for
use.
(g) Money in the fund does not revert to the state general fund
at the end of any fiscal year.
(h) The fund is considered a trust fund for purposes of
IC 4-9.1-1-7. Money may not be transferred, assigned, or otherwise
removed from the fund by the state board of finance, the budget
agency, or any other state agency.
Sec. 18. (a) The office may not:
(1) enroll applicants;
(2) approve any contracts with vendors to provide services or
administer the plan;
(3) incur costs other than costs necessary to study and plan for
the implementation of the plan; or
(4) create financial obligations for the state;
unless both of the conditions of subsection (b) are satisfied.
(b) The office may not take any action described in subsection
(a) unless:
(1) there is a specific appropriation from the general assembly
to implement the plan; and
(2) after review by the budget committee, the budget agency
approves an actuarial analysis that reflects a determination
that sufficient funding is reasonably estimated to be available
to operate the plan for at least the following five (5) years.
The actuarial analysis approved under subdivision (2) must clearly
indicate the cost and revenue assumptions used in reaching the
determination.
(c) The office may not operate the plan in a manner that would
obligate the state to financial participation beyond the level of state
appropriations authorized for the plan.
Sec. 19. (a) The office may adopt rules under IC 4-22-2
necessary to implement this chapter.
(b) The office may adopt emergency rules under IC 4-22-2-37.1
to implement the plan on an emergency basis.
(c) Notwithstanding IC 12-8-1-9 and IC 12-8-3, rules adopted
under this section before January 1, 2009, are not subject to review
or approval by the family and social services committee established
by IC 12-8-3-2. This subsection expires December 31, 2009.
Sec. 20. (a) The office may establish a health insurance coverage
premium assistance program for individuals who:
of the person's county of residence. If the person is not a resident of
Indiana, the division shall provide a copy of the application to the
county office of the county where the onset of the medical condition
that necessitated the care occurred. If the division cannot determine
whether the person is a resident of Indiana or, if the person is a resident
of Indiana, the person's county of residence, the division shall provide
a copy of the application to the county office of the county where the
onset of the medical condition that necessitated the care occurred.
(c) A county office that receives a request from the division shall
cooperate with the division in determining whether a person is a
resident of Indiana and, if the person is a resident of Indiana, the
person's county of residence.
SECTION 25. IC 12-16-4.5-2, AS AMENDED BY P.L.145-2005,
SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]: Sec. 2. A hospital, physician, or transportation provider
must file the application with the division not more than forty-five (45)
days after the person has been released or discharged from the hospital,
unless the person is medically unable and the next of kin or legal
representative is unavailable.
SECTION 26. IC 12-16-4.5-7 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 7. (a) A patient must
sign an application if the patient is medically able to sign.
(b) If a patient is medically unable to sign an application, the
patient's next of kin or a legal representative, if available, may sign the
application.
(c) If no person under subsections (a) and (b) is able to sign the
application to file a timely application, a hospital provider's
representative may sign the application instead of the patient.
SECTION 27. IC 12-16-4.5-8.5, AS ADDED BY P.L.145-2005,
SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]: Sec. 8.5. A claim for hospital items or services,
physician services, or transportation services must be filed with the
division not more than one hundred eighty (180) days after the person
who received the care has been released or discharged from the
hospital. For good cause as determined by the division, this one
hundred eighty (180) day limit may be extended or waived for a claim.
SECTION 28. IC 12-16-5.5-1, AS AMENDED BY P.L.145-2005,
SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]: Sec. 1. (a) The division shall, upon receipt of an
application of or for a person who was admitted to, or who was
otherwise provided care by a hospital, provider, promptly investigate
to determine the person's eligibility under the hospital care for the
indigent program. The division shall consider the following
information obtained by the hospital provider regarding the person:
(1) Income.
(2) Resources.
(3) Place of residence.
(4) Medical condition.
(5) Hospital care.
(6) (5) Physician care.
(7) (6) Transportation to and from the hospital.
The division may rely on the hospital's provider's information in
determining the person's eligibility under the program.
(b) The division may choose not to interview the person if, based on
the information provided to the division, the division determines that
it appears that the person is eligible for the program. If the division
determines that an interview of the person is necessary, the division
shall allow the interview to occur by telephone with the person or with
the person's representative if the person is not able to participate in the
interview.
(c) The county office located in:
(1) the county where the person is a resident; or
(2) the county where the onset of the medical condition that
necessitated the care occurred if the person's Indiana residency or
Indiana county of residence cannot be determined;
shall cooperate with the division in determining the person's eligibility
under the program.
SECTION 29. IC 12-16-5.5-1.2, AS ADDED BY P.L.145-2005,
SECTION 14, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]: Sec. 1.2. (a) The division shall, upon receipt of a claim
pertaining to a person:
(1) who was admitted to, or who was otherwise provided care by
a hospital; an eligible provider; and
(2) whose medical condition satisfies one (1) or more of the
medical conditions identified in IC 12-16-3.5-1(a)(1) through
IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through
IC 12-16-3.5-2(a)(3);
promptly review the claim to determine if the health care items or
services identified in the claim were necessitated by the person's
medical condition or, if applicable, if the items or services were a direct
consequence of the person's medical condition.
