Bill Text: IN HB1047 | 2011 | Regular Session | Engrossed
Bill Title: Audit and survey requirement s of providers study.
Spectrum: Bipartisan Bill
Status: (Passed) 2011-05-16 - Effective 05/10/2011 [HB1047 Detail]
Download: Indiana-2011-HB1047-Engrossed.html
Citations Affected: IC 5-10; IC 6-8.1; IC 12-7; IC 12-12.7; IC 12-28;
IC 21-38; IC 27-8; noncode.
Effective: Upon passage; July 1, 2011.
(SENATE SPONSOR _ LAWSON C)
January 5, 2011, read first time and referred to Committee on Public Health.
January 20, 2011, amended, reported _ Do Pass.
January 24, 2011, read second time, ordered engrossed. Engrossed.
January 25, 2011, read third time, passed. Yeas 97, nays 0.
February 17, 2011, read first time and referred to Committee on Health and Provider Services.
March 31, 2011, amended, reported favorably _ Do Pass.
Digest Continued
for only one child per family during a billing period; and (4) specifies when termination of services may take place for nonpayment by families for program services. Requires certain reports to the division of disability and rehabilitative services advisory council. Eliminates priority criteria for formal categories for developmental disability waiver slots. Requires the office of Medicaid policy and planning to apply for federal approval to amend a Medicaid waiver to set an emergency placement priority for certain individuals. Requires the division to: (1) conduct a study on the number and types of audits and surveys required of entities providing services for which the division pays; and (2) evaluate whether certain providers that have achieved national accreditation should be considered by the division to be accredited for purposes of surveys conducted by state agencies; and to report back concerning the study to the developmental disabilities commission and the health finance commission by September 1, 2011.
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
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
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
(1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
(2) entitled to services under a contract with a prepaid health care delivery plan that is entered into or renewed under section 7(c) of this chapter.
(b) As used in this section, "early intervention services" means services provided to a first steps child under IC 12-12.7-2 and 20 U.S.C. 1432(4).
(c) As used in this section, "first steps child" means an infant or toddler from birth through two (2) years of age who is enrolled in the Indiana first steps program and is a covered individual.
(d) As used in this section, "first steps program" refers to the program established under IC 12-12.7-2 and 20 U.S.C. 1431 et seq. to
meet the needs of:
(1) children who are eligible for early intervention services; and
(2) their families.
The term includes the coordination of all available federal, state, local,
and private resources available to provide early intervention services
within Indiana.
(e) As used in this section, "health benefits plan" means a:
(1) self-insurance program established under section 7(b) of this
chapter to provide group health coverage; or
(2) contract with a prepaid health care delivery plan that is
entered into or renewed under section 7(c) of this chapter.
(f) A health benefits plan that provides coverage for early
intervention services shall reimburse the first steps program for
payments made by the program for early intervention services that are
covered under the health benefits plan. a monthly fee established by
the division of disability and rehabilitative services established by
IC 12-9-1-1. The monthly fee shall be provided instead of claims
processing of individual claims.
(g) The reimbursement required under subsection (f) may not be
applied to any annual or aggregate lifetime limit on the first steps
child's coverage under the health benefits plan.
(h) The first steps program may pay required deductibles,
copayments, or other out-of-pocket expenses for a first steps child
directly to a provider. A health benefits plan shall apply any payments
made by the first steps program to the health benefits plan's
deductibles, copayments, or other out-of-pocket expenses according to
the terms and conditions of the health benefits plan.
(h) The monthly fee required under subsection (f) may not be
reduced or denied as a result of:
(1) a required deductible;
(2) copayments;
(3) coinsurance; or
(4) other out-of-pocket expenses.
Chapter 9.7. Set Off of Refunds On Debt Owed Under the Infants and Toddlers With Disabilities Program
Sec. 1. (a) As used in this chapter, "agency" means a department, commission, council, board, bureau, division, service, office, or administration that is responsible for providing services under the infants and toddlers with disabilities program, including
the following:
(1) The division of mental health and addiction.
(2) The state department of health.
(3) The division of family resources.
(4) The division of disability and rehabilitative services.
(5) The department of education.
(6) The department of child services.
(b) As used in this chapter, "debt" means any amounts,
including required copayments, that are owed and past due to an
agency for a period of at least sixty (60) days for services provided
under the program.
(c) As used in this chapter, "program" refers to the infants and
toddlers with disabilities program under IC 12-12.7-2.
Sec. 2. If a person owes an agency a certified delinquent debt,
the agency is entitled to have the department set off the person's
tax refund against the delinquent debt.
Sec. 3. (a) To obtain a set off by the department under section 2
of this chapter, the agency must file an application for the set off
with the department before November 30 of the year preceding the
calendar year in which a tax refund is payable by the department.
