February 18, 2011
SENATE BILL No. 218
_____
DIGEST OF SB 218
(Updated February 16, 2011 2:19 pm - DI 104)
Citations Affected: IC 5-10; IC 12-7; IC 12-12.7; IC 12-28; IC 21-38;
IC 27-8; noncode.
Synopsis: Developmental disabilities. Changes the definition of
"developmental disabilities" to conform to the federal definition.
Repeals the community residential council and gives the duties of the
council to the division of disability and rehabilitative services
(division). Changes the following concerning the first steps program:
(1) the third party payor requirements; and (2) the copayment structure
and amounts; and (3) allows the division to require a copayment for
only one child per family during a billing period. 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.
Effective: July 1, 2011.
Lawson C
, Miller, Taylor
January 5, 2011, read first time and referred to Committee on Health and Provider
Services.
February 17, 2011, amended, reported favorably _ Do Pass.
February 18, 2011
First Regular Session 117th General Assembly (2011)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
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SENATE BILL No. 218
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 5-10-8-7.3; (11)SB0218.1.1. -->
SECTION 1. IC 5-10-8-7.3, AS AMENDED BY P.L.93-2006,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2011]: Sec. 7.3. (a) As used in this section, "covered
individual" means an individual who is:
(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.
SOURCE: IC 12-7-2-44; (11)SB0218.1.2. -->
SECTION 2. IC 12-7-2-44, AS AMENDED BY P.L.130-2009,
SECTION 15, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2011]: Sec. 44. "Council" means the following:
(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.
SOURCE: IC 12-7-2-61; (11)SB0218.1.3. -->
SECTION 3. IC 12-7-2-61 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 61. "
(a) Except as
provided in subsection (b), "developmental disability" means
the
following:
(1) Except as provided in subdivision (2), before July 1, 1993, the
term means a
severe, chronic disability of an individual that
meets all of the following conditions:
(A) (1) Is attributable to:
(i) (A) mental retardation, intellectual disability, cerebral
palsy, epilepsy, or autism;
or
(ii) (B) any other condition
(other than a sole diagnosis of
mental illness) found to be closely related to
mental
retardation, intellectual disability, because this condition
results in similar impairment of general intellectual
functioning or adaptive behavior or requires
similar treatment
and or services
similar to those required for a person with
an intellectual disability. or
(iii) dyslexia resulting from a disability described in this
subdivision;
(B) originates before the person is eighteen (18) years of age;
(C) has continued or is expected to continue indefinitely; and
(D) constitutes a substantial disability to the individual's
ability to function normally in society.
(2) For purposes of IC 12-10-7 and IC 12-28-1 before July 1,
1993, and for purposes of IC 12 after June 30, 1993, the term
means a severe, chronic disability of an individual that:
(A) is attributable to a mental or physical impairment, or a
combination of mental and physical impairments (other than
a sole diagnosis of mental illness);
(B) (2) Is manifested before the individual is twenty-two (22)
years of age.
(C) (3) Is likely to continue indefinitely.
(D) reflects the individual's need for a combination and
sequence of special, interdisciplinary, or generic care,
treatment, or other services that are of lifelong or extended
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.
SOURCE: IC 12-7-2-69; (11)SB0218.1.4. -->
SECTION 4. IC 12-7-2-69, AS AMENDED BY P.L.1-2007,
SECTION 108, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2011]: Sec. 69. (a) "Division", except as
provided in subsections (b) and (c), refers to any of the following:
(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.
SOURCE: IC 12-12.7-2-17; (11)SB0218.1.5. -->
SECTION 5. IC 12-12.7-2-17, AS ADDED BY P.L.93-2006,
SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2011]: Sec. 17. (a) As used in this section, "per unit of
treatment" means an increment of fifteen (15) minutes for services
provided to an individual.
(a) (b) A family shall participate in the cost of programs and
services provided under this chapter to the extent allowed by federal
law according to the following cost participation schedule:
Percentage of Copayment Maximum
Federal Income Per Unit of Monthly
Poverty Level Treatment Cost Share
At
But Not
Least
More Than
0%
250%
$ 0
$ 0
251%
350%
$3 0.75 $ 24
351%
450%
$6 1.50 $ 48
451%
550%
$ 15 3.75 $ 120
551%
650%
$25 6.25 $ 200
651%
750%
$50 13 $ 400
751%
850%
$75 19 $ 600
851%
1000%
$100 25 $ 800
1001%
$ 120 $ 960
(b) (c) A cost participation plan used by the division for families to
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.
SOURCE: IC 12-28-5-10; (11)SB0218.1.6. -->
SECTION 6. IC 12-28-5-10, AS AMENDED BY P.L.99-2007,
SECTION 147, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2011]: Sec. 10.
In conjunction with the The
division
of disability and rehabilitative services, the council shall do
the following:
(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.
