Requires the office of the secretary of family and social services to apply, not later than October 1, 2026, for approval of a Section 1115 Medicaid demonstration waiver to provide coverage for health related social needs.
Amends the duties of the office of the secretary of family and social services (office) concerning Medicaid home and community based services waivers (waiver). Requires: (1) a provider of waiver services to provide certain documentation to a waiver recipient; (2) a waiver recipient to review the documentation and report errors or inconsistencies; and (3) the recipient's case manager to provide assistance to the recipient in reviewing the documentation and reporting any errors or inconsistencies. Requires certain Medicaid recipients to choose the recipient's provider of integrated health care coordination. Provides that integrated health care coordination provided by a provider of assisted living services is not duplicative of certain other services. Establishes a time frame in which the bureau of disabilities services must review and approve or deny requests for an increase in service units provided to certain individuals with a disability. Requires the office to apply to the federal government for: (1) a new Medicaid waiver to provide assisted living services; and (2) an amendment to a specific Medicaid home and community based services waiver to establish an individual cost limit of not more than the institutional cost of nursing facility services. Specifies that provisions concerning reimbursement for assisted living services for individuals who are aged and disabled and receiving services under a Medicaid waiver apply to the new assisted living Medicaid waiver. Provides that, beginning July 1, 2027, an individual is no longer a member of the covered population upon receiving nursing facility services for 100 consecutive days. Provides that on the one hundredth day, the individual is not a member of the covered population and shall receive Medicaid services under a fee for service program. Provides that a provision prohibiting the office from reducing reimbursement for home health services expires June 30, 2027. Requires the office to collaborate with certain entities to develop a new reimbursement methodology for home health services. Specifies that public notice of at least six months (rather than one year) must be provided before a health facility service reimbursement that results in a reduction in reimbursement may be changed. Amends the definition of "bulk drug substance" for provisions concerning drug compounding. Provides that a claim by the estate recovery unit of the office of Medicaid policy and planning (estate recovery unit) is forever barred unless the estate recovery unit files a claim in the court in which the decedent's estate is being administered not later than nine months after the date of death of the decedent.
Amends the duties of the office of the secretary of family and social services (office) concerning home and community based services waivers (waiver). Requires: (1) a provider of waiver services to provide certain documentation to a waiver recipient; (2) a waiver recipient to review the documentation and report errors or inconsistencies; and (3) the recipient's case manager to provide assistance to the recipient in reviewing the documentation and reporting any errors or inconsistencies. Establishes a time frame in which the bureau of disabilities services must review and approve or deny requests for an increase in service units provided to certain individuals with a disability. Creates an exemption for presumptive eligibility standards. Provides reimbursement exemptions under certain Medicaid programs when operating under a value based health care reimbursement agreement. Provides that a provision prohibiting the office from reducing reimbursement for home health services expires June 30, 2027. Requires the office to collaborate with certain entities to develop a new reimbursement methodology for home health services. Specifies that public notice of at least six months (rather than one year) must be provided before a health facility service reimbursement that results in a reduction in reimbursement may be changed. Provides that a claim by the estate recovery unit of the office of Medicaid policy and planning (estate recovery unit) is forever barred unless the estate recovery unit files a claim in the court in which the decedent's estate is being administered not later than nine months after the date of death of the decedent.
Adds the 9-8-8 crisis response center and a mobile crisis team as first responders. Requires certified peers to be trained and certified by the division of mental health and addiction or an approved nationally accredited certification body. Amends the definition of "qualified provider" concerning the Medicaid program. Requires the office of the secretary of family and social services to limit presumptive eligibility determinations to qualified providers and sets forth requirements. Requires rules to be adopted concerning the implementation and administration of certification requirements for specified entities and amends standards. Allows a home health agency that meets certain conditions to continue to provide services to a Medicaid recipient and receive Medicaid reimbursement while the home health agency's application for Medicare enrollment is pending if the home health agency submitted the application or initiated the enrollment process before April 1, 2026. Changes the name of the division of disability and rehabilitative services to the division of disability, aging, and rehabilitative services. Repeals the division of aging and moves existing statutes and administrative rules to other locations. Renames the bureau of aging and in-home services to the bureau of better aging (bureau) and designates the bureau to perform certain duties once performed by the division of aging. Eliminates the requirement of a preferred drug list report. Extends the expiration of the micro facility pilot program. Authorizes the legislative services agency to prepare any legislation necessary to conform with the changes made.