(b) In conducting the review of a claim referenced in subsection (a),
the division shall calculate the amount of the claim. For purposes of
this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, and
IC 12-16-7.5, the amount of a claim shall be calculated in a manner
described in IC 12-16-7.5-2.5(c).
SECTION 30. IC 12-16-5.5-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 2. (a) The hospital
providing provider of medical care to a patient shall provide
information the hospital provider has that would assist in the
verification of indigency of a patient.
(b) A hospital provider that provides information under subsection
(a) is immune from civil and criminal liability for divulging the
information.
SECTION 31. IC 12-16-5.5-3, AS AMENDED BY P.L.145-2005,
SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]: Sec. 3. (a) Subject to subsection (b) and
IC 12-16-6.5-1.5, if the division is unable after prompt and diligent
efforts to verify information contained in the application that is
reasonably necessary to determine eligibility, the division may deny
assistance under the hospital care for the indigent program. The
pending expiration of the period specified in IC 12-16-6.5-1.5 is not a
valid reason for denying a person's eligibility for the hospital care for
the indigent program.
(b) Before denying assistance under the hospital care for the
indigent program, the division must provide the person and the
hospital, and any other provider who submitted a claim under
IC 12-16-4.5-8.5 written notice of:
(1) the specific information or verification needed to determine
eligibility;
(2) the specific efforts undertaken to obtain the information or
verification; and
(3) the statute or rule requiring the information or verification
identified under subdivision (1).
(c) The division must provide the hospital and any other provider
who submitted a claim under IC 12-16-4.5-8.5 a period of time, not less
than ten (10) days beyond the deadline established under
IC 12-16-6.5-1.5, to submit to the division information concerning the
person's eligibility. If the division does not make a determination of the
person's eligibility within ten (10) days after receiving the information
under this subsection, the person is eligible without the division's
determination of the person's eligibility for the hospital care for the
indigent care program under this article.
IC 12-16-5.5-1.2(b), the affected physician, hospital, or transportation
provider may appeal the calculation to the division not later than ninety
(90) days after the mailing of the notice of that calculation to the
affected physician, hospital, or transportation provider to the last
known address of the physician, hospital, or transportation provider.
SECTION 35. IC 12-16-6.5-4 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 4. A notice of the
hearing shall be served upon all persons interested in the matter,
including any affected physician, hospital, or transportation provider,
at least twenty (20) days before the time fixed for the hearing.
SECTION 36. IC 12-16-7.5-1.2, AS ADDED BY P.L.145-2005,
SECTION 23, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]: Sec. 1.2. (a) A person determined to be eligible under
the hospital care for the indigent program is not financially obligated
for hospital items or services, physician services, or transportation
services provided to the person during the person's eligibility under the
program, if the items or services were:
(1) identified in a claim filed with the division under
IC 12-16-4.5; and
(2) determined:
(A) to have been necessitated by one (1) or more of the
medical conditions listed in IC 12-16-3.5-1(a)(1) through
IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through
IC 12-16-3.5-2(a)(3); or
(B) to be a direct consequence of one (1) or more of the
medical conditions listed in IC 12-16-3.5-1(a)(1) through
IC 12-16-3.5-1(a)(3).
(b) Based on a hospital's items or services identified in a claim
under subsection (a), the hospital Hospitals may receive a payment
from the office calculated and made under IC 12-15-15-9 and, if
applicable, IC 12-15-15-9.5. Hospitals shall not file claims for
payments under IC 12-15-15-9 and IC 12-15-15-9.5 for payments
attributable to state fiscal years beginning after June 30, 2007.
(c) Based on a physician's services identified in a claim under
subsection (a), the physician may receive a payment from the division
calculated and made under section 5 of this chapter.
(d) Based on the transportation services identified in a claim under
subsection (a), the transportation provider may receive a payment from
the division calculated and made under section 5 of this chapter.
SECTION 37. IC 12-16-7.5-2.5, AS AMENDED BY P.L.1-2006,
SECTION 189, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 2.5. (a) Payable claims shall be
segregated by state fiscal year.
(b) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5,
and IC 12-16-14, "payable claim" refers to the following:
(1) Subject to subdivision (2), a claim for payment for physician
care, hospital care, or transportation services under this chapter:
(A) that includes, on forms prescribed by the division, all the
information required for timely payment;
(B) that is for a period during which the person is determined
to be financially and medically eligible for the hospital care for
the indigent program; and
(C) for which the payment amounts for the care and services
are determined by the division.
This subdivision applies for the state fiscal year ending June 30,
2004.
(2) For state fiscal years ending after June 30, 2004, and before
July 1, 2007, a claim for payment for physician care, hospital
care, or transportation services under this chapter:
(A) provided to a person under the hospital care for the
indigent program under this article during the person's
eligibility under the program;
(B) identified in a claim filed with the division; and
(C) determined to:
(i) have been necessitated by one (1) or more of the medical
conditions listed in IC 12-16-3.5-1(a)(1) through
IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through
IC 12-16-3.5-2(a)(3); or
(ii) be a direct consequence of one (1) or more of the
medical conditions listed in IC 12-16-3.5-1(a)(1) through
IC 12-16-3.5-1(a)(3).
