2015 Indiana Code TITLE 12. HUMAN SERVICES ARTICLE 15. MEDICAID CHAPTER 44.5. HEALTHY INDIANA PLAN 2.0
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IC 12-15-44.5
Chapter 44.5. Healthy Indiana Plan 2.0
IC 12-15-44.5-1
"Phase out period"
Sec. 1. As used in this chapter, "phase out period" refers to the
following periods:
(1) The time during which a:
(A) phase out plan;
(B) demonstration expiration plan; or
(C) similar plan approved by the United States Department
of Health and Human Services;
is in effect for the plan set forth in this chapter.
(2) The time beginning upon the office's receipt of written
notice by the United States Department of Health and Human
Services of its decision to:
(A) terminate or suspend the waiver demonstration for the
plan; or
(B) withdraw the waiver or expenditure authority for the
plan;
and ending on the effective date of the termination, suspension,
or withdrawal of the waiver or expenditure authority.
(3) The time beginning upon:
(A) the office's determination to terminate the plan; or
(B) the termination of the plan under section 4(b) of this
chapter;
if subdivisions (1) through (2) do not apply, and ending on the
effective date of the termination of the plan.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-2
"Plan"
Sec. 2. As used in this chapter, "plan" refers to the healthy Indiana
plan 2.0 established by section 3 of this chapter.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-3
Plan established; eligibility; supercedes conflicting provisions
during applicable period; administration; phase out period
Sec. 3. (a) The healthy Indiana plan 2.0 is established. This
chapter is in addition to the provisions set forth in IC 12-15-44.2. For
the period beginning February 1, 2015, and ending the date the plan
is terminated upon the completion of a phase out period, if a
provision in this chapter conflicts with IC 12-15-44.2, this chapter
supersedes the conflicting provision in IC 12-15-44.2.
(b) The office shall administer the plan.
(c) The following individuals are eligible for the plan:
(1) An individual who is eligible and described in
IC 12-15-44.2-9.
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(2) The adult group described in 42 CFR 435.119.
(3) Pregnant women who choose to remain in the plan during
the pregnancy.
(4) Parents and caretaker relatives eligible under 42 CFR
435.110.
(5) Low income individuals who are:
(A) at least nineteen (19) years of age; and
(B) less than twenty-one (21) years of age;
and eligible under 42 CFR 435.222.
(6) Individuals, for purposes of receiving transitional medical
assistance.
(d) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare
program (42 U.S.C. 1395 et seq.).
(2) Except for an individual described in subsection (c), an
individual who is otherwise eligible for medical assistance.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-4
Scope of the plan; factors that trigger termination of the plan;
implementation of other plan upon termination
Sec. 4. (a) The plan:
(1) is not an entitlement program; and
(2) serves as an alternative to health care coverage under Title
XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(b) If either of the following occurs, the office shall terminate the
plan in accordance with section 6(b) of this chapter:
(1) The:
(A) percentages of federal medical assistance available to the
plan for coverage of plan participants described in Section
1902(a)(10)(A)(i)(VIII) of the federal Social Security Act are
less than the percentages provided for in Section
2001(a)(3)(B) of the federal Patient Protection and
Affordable Care Act; and
(B) hospital assessment committee (IC 16-21-10), after
considering the modification and the reduction in available
funding, does not alter the formula established under
IC 16-21-10-13.3(b)(1) to cover the amount of the reduction
in federal medical assistance.
For purposes of this subdivision, "coverage of plan participants"
includes payments, contributions, and amounts referred to in
IC 16-21-10-13.3(b)(1)(A), IC 16-21-10-13.3(b)(1)(C), and
IC 16-21-10-13.3(b)(1)(D), including payments, contributions,
and amounts incurred during a phase out period of the plan.
(2) The:
(A) methodology of calculating the incremental fee set forth
in IC 16-21-10-13.3 is modified in any way that results in a
reduction in available funding;
(B) hospital assessment fee committee (IC 16-21-10), after
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considering the modification and reduction in available
funding, does not alter the formula established under
IC 16-21-10-13.3(b)(1) to cover the amount of the reduction
in fees; and
(C) office does not use alternative financial support to cover
the amount of the reduction in fees.
(c) If the plan is terminated under subsection (b), the secretary
may implement a plan for coverage of the affected population in a
manner consistent with the healthy Indiana plan (IC 12-15-44.2) in
effect on January 1, 2014:
(1) subject to prior approval of the United States Department of
Health and Human Services; and
(2) without funding from the incremental fee set forth in
IC 16-21-10-13.3.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-5
Responsibilities of an insurer or health maintenance organization
that contracts with the office; reimbursement rate; requirement to
incorporate cultural competency standards
Sec. 5. (a) An insurer or health maintenance organization that
contracts with the office to provide health insurance coverage, dental
coverage, or vision coverage to an individual who participates in the
plan:
(1) is responsible for the claim processing for the coverage;
(2) shall reimburse providers at a rate that is not less than the
rate established by the secretary. The rate set by the secretary
must be based on a reimbursement formula that is:
(A) comparable to the federal Medicare reimbursement rate
for the service provided by the provider; or
(B) one hundred thirty percent (130%) of the Medicaid
reimbursement rate for a service that does not have a
Medicare reimbursement rate; and
(3) may not deny coverage to an eligible individual who has
been approved by the office to participate in the plan.