The department shall prescribe the form and contents of the
application.
(b) An application filed under this section is effective only for
the purpose of a set off of a tax refund that is payable in the
calendar year that succeeds the calendar year in which the
application is filed.
Sec. 4. After the department receives an application for a set off
of a debtor's tax refund under section 3 of this chapter, the
department shall determine whether the debtor is entitled to a tax
refund. If the department determines that the debtor is entitled to
a tax refund, the department shall notify the agency that filed the
application of this fact.
Sec. 5. Within fifteen (15) days after an agency receives notice
under section 4 of this chapter that a debtor is entitled to a tax
refund from the department, the agency must send written notice
to the debtor and the department of the agency's intent to have the
debtor's tax refund set off. The notice must clearly set forth the
basis for the agency's claim to the debt and set off.
Sec. 6. A debtor who receives written notice under section 5 of
this chapter is entitled to contest the agency's claim to the debt and
set off at a hearing only if the debtor, within thirty (30) days after
receipt of the notice, mails to the agency written notice that the
debtor intends to contest the agency's claim to the debt.
Sec. 7. If the agency receives written notice that a debtor intends
to contest the agency's claim to a debt and set off, the agency shall
hold a hearing under IC 4-21.5-3.
Sec. 8. (a) After a final determination under sections 6 and 7 of
this chapter of the validity of a debt due to an agency, the agency
shall certify to the department the amount owed by the debtor to
the agency that is subject to set off.
(b) Upon receipt of certification of a debt, the department shall
set off the appropriate amount and pay that amount to the
appropriate agency.
Sec. 9. If the department sets off a debtor's tax refund under this
chapter, the department shall serve the debtor written notice of the
action and provide an accounting of the action taken on any
refund.
Sec. 10. (a) The department may charge the agency a fee of
fifteen percent (15%) of any funds the department sets off under
this chapter as a collection fee for the department's services.
(b) The department must bill the agency in order to collect the
fee described in subsection (a).
Sec. 11. (a) Notwithstanding IC 6-8.1-7, or any other law
prohibiting disclosure of a taxpayer's records or information, all
information exchanged among the department, the agency, and the
debtor necessary to accomplish the purposes of this chapter is
lawful.
(b) If the agency seeks action under this chapter against a
debtor's tax refund, the agency shall make the following
information, if known, available to the department:
(1) A list of the debtors.
(2) Each debtor's Social Security account number (or
numbers, if the debtor has more than one (1) number).
(3) Each debtor's home address.
(1) For purposes of IC 12-9-4, the meaning set forth in IC 12-9-4-1.
(2) For purposes of IC 12-12-8, the meaning set forth in IC 12-12-8-2.5.
(3) For purposes of IC 12-13-4, the meaning set forth in IC 12-13-4-1.
(4) For purposes of IC 12-15-41 and IC 12-15-42, the Medicaid
work incentives council established by IC 12-15-42-1.
(5) For purposes of IC 12-12.7-2, the meaning set forth in
IC 12-12.7-2-2.
(6) For purposes of IC 12-21-4, the meaning set forth in
IC 12-21-4-1.
(7) For purposes of IC 12-28-5, the meaning set forth in
IC 12-28-5-1.
duration and are individually planned and coordinated; and
(E) (4) Results in substantial functional limitations in at least
three (3) of the following areas of major life activities:
(i) (A) Self-care.
(ii) (B) Receptive and expressive Understanding and use of
language.
(iii) (C) Learning.
(iv) (D) Mobility.
(v) (E) Self-direction.
(vi) (F) Capacity for independent living.
(vii) (G) Economic self-sufficiency.
(b) The definition in subsection (a) does not apply and may not
affect services provided to an individual receiving:
(1) home and community based Medicaid waiver; or
(2) ICF/MR;
services through the division on June 30, 2011.
(1) The division of disability and rehabilitative services established by IC 12-9-1-1.
(2) The division of aging established by IC 12-9.1-1-1.
(3) The division of family resources established by IC 12-13-1-1.
(4) The division of mental health and addiction established by IC 12-21-1-1.
(b) The term refers to the following:
(1) For purposes of the following statutes, the division of disability and rehabilitative services established by IC 12-9-1-1:
(A) IC 12-9.
(B) IC 12-11.
(C) IC 12-12.
(D) IC 12-12.5.
(E) IC 12-12.7.
(F) IC 12-28-5.
(2) For purposes of the following statutes, the division of aging established by IC 12-9.1-1-1:
(A) IC 12-9.1.
(B) IC 12-10.
(3) For purposes of the following statutes, the division of family resources established by IC 12-13-1-1:
(A) IC 12-13.
(B) IC 12-14.
(C) IC 12-15.