(3) For state fiscal years beginning after June 30, 2007, a
claim for payment for physician care or transportation
services under this chapter:
(A) provided to a person under the hospital care for the
indigent program under this article during the person's
eligibility under the program;
(B) identified in a claim filed with the division; and
(C) determined to:
(i) be necessary after the onset of a medical condition
that was manifested by symptoms of sufficient severity
that the absence of immediate medical attention would
probably result in any of the outcomes described in
IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or
IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
(ii) be a direct consequence of the onset of a medical
condition that was manifested by symptoms of sufficient
severity that the absence of immediate medical attention
would probably result in any of the outcomes listed in
IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
(c) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5,
and IC 12-16-14, "amount" when used in regard to a claim or payable
claim means an amount calculated under STEP THREE of the
following formula:
STEP ONE: Identify the items and services identified in a
claim or payable claim.
STEP TWO: Using the applicable Medicaid fee for service
reimbursement rates, calculate the reimbursement amounts for
each of the items and services identified in STEP ONE.
STEP THREE: Calculate the sum of the amounts identified in
STEP TWO.
(d) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5,
and IC 12-16-14, a physician, hospital, or transportation provider that
submits a claim to the division is considered to have submitted the
claim during the state fiscal year during which the amount of the claim
was determined under IC 12-16-5.5-1.2(b) or, if successfully appealed
by a physician, hospital, or transportation provider, the state fiscal year
in which the appeal was decided.
(e) The division shall determine the amount of a claim under
IC 12-16-5.5-1.2(b).
SECTION 38. IC 12-16-7.5-4.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 4.5. (a) Not later than
October 31 following the end of each state fiscal year, the division
shall:
(1) calculate for each county the total amount of payable claims
submitted to the division during the state fiscal year attributed to:
(A) patients who were residents of the county; and
(B) patients:
(i) who were not residents of Indiana;
(ii) whose state of residence could not be determined by the
division; and
(iii) who were residents of Indiana but whose county of
residence in Indiana could not be determined by the
division;
and whose medical condition that necessitated the care or
service occurred in the county;
(2) notify each county of the amount of payable claims attributed
to the county under the calculation made under subdivision (1);
and
(3) with respect to payable claims attributed to a county under
subdivision (1):
(A) calculate the total amount of payable claims submitted
during the state fiscal year for:
(i) each hospital;
(ii) each physician; and
(iii) each transportation provider; and
(B) determine the amount of each payable claim for each
hospital, physician, and transportation provider listed in clause
(A).
(b) For the state fiscal years beginning after June 30, 2005, but
before July 1, 2007, and before November 1 following the end of a
state fiscal year, the division shall allocate the funds transferred from
a county's hospital care for the indigent fund to the state hospital care
for the indigent fund under IC 12-16-14 during or for the following
state fiscal year: years:
(1) For the state fiscal year ending June 30, 2006, as required
under the following STEPS:
STEP ONE: Determine the total amount of funds
transferred from all counties' hospital care for the indigent
funds by the counties to the state hospital care for the
indigent fund under IC 12-16-14 during or for the state
fiscal year.
STEP TWO: Of the total amount of payable claims
submitted to the division during the state fiscal year from
all counties under subsection (a), determine the amount
that is the lesser of:
(A) the amount of total physician payable claims and
total transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by
the division to make payments under section 5 of this
chapter.
STEP THREE: Transfer an amount equal to the sum of:
(A) the non-federal share of the payments made under
clause (A) of STEP FIVE of IC 12-15-15-1.5(b);
(B) the amount transferred under IC 12-15-20-2(8)(F);
and
(C) the non-federal share of the payments made under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the
payments identified in this STEP.
STEP FOUR: Transfer an amount equal to sixty-one
million dollars ($61,000,000) less the sum of:
(A) the amount determined in STEP TWO; and
(B) the amount transferred under STEP THREE;
to the Medicaid indigent care trust fund for funding the
non-federal share of payments under clause (B) of STEP
FIVE of IC 12-15-15-1.5(b).
STEP FIVE: Transfer to the Medicaid indigent care trust
fund for the programs referenced at
IC 12-15-20-2(8)(D)(vi) and funded in accordance with
IC 12-15-20-2(8)(H) the amount determined under STEP
ONE, less the sum of the amount:
(A) determined in STEP TWO;
(B) transferred in STEP THREE; and
(C) transferred in STEP FOUR.
(2) For the state fiscal year ending June 30, 2007, as required
under the following steps:
STEP ONE: Determine the total amount of funds
transferred from all counties' hospital care for the indigent
funds by the counties to the state hospital care for the
indigent fund under IC 12-16-14 during or for the state
fiscal year.
STEP TWO: Of the total amount of payable claims
submitted to the division during the state fiscal year from
all counties under subsection (a), determine the amount
that is the lesser of:
(A) the amount of total physician payable claims and
total transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by
the division for making payments under section 5 of this
chapter or for the non-federal share of Medicaid payments
for physicians and transportation providers, as determined
by the office.
STEP THREE: Transfer an amount equal to the sum of:
(A) the non-federal share of five million dollars
($5,000,000) for the payment made under clause (A) of
STEP FIVE of IC 12-15-15-1.5(b);
(B) the amount transferred under IC 12-15-20-2(8)(F);
and
(C) the non-federal share of the payments made under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the
payments identified in this STEP.
