Citations Affected: IC 2-5-26-16; IC 5-22-9-2.5; IC 12-15.
Synopsis: Health disparities in Medicaid. Requires a managed care
organization (MCO) that contracts with the office of Medicaid policy
and planning (OMPP) to provide Medicaid services to do the
following: (1) Report to the select joint commission on Medicaid
oversight concerning the MCO's culturally and linguistically
appropriate services standards plan and the progress in implementing
these standards. (2) Report to OMPP specified member related
information. (3) Implement standards concerning culturally and
linguistically appropriate services (CLAS), and encourage practices
that are more culturally and linguistically accessible. (4) Develop and
administer a community based health disparities advisory council. (5)
Include as part of the member's pharmacy benefits that the labeling of
the prescription drug be printed in the member's preferred language.
Requires OMPP to, beginning January 1, 2011, withhold a percentage
of reimbursement from a managed care organization under specified
circumstances. Requires the inclusion of criteria evaluating the MCO's
cultural competency in working with minority populations in a request
for proposal, and requires preferences to be awarded to an MCO that
shows evidence of cultural competency. Requires OMPP to: (1)
annually report certain Medicaid claims information to the legislative
council; and (2) establish standards and guidelines and ensure
continuity of care for Medicaid recipients who transfer from an MCO.
Requires Medicaid vendors to establish specified quality initiatives.
Effective: July 1, 2010.
January 12, 2010, read first time and referred to Committee on Public Health.
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
Medicaid policy and planning concerning managed care
organizations providing services for the risk-based managed care
Medicaid program under IC 12-15, the office of Medicaid policy
and planning shall:
(1) include as criteria that will be used in evaluating the
proposal information concerning the managed care
organization's cultural competency in working with minority
populations in Indiana; and
(2) award preferences to a managed care organization that
provides evidence of cultural competency in working with
minority populations.
including the following:
(i) Doctor visits.
(ii) Dental visits.
(iii) Any other professional care provided, including care
for human immunodeficiency virus (HIV).
(F) Immunizations.
(8) The number of Medicaid recipients who transfer from a
managed care organization to a different managed care
organization under the Medicaid program, including the
following:
(A) The number of Medicaid recipients transferring out of
each managed care organization.
(B) The number of Medicaid recipients transferring into
each managed care organization.
(C) The following information regarding the transferring
recipient:
(i) Race.
(ii) Reason for transfer.
(iii) The health outcomes for each recipient during the
six (6) months after the recipient transfers.
The report must be in an electronic format under IC 5-14-6.
federal law to encourage practices that are more culturally
and linguistically accessible, including:
(A) establishing and administering a written plan; and
(B) reporting annually on the progress of the plan.
(3) Develop and administer a community based health
disparities advisory council as described in subsection (c).
(4) Include as part of the member's pharmacy benefits that
the labeling of the prescription drug be printed in the
member's preferred language.
(b) The managed care organization shall:
(1) provide the culturally and linguistically appropriate
services (CLAS) standards report required by subsection (a)
to the interagency state council on black and minority health
established by IC 16-46-6-3; and
(2) make the report available to the public upon request.
(c) The community based health disparities advisory council
developed by each managed care organization as required in
subsection (a)(3) must include the following:
(1) At least two (2) members who are minority (as defined in
IC 16-46-6-2) Medicaid recipients.
(2) Seventy-five percent (75%) of the members must be
individuals who are not employed by the managed care
organization, representing the following:
(A) Health care professionals.
(B) Advocates in the health and human services area.
(C) Individuals who provide direct services to risk-based
managed care recipients.
(3) At least one (1) member representing each of the
following:
(A) The Indiana Minority Health Coalition.
(B) The commission on Hispanic/Latino affairs established
by IC 4-23-28-2.
(C) American Indian Center of Indiana.
(D) Asian Help Services.
(E) The Arc of Indiana.
(F) The Central Indiana Council on Aging.
(G) An entity that provides direct services to risk-based
managed care recipients.
The council membership must reflect the population served.
(d) A community based health disparities advisory council shall
do the following:
(1) Provide input and assist the managed care organization in
the development and implementation of the culturally and
linguistically appropriate services (CLAS) standards.
(2) Review the annual assessment and evaluate whether the
plan is improving minority health outcomes.
(3) Review the final report required by subsection (a)(1).
(4) Approve stipend reimbursement for travel expenses,
including mileage for council members who reside in a city
other than where the council meeting is being held to travel to
attend a council meeting.
(e) A managed care organization shall pay for the costs of the
managed care organization's community based health disparities
advisory council.
(f) Beginning January 1, 2011, the office shall withhold a
percentage of reimbursement from a managed care organization
based on a lack of progress by the managed care organization in
improving health disparity outcomes.
initiatives.
(4) Be in one (1) of the following categories:
(A) Obstetrics.
(B) Asthma.
(C) Diabetes.
(D) Immunizations.
(E) Healthcare effectiveness data and information set.