(5) Recommend social and habilitation programs to the Indiana
health facilities council for individuals with a developmental
disability who reside in health facilities licensed under IC 16-28.
(6) Develop and update semiannually a report that identifies the
numbers of individuals with a developmental disability who live
in health facilities licensed under IC 16-28. The Indiana health
facilities council shall assist in developing and updating this
report.
SOURCE: IC 12-28-5-11; (11)SB0218.1.7. -->
SECTION 7. IC 12-28-5-11 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 11. (a) A supervised
group living facility must have a license or provisional license issued
under this chapter to operate.
(b) An entity that provides supported living services must be
approved by the council division under this chapter to operate.
SOURCE: IC 12-28-5-12; (11)SB0218.1.8. -->
SECTION 8. IC 12-28-5-12, AS AMENDED BY P.L.99-2007,
SECTION 148, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2011]: Sec. 12. (a) The council division may
license only those supervised group living facilities that:
(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.
(b) A supervised group living facility described in subsection (c)
may locate in only one (1) of the following counties:
(1) A county having a population of more than twenty-seven
thousand (27,000) but less than twenty-seven thousand two
hundred (27,200).
(2) A county having a population of more than one hundred
seventy thousand (170,000) but less than one hundred eighty
thousand (180,000).
(3) A county having a population of more than fifty thousand
(50,000) but less than fifty-five thousand (55,000).
(c) (b) Notwithstanding 431 IAC 1.1-3-7(c) and 431 IAC 1.1-3-7(d),
the council division shall license one (1) supervised group living
facility that is located less than one thousand (1,000) feet from another
supervised group living facility or a sheltered workshop under the
following conditions:
(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 community formed by the supervised group living
facilities provides job opportunities for residents of the supervised
group living facilities, as appropriate.
(d) (c) The council division may approve an entity to provide
supported living services only if the entity meets the standards
established under section 10 of this chapter.
SOURCE: IC 12-28-5-13; (11)SB0218.1.9. -->
SECTION 9. IC 12-28-5-13 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 13. The council
division may revoke:
(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 council,
division, the council division may designate a person as its agent or
representative to conduct a hearing. The agent or representative shall
conduct the hearing under IC 4-21.5-3.
SOURCE: IC 12-28-5-14; (11)SB0218.1.10. -->
SECTION 10. IC 12-28-5-14 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 14. (a) The
council
division may issue a provisional license to a facility that does not
qualify for a license under section 12 of this chapter but that provides
satisfactory evidence that the facility will qualify within a period
prescribed by the
council. division. The period may not exceed six (6)
months.
(b) The council division may issue provisional approval to an entity
providing supported living services that does not qualify for approval
under section 12 of this chapter but that provides satisfactory evidence
that the entity will qualify within a period prescribed by the council.
division. The period may not exceed six (6) months.
SOURCE: IC 12-28-5-19; (11)SB0218.1.11. -->
SECTION 11. IC 12-28-5-19 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 19. (a) The council
division may adopt rules under IC 4-22-2 to implement this chapter.
(b) After June 30, 2011, rules of the former community
residential council (repealed) are considered rules of the division.
SOURCE: IC 21-38-6-1; (11)SB0218.1.12. -->
SECTION 12. IC 21-38-6-1, AS ADDED BY P.L.2-2007,
SECTION 279, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2011]: Sec. 1. An employee health 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 employee health plan.
a monthly fee established by the division of disability and
rehabilitative services. The monthly fee shall be provided instead
of claims processing of individual claims.
SOURCE: IC 21-38-6-3; (11)SB0218.1.13. -->
SECTION 13. IC 21-38-6-3, AS ADDED BY P.L.2-2007,
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.
SOURCE: IC 27-8-27-6; (11)SB0218.1.14. -->
SECTION 14. IC 27-8-27-6 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 6. A health insurance
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
insurance plan. a monthly fee established by the division of
disability and rehabilitative services. The monthly fee shall be
provided instead of claims processing of individual claims.
SOURCE: IC 27-8-27-9; (11)SB0218.1.15. -->
SECTION 15. IC 27-8-27-9 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 9. 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
insurer (as defined in IC 27-8-14.5-3) shall apply any payments made
by the first steps program to the health insurance plan's deductibles,
copayments, or other out-of-pocket expenses according to the terms
and conditions of the health insurance plan. Reimbursement required
under section 6 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.
SOURCE: 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.
; (11)SB0218.1.16. -->
SECTION 16. 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.
SOURCE: ; (11)SB0218.1.17. -->
SECTION 17. P.L.73-2008, SECTION 1 IS AMENDED TO READ
AS FOLLOWS [EFFECTIVE JULY 1, 2011]: SECTION 1. (a) As used
in this SECTION, "division" refers to the division of disability and
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.