STEP FOUR: Transfer an amount equal to the amount
determined under STEP ONE less the sum of:
(A) the amount determined in STEP TWO; and
(B) the amount transferred under STEP THREE;
to the Medicaid indigent care trust fund for funding the
non-federal share of payments under clause (B) of STEP
FIVE of IC 12-15-15-1.5(b).
(c) For the state fiscal years beginning after June 30, 2007,
before November 1 following the end of the state fiscal year, the
division shall allocate the funds transferred from a county's
hospital care for the indigent fund to the state hospital care for the
indigent fund under IC 12-16-14 during or for the state fiscal year
as required under the following STEPS:
STEP ONE: Determine the total amount of funds transferred from
a county's hospital care for the indigent fund by the county to the
state hospital care for the indigent fund under IC 12-16-14 during
or for the state fiscal year.
STEP TWO: Of the total amount of payable claims submitted to
the division during the state fiscal year attributed to the county
under subsection (a), determine the amount of total hospital
payable claims, total physician payable claims, and total
transportation provider payable claims. Of the amounts
determined for physicians and transportation providers, calculate
the sum of those amounts as a percentage of an amount equal to
the sum of the total payable physician claims and total payable
transportation provider claims attributed to all the counties
submitted to the division during the state fiscal year.
STEP THREE: Multiply three million dollars ($3,000,000) by the
percentage calculated under STEP TWO.
taxes first due and payable in the preceding year; multiplied by
(2) the assessed value growth quotient determined in the last
STEP of the following STEPS:
STEP ONE: Determine the three (3) calendar years that most
immediately precede the ensuing calendar year and in which a
statewide general reassessment of real property does not first
become effective.
STEP TWO: Compute separately, for each of the calendar years
determined in STEP ONE, the quotient (rounded to the nearest
ten-thousandth) of the county's total assessed value of all taxable
property in the particular calendar year, divided by the county's
total assessed value of all taxable property in the calendar year
immediately preceding the particular calendar year.
STEP THREE: Divide the sum of the three (3) quotients
computed in STEP TWO by three (3).
(d) Except as provided in subsection (e):
(1) for taxes first due and payable in 2009, each county shall
impose a hospital care for the indigent property tax levy equal to
the average of the annual amount of payable claims attributed to
the county under IC 12-16-7.5-4.5 during the state fiscal years
beginning:
(A) July 1, 2005;
(B) July 1, 2006; and
(C) July 1, 2007; and
(2) for all subsequent annual levies under this section, the average
annual amount of payable claims attributed to the county under
IC 12-16-7.5-4.5 during the three (3) most recently completed
state fiscal years.
(e) A county may not impose an annual levy under subsection (d) in
an amount greater than the product of:
(1) The greater of:
(A) the county's hospital care for the indigent property tax levy
for taxes first due and payable in 2008; or
(B) the amount of the county's maximum hospital care for the
indigent property tax levy determined under this subsection for
taxes first due and payable in the immediately preceding year;
multiplied by
(2) the assessed value growth quotient determined in the last
STEP of the following STEPS:
STEP ONE: Determine the three (3) calendar years that most
immediately precede the ensuing calendar year and in which a
statewide general reassessment of real property does not first
become effective.
STEP TWO: Compute separately, for each of the calendar years
determined in STEP ONE, the quotient (rounded to the nearest
ten-thousandth) of the county's total assessed value of all taxable
property in the particular calendar year, divided by the county's
total assessed value of all taxable property in the calendar year
immediately preceding the particular calendar year.
STEP THREE: Divide the sum of the three (3) quotients
computed in STEP TWO by three (3).
SECTION 41. IC 12-17.6-3-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 2. (a) To be eligible to
enroll in the program, a child must meet the following requirements:
(1) The child is less than nineteen (19) years of age.
(2) The child is a member of a family with an annual income of:
(A) more than one hundred fifty percent (150%); and
(B) not more than two three hundred percent (200%);
(300%);
of the federal income poverty level.
(3) The child is a resident of Indiana.
(4) The child meets all eligibility requirements under Title XXI
of the federal Social Security Act.
(5) The child's family agrees to pay any cost sharing amounts
required by the office.
(b) The office may adjust eligibility requirements based on available
program resources under rules adopted under IC 4-22-2.
SECTION 42. IC 12-17.6-3-3 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 3. (a) Subject to
subsection subsections (b) and (c), a child who is eligible for the
program shall receive services from the program until the earlier of the
following:
(1) The child becomes financially ineligible.
(2) The child becomes nineteen (19) years of age.
(b) Subsection (a) applies only if the child and the child's family
comply with enrollment requirements.
(c) After a child who is less than three (3) years of age is
determined to be eligible for the program, the child is not required
to submit eligibility information more frequently than once in a
twelve (12) month period until the child becomes three (3) years of
age.
SECTION 43. IC 16-18-2-331.8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 331.8. "Small employer", for
purposes of IC 16-46-13 has the meaning set forth in
IC 16-3.1-31.2-3.
SECTION 44. IC 16-46-13 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2007]:
Chapter 13. Small Employer Wellness Programs
Sec. 1. (a) The state department shall adopt rules under
IC 4-22-2 to establish:
(1) minimum standards for use by a small employer in
establishing a wellness program to improve the health of
employees of the small employer; and
(2) criteria and a process for certification of a small
employer's wellness program that meets the minimum
standards established under subdivision (1) as a qualified
wellness program for purposes of IC 6-3.1-31.2.