(D) IC 12-16.
(E) IC 12-17.2.
(F) IC 12-18.
(G) IC 12-19.
(H) IC 12-20.
(4) For purposes of the following statutes, the division of mental health and addiction established by IC 12-21-1-1:
(A) IC 12-21.
(B) IC 12-22.
(C) IC 12-23.
(D) IC 12-25.
(c) With respect to a particular state institution, the term refers to the division whose director has administrative control of and responsibility for the state institution.
(d) For purposes of IC 12-24, IC 12-26, and IC 12-27, the term refers to the division whose director has administrative control of and responsibility for the appropriate state institution.
Percentage of Copayment
Federal Income Per Unit of
Poverty Level Treatment
At But Not
Least More Than
0% 250% $ 0
251% 350% $
351% 450%
451% 550% $
551% 650% $
651% 750% $
751% 850% $
851%
participate in the cost of the programs and services provided under this
chapter:
(1) must:
(A) be based on income and ability to pay;
(B) provide for a review of a family's cost participation
amount:
(i) annually; and
(ii) within thirty (30) days after the family reports a
reduction in income; and
(C) allow the division to waive a required copayment if other
medical expenses or personal care needs expenses for any
member of the family reduce the level of income the family
has available to pay copayments under this section;
(2) may allow:
(A) the division to require a copayment for only one (1)
child per family during a billing period; and
(B) a family to voluntarily contribute payments that exceed the
family's required cost participation amount;
(3) must require the family to allow the division access to all
health care coverage information that the family has concerning
the infant or toddler who is to receive services;
(4) must require families to consent to the division billing third
party payors for early intervention services provided;
(5) may allow the division to waive the billing to third party
payors if the family is able to demonstrate financial or personal
hardship on the part of the family member; and
(6) must require the division to waive the family's monthly
copayments in any month for those services for which it receives
payment from the family's health insurance coverage.
(c) (d) Funds received through a cost participation plan under this
section must be used to fund programs described in section 18 of this
chapter.
(1) Set off under IC 6-8.1-9.7 on any state tax refund owed to the person against the delinquent debt.
(2) Terminate services provided to an individual under the program for failure to pay the cost participation set forth in
section 17 of this chapter.
(b) The agency may not terminate services under subsection
(a)(2) until the agency has provided the family with written notice:
(1) stating:
(A) the amount of money owed by the family that is past
due for services provided; and
(B) the amount of payment necessary in order to prevent
termination of services; and
(2) advising the family to contact the agency:
(A) for assistance; or
(B) to negotiate an alternative payment arrangement or to
recalculate the amount of payment owed.
(1) Determine the current and projected needs of each geographic area of Indiana for residential services for individuals with a developmental disability and, beginning July 1, 2012, annually report the findings to the division of disability and rehabilitative services advisory council established by IC 12-9-4-2.
(2) Determine how the provision of developmental or vocational services for residents in these geographic areas affects the availability of developmental or vocational services to individuals with a developmental disability living in their own homes and, beginning July 1, 2012, report the findings to the division of disability and rehabilitative services advisory council established by IC 12-9-4-2.
(3) Develop standards for licensure of supervised group living facilities regarding the following:
(A) A sanitary and safe environment for residents and employees.
(B) Classification of supervised group living facilities.
(C) Any other matters that will ensure that the residents will receive a residential environment.
(4) Develop standards for the approval of entities providing supported living services.
(b) An entity that provides supported living services must be approved by the
(1) meet the standards established under section 10 of this chapter; and
(2) are necessary to provide adequate services to individuals with a developmental disability in that geographic area.
(1) Both of the supervised group living facilities meet all standards for licensure as provided in section 10(3) of this chapter.
(2) Both of the supervised group living facilities are built on land that is owned by one (1) private entity.
(3) The
(1) the license of a supervised group living facility; or
(2) the approval of an entity that provides supported living services;
that no longer meets the standards established under section 10 of this chapter after following the procedures prescribed by IC 4-21.5-3. If a hearing is provided for or authorized to be held by the
(b) The
(b) After June 30, 2011, rules of the former community residential council (repealed) are considered rules of the division.
SECTION 279, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2011]: Sec. 3. The first steps program may pay
required deductibles, copayments, or other out-of-pocket expenses for
a first steps child directly to a provider. An employee health plan shall
apply any payments made by the first steps program to the employee
health plan's deductibles, copayments, or other out-of-pocket expenses
according to the terms and conditions of the employee health plan. The
reimbursement required under section 1 of this chapter may not be
reduced or denied as a result of:
(1) a required deductible;
(2) copayments;
(3) coinsurance; or
(4) other out-of-pocket expenses.
(1) a required deductible;
(2) copayments;
(3) coinsurance; or
(4) other out-of-pocket expenses.
