Bill Text: IN SB0373 | 2010 | Regular Session | Introduced
Bill Title: Health facility third party dispute resolution.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2010-01-12 - First reading: referred to Committee on Health and Provider Services [SB0373 Detail]
Download: Indiana-2010-SB0373-Introduced.html
Citations Affected: IC 16-28-10-4.
Synopsis: Health facility third party dispute resolution. Establishes a
third party dispute resolution process that a health facility may use to
appeal a deficiency finding in the health facility's state department of
health (state department) survey report. Requires the state department
to contract with an independent third party to conduct the third party
dispute resolution process. Requires the state department and the
independent third party to collect and report specified statistical data
to the select joint commission on Medicaid oversight and long term
care trade associations.
Effective: July 1, 2010.
January 12, 2010, read first time and referred to Committee on Health and Provider
Services.
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A BILL FOR AN ACT to amend the Indiana Code concerning
health.
(b) The state department shall include the following in the voluntary third party dispute resolution process:
(1) Provisions contained in 42 CFR 488.331.
(2) A requirement that the state department send to the health facility by certified mail:
(A) a statement of deficiencies committed by the health facility not later than ten (10) business days after the conclusion of the survey;
(B) notice that the health facility may participate in third
party dispute resolution; and
(C) an explanation of the third party dispute resolution
process.
(3) The time frames in subsections (c) and (d).
(c) A health facility shall, not more than ten (10) calendar days
after receipt of the materials described in subsection (b)(2), send to
the state department the following:
(1) A plan of correction of any deficiencies.
(2) Written notice of the health facility's request to participate
in the third party dispute resolution process to refute a
deficiency cited in the statement of deficiency.
(d) The third party that contracts with the state department
under subsection (a) shall hold an independent dispute resolution
review not later than thirty (30) days after the state department's
receipt of the notice described in subsection (c)(2). The review must
include the following:
(1) An opportunity for the health facility to provide additional
information or clarification in support of the health facility's
contention that the cited deficiency was in error.
(2) At least one (1) of the following reviews:
(A) A review by the third party contractor of written
information submitted by the health facility.
(B) A telephone conference between the third party
contractor and a representative of the health facility.
(C) A face-to-face conference between the third party
contractor and a representative of the health facility.
(e) A health facility that requests a review under subsection (c)
may:
(1) request that the review be held at the health facility; and
(2) be accompanied by counsel during the review.
The third party contractor shall grant a request described in
subdivision (1).
(f) The state department and health facility shall:
(1) cooperate with a third party contractor in the third party
contractor's review of information; and
(2) provide to the third party contractor any additional
information requested by the third party contractor.
(g) A third party contractor shall, not later than thirty (30)
business days after a review described in this section:
(1) make a determination based on the information presented
to the third party contractor by the state department and the
health facility; and
(2) transmit written notice of the determination and the rationale for the determination to the health facility and the state department.
(h) If a third party contractor's determination described in subsection (g)(1) is that a deficiency exists, the health facility shall submit a plan of correction to the state department not later than ten (10) business days after receipt of the written notice under subsection (g)(2).
(i) If the state department disagrees with and reverses a third party contractor's determination described in subsection (g)(1), the state department shall, not later than ten (10) calendar days after receipt of the written notice under subsection (g)(2), transmit to the health facility written notice of the state department's decision and rationale for the reversal. If the state department determines that the deficiency will remain against the facility, the facility shall, not later than ten (10) business days after receipt of the written notice under this subsection, submit a plan of correction to the state department.
(j) The state department may not disclose or report to any agency any information concerning a deficiency that is the subject of a dispute under this section until a determination is made under subsection (g) or (i) and, if applicable, the health facility has responded with a plan of correction.
(k) The state department shall pay for any costs incurred under this section from the civil money penalty fund administered by the state department.
(l) Every six (6) months after the effective date of the contract, the state department and the independent third party contracted with to conduct the voluntary third party dispute resolution process under subsection (a) shall report to the select joint commission on Medicaid oversight established by IC 2-5-26-3 in writing and in an electronic format under IC 5-14-6 on the statistical utilization and outcomes of the process. The state department shall make the statistical utilization and outcomes data collected available to a long term care trade association on a quarterly basis.
(m) The state department may adopt rules under IC 4-22-2 to implement this section.