(b) The minimum standards established under subsection (a)
must include a requirement that a wellness program provide
rewards for employee:
(1) appropriate weight loss;
(2) smoking cessation; and
(3) pursuit of preventative health care services.
Sec. 2. (a) A small employer may submit to the state department
for certification a wellness program developed by the small
employer.
(b) The state department shall review and, based on the criteria
established under section 1 of this chapter, make a determination
of whether to certify a wellness program submitted under
subsection (a) as a qualified wellness program.
(c) If a wellness program is certified by the state department,
the state department shall provide to the small employer a
certificate reflecting that the wellness program is a qualified
wellness program for purposes of IC 6-3.1-31.2.
SECTION 45. IC 27-8-5-2, AS AMENDED BY SEA 94-2007,
SECTION 194, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2007]: Sec. 2. (a) No individual policy of
accident and sickness insurance shall be delivered or issued for
delivery to any person in this state unless it complies with each of the
following:
(1) The entire money and other considerations for the policy are
expressed in the policy.
(2) The time at which the insurance takes effect and terminates is
expressed in the policy.
(3) The policy purports to insure only one (1) person, except that
a policy may must insure, originally or by subsequent
amendment, upon the application of any member of a family who
shall be deemed the policyholder and who is at least eighteen (18)
years of age, any two (2) or more eligible members of that family,
including husband, wife, dependent children, or any children
under a specified age, which shall not exceed nineteen (19) who
are less than twenty-four (24) years of age, and any other person
dependent upon the policyholder.
(4) The style, arrangement, and overall appearance of the policy
give no undue prominence to any portion of the text, and unless
every printed portion of the text of the policy and of any
endorsements or attached papers is plainly printed in lightface
type of a style in general use, the size of which shall be uniform
and not less than ten point with a lower-case unspaced alphabet
length not less than one hundred and twenty point (the "text" shall
include all printed matter except the name and address of the
insurer, name or title of the policy, the brief description if any,
and captions and subcaptions).
(5) The exceptions and reductions of indemnity are set forth in the
policy and, except those which are set forth in section 3 of this
chapter, are printed, at the insurer's option, either included with
the benefit provision to which they apply, or under an appropriate
caption such as "EXCEPTIONS", or "EXCEPTIONS AND
REDUCTIONS", provided that if an exception or reduction
specifically applies only to a particular benefit of the policy, a
statement of such exception or reduction shall be included with
the benefit provision to which it applies.
(6) Each such form of the policy, including riders and
endorsements, shall be identified by a form number in the lower
left-hand corner of the first page of the policy.
(7) The policy contains no provision purporting to make any
portion of the charter, rules, constitution, or bylaws of the insurer
a part of the policy unless such portion is set forth in full in the
policy, except in the case of the incorporation of or reference to
a statement of rates or classification of risks, or short-rate table
filed with the commissioner.
(8) If an individual accident and sickness insurance policy or
hospital service plan contract or medical service plan contract
provides that hospital or medical expense coverage of a
dependent child terminates upon attainment of the limiting age for
dependent children specified in such policy or contract, the policy
or contract must also provide that attainment of such limiting age
does not operate to terminate the hospital and medical coverage
of such child while the child is and continues to be both:
(A) incapable of self-sustaining employment by reason of
mental retardation or mental or physical disability; and
(B) chiefly dependent upon the policyholder for support and
maintenance.
Proof of such incapacity and dependency must be furnished to the
insurer by the policyholder within thirty-one (31) days of the
child's attainment of the limiting age. The insurer may require at
reasonable intervals during the two (2) years following the child's
attainment of the limiting age subsequent proof of the child's
disability and dependency. After such two (2) year period, the
insurer may require subsequent proof not more than once each
year. The foregoing provision shall not require an insurer to
insure a dependent who is a child who has mental retardation or
a mental or physical disability where such dependent does not
satisfy the conditions of the policy provisions as may be stated in
the policy or contract required for coverage thereunder to take
effect. In any such case the terms of the policy or contract shall
apply with regard to the coverage or exclusion from coverage of
such dependent. This subsection applies only to policies or
contracts delivered or issued for delivery in this state more than
one hundred twenty (120) days after August 18, 1969.
(b) If any policy is issued by an insurer domiciled in this state for
delivery to a person residing in another state, and if the official having
responsibility for the administration of the insurance laws of such other
state shall have advised the commissioner that any such policy is not
subject to approval or disapproval by such official, the commissioner
may by ruling require that such policy meet the standards set forth in
subsection (a) and in section 3 of this chapter.
(c) An insurer may issue a policy described in this section in
electronic or paper form. However, the insurer shall:
(1) inform the insured that the insured may request the policy in
paper form; and
(2) issue the policy in paper form upon the request of the insured.