(b) An insurer or a health maintenance organization that contracts
with the office to provide health insurance coverage under the plan
must incorporate cultural competency standards established by the
office. The standards must include standards for non-English
speaking, minority, and disabled populations.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-6
Phase out funds deposited from incremental hospital assessment
fees; notice and phase out if plan is terminated
Sec. 6. (a) For:
(1) the state fiscal year beginning July 1, 2016, through the state
fiscal year beginning July 1, 2019, fees totaling eleven million
five hundred thousand dollars ($11,500,000) from incremental
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fees collected under IC 16-21-10-13.3 shall be deposited
annually into the phase out trust fund established under section
7 of this chapter; and
(2) the state fiscal years beginning July 1, 2020, and thereafter,
the hospital assessment fee committee (IC 16-21-10), after
consulting with the office and the Indiana Hospital Association,
shall determine the amount of fees to be deposited into the phase
out trust fund for the state fiscal year to augment the balance of
the trust fund at a projected amount, subject to amounts that
would be available under IC 12-15-44.2-17 and funds
previously deposited into the phase out trust fund under this
subsection that are necessary to cover the state share of the
expenses described in IC 16-21-10-13.3(b)(1)(A) through
IC 16-21-10-13.3(b)(1)(F) for a twelve (12) month period.
The phase out funds shall be deposited into the phase out trust fund
established in section 7 of this chapter from the incremental fee
collected under IC 16-21-10-13.3.
(b) If the plan is to be terminated for any reason, the office shall:
(1) if required, provide notice of termination of the plan to the
United States Department of Health and Human Services and
begin the process of phasing out the plan; or
(2) if notice and a phase out plan is not required under federal
law, notify the hospital assessment fee committee (IC 16-21-10)
of the office's intent to terminate the plan and the plan shall be
phased out under a procedure approved by the hospital
assessment fee committee.
The office may not submit any phase out plan to the United States
Department of Health and Human Services or accept any phase out
plan proposed by the Department of Health and Human Services
without the prior approval of the hospital assessment fee committee.
(c) Before submitting:
(1) an extension of; or
(2) a material amendment to;
the plan to the United States Department of Health and Human
Services, the office shall inform the Indiana Hospital Association of
the extension or material amendment to the plan.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-7
Phase out trust fund established; purpose of the fund; uses;
administration; fund is considered a trust fund
Sec. 7. (a) The phase out trust fund is established for the purpose
of holding the money needed during a phase out period of the plan.
Funds deposited under this section shall be used only:
(1) to fund the state share of the expenses described in
IC 16-21-10-13.3(b)(1)(A) through IC 16-21-10-13.3(b)(1)(F)
incurred during a phase out period of the plan;
(2) after funds from the healthy Indiana trust fund (IC
12-15-44.2-17) are exhausted; and
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(3) to refund hospitals in the manner described in subsection (h).
The fund is separate from the state general fund.
(b) The fund shall be administered by the office.
(c) The expenses of administering the fund shall be paid from
money in the fund.
(d) The trust fund must consist of:
(1) the funds described in section 6 of this chapter; and
(2) any interest accrued under this section.
(e) The treasurer of state shall invest the money in the fund not
currently needed to meet the obligations of the fund in the same
manner as other public money may be invested. Interest that accrues
from these investments shall be deposited in the fund.
(f) Money in the fund does not revert to the state general fund at
the end of any fiscal year.
(g) The fund is considered a trust fund for purposes of
IC 4-9.1-1-7. Money may not be transferred, assigned, or otherwise
removed from the fund by the state board of finance, the budget
agency, or any other state agency unless specifically authorized under
this chapter.
(h) At the end of the phase out period, any remaining funds and
accrued interest shall be distributed to the hospitals on a pro rata basis
based on the fees authorized by IC 16-21-10 that were paid by each
hospital for the state fiscal year that ended immediately before the
beginning of the phase out period.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-8
Requirements for use of money appropriated to the fund;
requirements for use of the incremental hospital assessment fee;
payment for health care services; administrative costs; profit
Sec. 8. The following requirements apply to funds appropriated by
the general assembly to the plan and the incremental fee used for
purposes of IC 16-21-10-13.3:
(1) At least eighty-seven percent (87%) of the funds must be
used to fund payment for health care services.
(2) An amount determined by the office of the secretary to fund:
(A) administrative costs of; and
(B) any profit made by;
an insurer or a health maintenance organization under a contract
with the office to provide health insurance coverage under the
plan. The amount determined under this subdivision may not
exceed thirteen percent (13%) of the funds.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-9
Rules
Sec. 9. (a) The office may adopt rules under IC 4-22-2 necessary
to implement:
(1) this chapter; or
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(2) a Section 1115 Medicaid demonstration waiver concerning
the plan that is approved by the United States Department of
Health and Human Services.
(b) The office may adopt emergency rules under IC 4-22-2-37.1
to implement the plan on an emergency basis.
(c) An emergency rule or an amendment to an emergency rule
adopted under this section expires not later than the earlier of:
(1) one (1) year after the rule is accepted for filing under
IC 4-22-2-37.1(e); or
(2) July 1, 2016.
As added by P.L.213-2015, SEC.136.
IC 12-15-44.5-10
Authorized changes to the plan
Sec. 10. The secretary may make changes to the plan under this
chapter if the changes are required by one (1) of the following:
(1) The United States Department of Health and Human
Services.
(2) Federal law or regulation.
As added by P.L.213-2015, SEC.136.
Indiana Code 2015
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