---

---

SENATE BILL No. 360

Citations Affected: IC 12-10; IC 12-15-2.1.

Synopsis: Long term care services. Provides the area agencies on aging (agency) with flexibility in the management of certain program funding, and prohibits the division of aging from imposing restrictions that are not in the division's contract with an agency. Allows spouses and parents of individuals who are at risk of being institutionalized to provide attendant care services, and limits the amount of services that can be reimbursed. Requires the dissemination of specified information as part of: (1) the screening and counseling program for individuals seeking long term care services; (2) a nursing facility's notification to applicants; (3) the nursing facility preadmission screening program; and (4) the hospital discharge process. Prohibits a patient from being discharged from a hospital to a nursing facility in which certain representatives of the hospital have a financial interest unless the patient consents to the discharge and authorizes the division of aging to charge hospitals for specified costs for certain inappropriate placements. Allows an area agency on aging to make presumptive eligibility determinations for the aged and disabled Medicaid waiver under specified circumstances.

Effective: July 1, 2010.

---

---

Becker

---

---

    January 12, 2010, read first time and referred to Committee on Health and Provider Services.

---

---

---

PRINTING CODE. 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 2009 Regular and Special Sessions of the General Assembly.

---

    A BILL FOR AN ACT to amend the Indiana Code concerning human services.

SOURCE: IC 12-10-1-6; (10)IN0360.1.1. -->     SECTION 1. IC 12-10-1-6 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2010]: Sec. 6. (a) The area agencies on aging designated by the bureau in each planning and service region shall do the following:
        (1) Determine the needs and resources of the aged in the area.
        (2) Coordinate, in cooperation with other agencies or organizations in the area, region, district, or county, all programs and activities providing health, recreational, educational, or social services for the aged.
        (3) Secure local matching money from public and private sources to provide, improve, or expand the sources available to meet the needs of the aged.
        (4) Develop, in cooperation with the division and in accordance with the regulations of the commissioner of the federal Administration on Aging, an area plan for each planning and service area to provide for the following:
            (A) A comprehensive and coordinated system for the delivery

of services needed by the aged in the area.
            (B) The collection and dissemination of information and referral sources.
            (C) The effective and efficient use of all resources meeting the needs of the aged.
            (D) The inauguration of new services and periodic evaluation of all programs and projects delivering services to the aged, with special emphasis on the low income and minority residents of the planning and service area.
            (E) The establishment, publication, and maintenance of a toll free telephone number to provide information, counseling, and referral services for the aged residents of the planning and service area.
        (5) Conduct case management (as defined in IC 12-10-10-1).
        (6) Perform any other functions required by regulations established under the Older Americans Act (42 U.S.C. 3001 et seq.).
    (b) The division shall pay the costs associated with the toll free telephone number required under subsection (a).
     (c) To the extent allowable under federal law concerning the expenditure of funds, the division shall:
        (1) authorize area agencies on aging to manage funds for a program specified in section 3 of this chapter with maximum flexibility to allow the delivery of the most appropriate and cost effective services under the program; and
        (2) refrain from imposing any restrictions on an area agency on aging other than those required under the terms of the contract between the division and the area agency on aging or agreed upon by both the division and the area agency on aging.

SOURCE: IC 12-10-12-6; (10)IN0360.1.2. -->     SECTION 2. IC 12-10-12-6, AS AMENDED BY P.L.121-2008, SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2010]: Sec. 6. (a) This subsection does not apply after December 30, 2008. If an individual who is discharged from a hospital licensed under IC 16-21:
        (1) is admitted to a nursing facility after the individual has been screened under the nursing facility preadmission program described in this chapter; and
        (2) is eligible for participation in the federal Medicaid program;
prior approval of the individual's admission to the nursing facility may not be required by the office under IC 12-15-21-1 through IC 12-15-21-3.

---

    (b) This subsection applies beginning December 31, 2008. If an individual:
        (1) is admitted to a nursing facility after the individual has been screened under the nursing facility preadmission program described in this chapter; and
        (2) is eligible for participation in the federal Medicaid program;
prior approval of the individual's admission to the nursing facility may be required by the office under IC 12-15-21-1 through IC 12-15-21-3.
    (c) The office shall adopt rules under IC 4-22-2 to implement:
        (1) subsection (b);
        (2) a screening and counseling program for individuals seeking long term care services; and
        (3) a biennial review of Medicaid waiver reimbursement rates.
     (d) As part of the screening and counseling program described in subsection (c)(2), the area agencies on aging shall provide the following information to an individual within seven (7) days after the individual's admission to a nursing facility:
        (1) Contact information for the area agency on aging that provides services in the area in which the nursing facility is located.
        (2) A list of all the long term care options that may be available to the individual in the local area.

SOURCE: IC 12-10-12-10; (10)IN0360.1.3. -->     SECTION 3. IC 12-10-12-10 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2010]: Sec. 10. (a) The notification required under section 8 of this chapter must notify the applicant of the following:
        (1) That the applicant is required under state law to apply to the agency serving the county of the applicant's residence for participation in a nursing facility preadmission screening program.
        (2) That the applicant's failure to participate in the nursing facility preadmission screening program could result in the applicant's ineligibility for Medicaid reimbursement for per diem in any nursing facility for not more than one (1) year.
        (3) That the nursing facility preadmission screening program consists of an assessment of the applicant's need for care in a nursing facility made by a team of individuals familiar with the needs of individuals seeking admission to nursing facilities.
         (4) The contact information for the agency that provides services in the area in which the nursing facility is located.
        (5) A list developed by the office under section 6 of this chapter of all long term care options that may be available to

the individual in the area.
    (b) The notification must be signed by the applicant or the applicant's parent or guardian if the applicant is not competent before admission.
    (c) If the applicant is admitted:
        (1) the nursing facility shall retain one (1) signed copy of the notification for one (1) year; and
        (2) the nursing facility shall deliver one (1) signed copy to the agency serving the county in which the applicant resides.
    (d) A person who violates this section commits a Class A infraction.