SECTION 46. IC 27-8-5-16 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2007]: Sec. 16. Except as provided
in sections 17 and 24 of this chapter, no policy of group accident and
sickness insurance may be delivered or issued for delivery to a group
that has a legal situs in Indiana unless it conforms to one (1) of the
following descriptions:
(1) A policy issued to an employer or to the trustees of a fund
established by an employer (which employer or trustees must be
deemed the policyholder) to insure employees of the employer for
the benefit of persons other than the employer, subject to the
following requirements:
(A) The employees eligible for insurance under the policy
must be all of the employees of the employer, or all of any
class or classes of employees. The policy may provide that the
term "employees" includes the employees of one (1) or more
subsidiary corporations and the employees, individual
proprietors, members, and partners of one (1) or more
affiliated corporations, proprietorships, limited liability
companies, or partnerships if the business of the employer and
of the affiliated corporations, proprietorships, limited liability
companies, or partnerships is under common control. The
policy may provide that the term "employees" includes retired
employees, former employees, and directors of a corporate
employer. A policy issued to insure the employees of a public
body may provide that the term "employees" includes elected
or appointed officials.
(B) The premium for the policy must be paid either from the
employer's funds, from funds contributed by the insured
employees, or from both sources of funds. Except as provided
in clause (C), a policy on which no part of the premium is to
be derived from funds contributed by the insured employees
must insure all eligible employees, except those who reject the
coverage in writing.
(C) An insurer may exclude or limit the coverage on any
person as to whom evidence of individual insurability is not
satisfactory to the insurer.
(2) A policy issued to a creditor or its parent holding company or
to a trustee or trustees or agent designated by two (2) or more
creditors (which creditor, holding company, affiliate, trustee,
trustees, or agent must be deemed the policyholder) to insure
debtors of the creditor, or creditors, subject to the following
requirements:
organization (which must be deemed to be the policyholder) to
insure members of the union or organization for the benefit of
persons other than the union or organization or any of its officials,
representatives, or agents, subject to the following requirements:
(A) The members eligible for insurance under the policy must
be all of the members of the union or organization, or all of
any class or classes of members.
(B) The premium for the policy must be paid either from funds
of the union or organization, from funds contributed by the
insured members specifically for their insurance, or from both
sources of funds. Except as provided in clause (C), a policy on
which no part of the premium is to be derived from funds
contributed by the insured members specifically for their
insurance must insure all eligible members, except those who
reject the coverage in writing.
(C) An insurer may exclude or limit the coverage on any
person as to whom evidence of individual insurability is not
satisfactory to the insurer.
(4) A policy issued to a trust or to one (1) or more trustees of a
fund established or adopted by two (2) or more employers, or by
one (1) or more labor unions or similar employee organizations,
or by one (1) or more employers and one (1) or more labor unions
or similar employee organizations (which trust or trustees must be
deemed the policyholder) to insure employees of the employers
or members of the unions or organizations for the benefit of
persons other than the employers or the unions or organizations,
subject to the following requirements:
(A) The persons eligible for insurance must be all of the
employees of the employers or all of the members of the
unions or organizations, or all of any class or classes of
employees or members. The policy may provide that the term
"employees" includes the employees of one (1) or more
subsidiary corporations and the employees, individual
proprietors, and partners of one (1) or more affiliated
corporations, proprietorships, limited liability companies, or
partnerships if the business of the employer and of the
affiliated corporations, proprietorships, limited liability
companies, or partnerships is under common control. The
policy may provide that the term "employees" includes retired
employees, former employees, and directors of a corporate
employer. The policy may provide that the term "employees"
includes the trustees or their employees, or both, if their duties
are principally connected with the trusteeship.
(B) The premium for the policy must be paid from funds
contributed by the employer or employers of the insured
persons, by the union or unions or similar employee
organizations, or by both, or from funds contributed by the
insured persons or from both the insured persons and one (1)
or more employers, unions, or similar employee organizations.
Except as provided in clause (C), a policy on which no part of
the premium is to be derived from funds contributed by the
insured persons specifically for their insurance must insure all
eligible persons, except those who reject the coverage in
writing.
(C) An insurer may exclude or limit the coverage on any
person as to whom evidence of individual insurability is not
satisfactory to the insurer.
(5) A policy issued to an association or to a trust or to one (1) or
more trustees of a fund established, created, or maintained for the
benefit of members of one (1) or more associations. The
association or associations must have at the outset a minimum of
one hundred (100) persons, must have been organized and
maintained in good faith for purposes other than that of obtaining
insurance, must have been in active existence for at least one (1)
year, and must have a constitution and bylaws that provide that
the association or associations hold regular meetings not less than
annually to further purposes of the members, that, except for
credit unions, the association or associations collect dues or
solicit contributions from members, and that the members have
voting privileges and representation on the governing board and
committees. The policy must be subject to the following
requirements:
(A) The policy may insure members or employees of the
association or associations, employees of members, one (1) or
more of the preceding, or all of any class or classes of
members, employees, or employees of members for the benefit
of persons other than the employee's employer.
(B) The premium for the policy must be paid from funds
contributed by the association or associations, by employer
members, or by both, from funds contributed by the covered
persons, or from both the covered persons and the association,
associations, or employer members.
(Concerning hospitals providers for providing information verifying
indigency of patient).
SECTION 52. THE FOLLOWING ARE REPEALED [EFFECTIVE
JULY 1, 2007]: IC 12-15-15-9.8; IC 12-15-20.7-3; IC 12-16-2.5-6.5;
IC 12-16-8.5; IC 12-16-12.5.