; (11)EH1047.1.18. --> SECTION 18. THE FOLLOWING ARE REPEALED [EFFECTIVE JULY 1, 2011]: IC 12-28-5-1; IC 12-28-5-2; IC 12-28-5-3; IC 12-28-5-4; IC 12-28-5-5; IC 12-28-5-6; IC 12-28-5-7; IC 12-28-5-8; IC 12-28-5-9; IC 12-28-5-15.
rehabilitative services established by IC 12-9-1-1.
(b) As used in this SECTION, "office" refers to the office of
Medicaid policy and planning established by IC 12-8-6-1.
(c) As used in this SECTION, "waiver" refers to any waiver
administered by the office and the division under section 1915(c) of the
federal Social Security Act.
(d) Before July 1, 2008, the office shall apply to the United States
Department of Health and Human Services for approval to amend a
waiver to set priorities as described in subsection (e) in providing
services under the waiver.
(e) The waiver amendment must provide for the following
individuals to be given priority in receiving services under the waiver:
(1) An individual who is determined by the state department of
health to no longer need or receive active treatment provided in
a supervised group living setting.
(2) An individual who is receiving service under the direction of
the division in a supervised group living setting, nursing facility,
or large private intermediate care facility and has a history of
unexplained injuries or documented abuse that is substantiated by
the division and that threatens the health and welfare of the
individual.
(3) A current resident, or the guardian of a resident who is
incapacitated, of a large, private intermediate care facility for the
mentally retarded who requests to leave the facility.
(4) An individual who will be attaining the maximum age for a
residential or group home setting funded by the department of
education, the division of family resources, or the office.
(5) An individual for whom the primary caregiver of the
individual is no longer able to care for the individual due to:
(A) the death of the primary caregiver;
(B) the long term institutionalization of the primary caregiver;
(C) the long term incapacitation of the primary caregiver; or
(D) the long term incarceration of the primary caregiver.
(6) An individual who is on the waiver waiting list and has
been determined to have a shortened life span as defined by
the division.
(7) Any other priority as determined by the division.
(f) The office may not implement the amendment to the waiver until
the office files an affidavit with the governor attesting that the
amendment to the federal waiver applied for under this SECTION is in
effect. The office shall file the affidavit under this subsection not later
than five (5) days after the office is notified that the waiver amendment
is approved.
(g) If the office receives approval for the amendment to the waiver
under this SECTION from the United States Department of Health and
Human Services and the governor receives the affidavit filed under
subsection (f), the office shall implement the amendment to the waiver
not more than sixty (60) days after the governor receives the affidavit.
(d) Before October 1, 2011, the office shall apply to the United
States Department of Health and Human Services for approval to
amend a waiver to set an emergency placement priority for
individuals in the following situations:
(1) Death of a primary caregiver where alternative placement
in a supervised group living setting:
(A) is not available; or
(B) is determined by the division to be an inappropriate
option.
(2) A situation in which:
(A) the primary caregiver is at least eighty (80) years of
age; and
(B) alternate placement in a supervised group living setting
is not available or is determined by the division to be an
inappropriate option.
(3) There is evidence of abuse or neglect in the current
institutional or home placement, and alternate placement in
a supervised group living setting is not available or is
determined by the division to be an inappropriate option.
(4) There are other health and safety risks, as determined by
the division director, and alternate placement in a supervised
group living setting is not available or is determined by the
division to be an inappropriate option.
(h) (e) The division shall report on a quarterly basis the
following information to the division of disability and rehabilitative
services advisory council established by IC 12-9-4-2 concerning
each Medicaid waiver for which the office has been approved
under this section to administer an emergency placement priority
for individuals described in this section:
(1) The number of applications for emergency placement
priority waivers.
(2) The number of individuals served on the waiver.
(3) The number of individuals on a wait list for the waiver.
(f) The office may adopt rules under IC 4-22-2 necessary to
implement this SECTION.
(i) (g) This SECTION expires July 1, 2016.
(b) As used in this SECTION, "provider" refers to any entity that receives funding from the division.
(c) The division shall:
(1) conduct a study of the various federal, state, and local audits and reviews that are required to be conducted by providers; and
(2) report its findings to the commission on developmental disabilities established by IC 2-5-27.2-2 and to the health finance commission established by IC 2-5-23-3 not later than September 1, 2011.
(d) In conducting the study required by subsection (c), the division must consult with providers.
(e) The division shall evaluate whether a provider of supported living services that has achieved national accreditation for those services should be considered by the division to be accredited for purposes of surveys conducted by the bureau of quality improvement services and other state agencies. The division shall report the findings of the evaluation to the commission on developmental disabilities.
(f) This SECTION expires December 31, 2011.