SOURCE: IC 12-10-12-16; (10)IN0360.1.4. -->     SECTION 4. IC 12-10-12-16, AS AMENDED BY P.L.121-2008, SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2010]: Sec. 16. (a) A screening team shall conduct a nursing facility preadmission screening program for each individual within the time permitted under this chapter. The program must consist of an assessment of the following:
        (1) The individual's medical needs.
        (2) The availability of services, other than services provided in a nursing facility, that are appropriate to the individual's health and social needs to maintain the individual in the least restrictive environment.
        (3) The cost effectiveness of providing services appropriate to the individual's needs that are provided outside of, rather than within, a nursing facility.
    (b) The assessment must be conducted in accordance with rules adopted under IC 4-22-2 by the director of the division in cooperation with the office.
    (c) Communication among members of a screening team or between a screening team and the division, the office, or the agency during the prescreening process may be conducted by means including any of the following:
        (1) Standard mail.
        (2) Express mail.
        (3) Facsimile machine.
        (4) Secured electronic communication.
     (d) A representative:
        (1) of the agency serving the area in which the individual's residence is located; and
        (2) who is familiar with personal care assessment;
shall explain and provide a written copy of the results of the assessment to the individual or the individual's parent or guardian if the individual is not competent, in the least time practicable after

the completion of the assessment.
    (e) In the explanation required in subsection (d), the representative shall include the services identified in subsection (a)(2).

SOURCE: IC 12-10-12-28.5; (10)IN0360.1.5. -->     SECTION 5. IC 12-10-12-28.5 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2010]: Sec. 28.5. (a) Before discharging a patient who will be participating in preadmission screening under this chapter, a hospital licensed under IC 16-21 shall:
         (1) give the patient a list that has been provided to the hospital by the area agencies on aging of all the long term care options that:
            (1) (A) may be available to the patient;
            (2) (B) are located within the hospital's service area; and
            (3) (C) are known to the hospital;
        (2) provide the patient with contact information for the agency that provides services in the area in which the hospital is located;
        (3) indicate any long term care facility on the list in which:
            (A) the hospital;
            (B) the hospital's:
                (i) governing board;
                (ii) chief executive officer; or
                (iii) chief financial officer; or
            (C) any physician on the hospital's staff;
        has any financial interest;
        (4) inform the patient in writing that a representative from the agency is available to provide additional information and counseling at no cost to the patient concerning long term care options; and
        (5) coordinate whenever possible with the agency to facilitate counseling with the patient concerning long term care options before placement of the patient.
     (b) A patient may not be discharged to a facility described in subsection (a)(3) unless the patient, or the patient's legal representative if the patient is incompetent, has consented to the discharge.
    (c) The division may charge a hospital that violates this section with the costs incurred by the state and the patient to correct the inappropriate placement.

SOURCE: IC 12-10-17.1-10; (10)IN0360.1.6. -->     SECTION 6. IC 12-10-17.1-10, AS ADDED BY P.L.141-2006, SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2010]: Sec. 10. (a) An individual may not provide attendant

care services for compensation from Medicaid or the community and home options to institutional care for the elderly and disabled program for an individual in need of self-directed in-home care services unless the individual is registered under section 12 of this chapter.
    (b) Subject to rules adopted by the division under IC 4-22-2, the division shall reimburse under this chapter an individual who is a legally responsible relative of an individual who is at risk of being institutionalized and in need of self-directed in-home care including a parent of a minor individual and a spouse, is precluded from providing to provide attendant care services for compensation under this chapter. in an amount not to exceed eight (8) hours a day and five (5) days a week.

SOURCE: IC 12-15-2.1; (10)IN0360.1.7. -->     SECTION 7. IC 12-15-2.1 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2010]:
     Chapter 2.1. Presumptive Eligibility for Aged and Disabled Medicaid Waiver Applicants
    Sec. 1. (a) An area agency on aging employee may determine that an applicant who meets the following conditions is presumptively eligible for the Medicaid aged and disabled waiver:
        (1) The applicant or the applicant's legal guardian has completed the required Medicaid application form.
        (2) The applicant meets the medical eligibility requirements in IC 12-10-11.5-4(2)(B).
        (3) The applicant is at risk for being institutionalized if the applicant does not receive immediate long term care services.
    (b) The area agency on aging's determination that an individual is presumptively eligible for the Medicaid aged and disabled waiver under subsection (a):
        (1) must be based on information submitted by the applicant; and
        (2) authorizes the immediate commencement of the provision of services needed by the applicant in compliance with rules adopted by the office under section 4 of this chapter.
    Sec. 2. The office shall apply to the United States Department of Health and Human Services for an amendment to the Medicaid aged and disabled waiver if an amendment is necessary to implement this chapter.
    Sec. 3. The area agency on aging shall:
        (1) notify the office of the presumptive eligibility determination not later than five (5) business days after the date on which the determination is made; and

---

        (2) forward the application to the county office in the county in which the applicant resides for a final eligibility determination in the manner specified by the office.
    Sec. 4. The office:
        (1) shall adopt rules under IC 4-22-2 concerning the services an individual may receive if the individual is determined to be presumptively eligible for the Medicaid aged and disabled waiver under this chapter; and
        (2) may adopt rules under IC 4-22-2 to implement this chapter.