SECTION 53. [EFFECTIVE JANUARY 1, 2007
(RETROACTIVE)] IC 6-3.1-31 and IC 6-3.1-31.2, both as added by
this act, apply only to taxable years beginning after December 31,
2006.
SECTION 54. [EFFECTIVE JULY 1, 2007] Notwithstanding
IC 6-7-1-14, revenue stamps paid for before July 1, 2007, and in the
possession of a distributor may be used after June 30, 2007, only if
the full amount of the tax imposed by IC 6-7-1-12, as effective after
June 30, 2007, and as amended by this act, is remitted to the
department of state revenue under the procedures prescribed by
the department.
SECTION 55. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning established by IC 12-8-6-1.
(b) The office shall apply to the United States Department of
Health and Human Services for any amendment to the state
Medicaid plan or demonstration waiver that is needed to provide
for presumptive eligibility for a pregnant woman described in
IC 12-15-2-13, as amended by this act.
(c) The office may not implement the amendment or waiver
until the office files an affidavit with the governor attesting that the
amendment or waiver applied for under this SECTION is in effect.
The office shall file the affidavit under this subsection not more
than five (5) days after the office is notified that the amendment or
waiver is approved.
(d) If the office receives approval for the amendment or waiver
under this SECTION from the United States Department of Health
and Human Services and the governor receives the affidavit filed
under subsection (c), the office shall implement the amendment or
waiver not more than sixty (60) days after the governor receives
the affidavit.
(e) The office may adopt rules under IC 4-22-2 to implement this
SECTION.
SECTION 56. [EFFECTIVE JULY 1, 2007] (a) IC 27-8-5-2, as
amended by this act, and IC 27-8-5-28, as added by this act, apply
to a policy of accident and sickness insurance that is issued,
delivered, amended, or renewed after June 30, 2007.
(b) IC 27-13-7-3, as amended by this act, applies to a health
maintenance organization contract that is entered into, delivered,
amended, or renewed after June 30, 2007.
SECTION 57. [EFFECTIVE JULY 1, 2007] (a) The definitions in
IC 12-15-44, as added by this act, apply to this SECTION.
(b) As used in this SECTION, "task force" refers to the Indiana
check-up plan task force established by subsection (c).
(c) The Indiana check-up plan task force is established to:
(1) study, monitor, provide guidance, and make
recommendations to the state concerning the Indiana
check-up plan;
(2) develop methods to increase availability of affordable
coverage for health care services for all Indiana residents;
(3) develop an education and orientation program for
individuals participating in the plan; and
(4) make recommendations to the legislative council.
(d) The affirmative votes of a majority of the voting members
appointed to the task force are required for the task force to take
action on any measure, including final reports.
(e) The office of Medicaid policy and planning established by
IC 12-8-6-1 shall staff the task force.
(f) The task force consists of the following voting members:
(1) Four (4) members described in subsection (g)(1) through
(g)(4) appointed by the speaker of the house of
representatives, two (2) of whom are appointed based on the
recommendation of the minority leader of the house of
representatives and none of whom are legislators.
(2) Four (4) members described in subsection (g)(5) through
(g)(8) appointed by the president pro tempore of the senate,
two (2) of whom are appointed based on the recommendation
of the minority leader of the senate and none of whom are
legislators.
(3) Four (4) members described in subsection (g)(9) through
(g)(12) appointed by the governor, not more than two (2) of
whom are members of the same political party.
(g) The members appointed under subsection (f) must represent
the following interests:
(1) Hospitals.
(2) Insurance companies.
(3) Primary care providers.
(4) Health professionals who are not primary care providers.
(5) Minority health concern experts.
(6) Business.
(7) Organized labor.
(8) Consumers.
(9) Children's health issues.
(10) Adult health issues.
(11) Mental health issues.
(12) Pharmaceutical industry.
(h) The secretary of the office of the secretary of family and
social services shall call the first meeting of the task force, at which
the members shall elect the chairperson of the task force.
(i) The task force shall report findings and make
recommendations to the governor and to the legislative council in
an electronic format under IC 5-14-6 as follows:
(1) A report not later than November 1, 2008.
(2) A final report not later than November 1, 2009.
(j) The task force members are not eligible for per diem
reimbursement or reimbursement for expenses incurred for travel
to and from task force meetings.
(k) This SECTION expires December 31, 2009.
SECTION 58. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning established by IC 12-8-6-1.
(b) The office shall apply to the United States Department of
Health and Human Services for approval of a Section 1115
demonstration waiver or a Medicaid state plan amendment to
develop and implement the following:
(1) Health insurance coverage program to cover individuals
who meet the following requirements:
(A) The individual is at least eighteen (18) years of age and
less than sixty-five (65) years of age.
(B) The individual is a United States citizen and has been
a resident of Indiana for at least twelve (12) months.
(C) The individual has an annual household income of not
more than two hundred percent (200%) of the federal
income poverty level.
(D) The individual is not eligible for health insurance
coverage through the individual's employer.
(E) The individual has been without health insurance
coverage for at least six (6) months or is without health
insurance coverage because of a change in employment.
(2) A premium assistance program described in
IC 12-15-44-20, as added by this act.
(c) The office shall include in the waiver application or state
plan amendment a request to fund the program in part by using:
(1) enhanced federal financial participation; and
(2) hospital care for the indigent dollars, upper payment limit
dollars, or disproportionate share hospital dollars.
(d) The office may not implement the waiver or state plan
amendment until the office:
(1) files an affidavit with the governor attesting that the
federal waiver or amendment applied for under this
SECTION is in effect; and
(2) has sufficient funding for the program.
The office shall file the affidavit under this subsection not later
than five (5) days after the office is notified that the waiver or
amendment is approved.
(e) The office may adopt rules under IC 4-22-2 necessary to
implement this SECTION.
(f) This SECTION expires December 31, 2013.
SECTION 59. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "office" refers to the office of Medicaid policy and
planning established by IC 12-8-6-1.
(b) The office shall apply to the United States Department of
Health and Human Services for approval of an amendment to the
state's Medicaid plan that is necessary to do the following:
(1) Amend the state's upper payment limit program.
(2) Make changes to the state's disproportionate share
hospital program.
(c) The office may not implement an approved amendment to
the state plan until the office files an affidavit with the governor
attesting that the state plan amendment applied for under
subsection (b)(1) or (b)(2) of 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 state plan amendment is
approved.
(d) The office may adopt rules under IC 4-22-2 necessary to
implement this SECTION.
(e) This SECTION expires December 31, 2013.
SECTION 60. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "commission" refers to the health finance commission
established by IC 2-5-23-3.
(b) As used in this SECTION, "office" refers to the office of
Medicaid policy and planning established by IC 12-8-6-1.
(c) The office shall report to the commission during the 2007
interim, updating the commission on the status of the development
and implementation of the Indiana check-up plan established by
IC 12-15-44-3, as added by this act.
(d) The commission shall, during the 2007 interim of the general
assembly, study the following:
(1) Whether the acute care hospital in Gary, Indiana, should
be converted from a private corporation to a county hospital,
a municipal hospital, or other governmental hospital. In
considering whether a conversion should occur, the
commission shall consider the following:
(A) Whether the conversion would result in better quality
care that would be sufficient to meet the needs of the
community.
(B) Whether the hospital's finances would be improved.
(C) The legal requirements to convert the hospital.
(2) Ways in which the state and other entities can encourage
physicians to practice in rural and county hospitals.
(3) The manner in which a not-for-profit hospital can be
converted into a county or municipal hospital.
(4) Federal guidelines concerning county hospitals and
intergovernmental transfers.
(5) A prohibition against smoking in public places in Indiana.
(6) Mechanisms for providing programs to provide health
care coverage for uninsured individuals in Indiana.
(7) Review of the use of sources of funding for Medicaid
reimbursement and implications for the uses of the funding
sources.
(e) This SECTION expires December 31, 2008.
SECTION 61. [EFFECTIVE UPON PASSAGE] (a) As used in this
SECTION, "small employer" means any person, firm, corporation,
limited liability company, partnership, or association actively
engaged in business who, on at least fifty percent (50%) of the
working days of the employer during the preceding calendar year,
employed at least two (2) but not more than fifty (50) eligible
employees, the majority of whom work in Indiana. In determining
the number of eligible employees, companies that are affiliated
companies or that are eligible to file a combined tax return for
purposes of state taxation are considered one (1) employer.
(b) The commissioner of the department of insurance and the
office of the secretary of family and social services may implement
a program to allow two (2) or more small employers to join
together to purchase health insurance, as described in
IC 27-8-5-16(8), as amended by this act.
(c) The commissioner shall adopt rules under IC 4-22-2
necessary to implement this SECTION.
SECTION 62. [EFFECTIVE JULY 1, 2007] (a) There is annually
transferred from the state general fund to the Indiana tobacco use
prevention and cessation trust fund established by IC 4-12-4-10 one
million two hundred thousand dollars ($1,200,000) on a schedule
determined by the office of management and budget. The transfer
shall be treated as part of the amount described in IC 6-7-1-28.1(7),
as added by this act. There is annually appropriated to the Indiana
tobacco use prevention and cessation executive board one million
two hundred thousand dollars ($1,200,000) from the state general
fund for the purpose of tobacco education, prevention, and use
control. The appropriation under this subsection is in addition to
any other appropriation made by the general assembly to the
Indiana tobacco use prevention and cessation executive board.
(b) There is appropriated from the Indiana check-up plan trust
fund established by IC 12-15-44-17, as added by this act, for the
period beginning July 1, 2007, and ending June 30, 2008, eleven
million dollars ($11,000,000) to the state department of health for
use in childhood immunization programs. On June 30, 2008, the
state department shall transfer to the Indiana check-up plan trust
fund any unexpended funds appropriated to the state department
under this subsection.
(c) There is appropriated from the Indiana check-up plan trust
fund established by IC 12-15-44-17, as added by this act, for the
period beginning July 1, 2008, and ending June 30, 2009, eleven
million dollars ($11,000,000) to the state department of health for
use in childhood immunization programs. On June 30, 2009, the
state department shall transfer to the Indiana check-up plan trust
fund any unexpended funds appropriated to the state department
under this subsection.
(d) The money in the Indiana check-up plan trust fund
established by IC 12-15-44-17, as added by this act, is appropriated
to the office of the secretary of family and social services for the
period beginning July 1, 2007, and ending June 30, 2009, for the
purposes of the fund.
SECTION 63. An emergency is declared for this act.
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