Prohibits: (1) the state employee health plan; (2) the Medicaid program; (3) an accident and sickness insurance policy; and (4) a health maintenance organization individual or group contract; from imposing a time limit on the amount of anesthesia time for a medical procedure or otherwise restricting or excluding coverage or payment of anesthesia time. Modifies the definitions of "charity care" and "community benefits" for purposes of certain hospital reporting requirements. Requires additional reporting of information by nonprofit hospitals to the Indiana department of health (state department). Requires the report to be posted on the nonprofit hospital's website and the state department's website. Increases the penalty for failure to file the report and changes the time frame in which the penalty may be assessed. Specifies that any penalty be deposited in the local public health fund. Allows for certain practitioners to provide neuroplastogen treatment concerning qualified patients with life threatening conditions if certain requirements are met. Allows for research to be conducted on neuroplastogen access. Requires reporting of adverse events and annual reporting of patient statistical information concerning the neuroplastogen treatment. Provides for immunity when treating using neuroplastogens. Requires a clinical peer to disclose certain information for a peer to peer review of an adverse determination. Prohibits a utilization review entity from using artificial intelligence as the primary means for making adverse determinations. Prohibits a health insurer from engaging in certain downcoding practices and sets forth conditions for downcoding a claim. Authorizes the department of insurance to enforce the downcoding requirements and impose certain penalties for a violation. Prohibits an insurer, pharmacy benefit manager, or other administrator of pharmacy benefits from designating a prescription drug as a specialty drug unless certain conditions are met.
Requires (rather than allows) the development of programs designed to increase Medicaid reimbursement. Specifies that the reimbursement rates for a state directed payment program must be at least the Medicare reimbursement rates. Requires the office of the secretary of family and social services to perform a reconciliation of the capitation attributable to the incremental hospital fee. Prohibits money in the incremental hospital fee fund from being used to fund Medicaid. Amends the permissible use of funds collected under the hospital assessment fee. Removes language that allowed the hospital assessment fee to be used to fund a state directed payment program that depended upon the collection of the managed care assessment fee. Changes the definition of "prices" concerning the hospital statewide average rate study and pricing (study). Amends the requirements to conduct the study and the date by which the study must be completed.
Requires the office of the secretary of family and social services (office) to post information concerning the criteria for being determined to be medically frail and examples of notices on the office's website. Specifies requirements for a notice of Medicaid termination. Requires the office and managed care organizations to review all timely submitted information in a Medicaid redetermination before terminating coverage of a recipient. Requires a managed care organization to report information concerning: (1) claim denials under the Medicaid program on a quarterly basis; and (2) certain information on a monthly basis. Requires the office to post the reports on the office's website. Provides that the healthy Indiana plan includes at least 30 days of retroactive coverage.
Amends the duties of the office of the secretary of family and social services (office) concerning home and community based services waivers (waiver). Sets forth requirements for conducting an audit of a provider of waiver services. Requires: (1) a waiver recipient to review the recipient's monthly statement and report errors or inconsistencies; and (2) the recipient's case manager to provide assistance to the recipient in reviewing the statements and reporting any errors. Establishes the home and community based services waiver waiting list assistance fund (fund) to provide individuals on a waiver waiting list with access to certain supports. Provides that when the office determines an individual is ineligible for Medicaid, the office shall provide the specific reason for determining the individual is ineligible. Requires the office to review certain bank accounts in determining an individual's Medicaid eligibility. Requires a provider of waiver services to provide a recipient and the recipient's care coordinator with certain billing statements. Provides that appropriations in the budget bill for Medicaid assistance that are budgeted for a waiver that remain unexpended and unencumbered at the close of the state fiscal year and that would otherwise lapse and be returned to the state general fund do not revert to the state general fund, but instead shall be deposited in the fund. Provides that, for the state fiscal year beginning July 1, 2026, and ending June 30, 2027, appropriations in the budget bill for Medicaid assistance in an amount sufficient to cover costs incurred by the office in carrying out specified duties that remain unexpended and unencumbered at the close of the state fiscal year and that would otherwise lapse and be returned to the state general fund do not revert to the state general fund, but instead shall remain available to the office to cover these costs.
Sets forth requirements for a home and community based services attendant care service Medicaid provider to meet in the use of the state fund share of Medicaid reimbursement for compensation of direct care staff. Requires the provider to submit a cost report annually to verify compliance.
Requires a state employee health plan to reimburse the provider of behavior analysis services that provides behavior analysis services to a covered individual at a rate of not less than 110% of the Medicaid reimbursement rate for behavior analysis services under certain circumstances. Requires a policy of accident and sickness insurance to reimburse the provider of behavior analysis services that provides behavior analysis services to an insured at a rate of not less than 110% of the Medicaid reimbursement rate for behavior analysis services under certain circumstances. Requires a health maintenance organization contract to reimburse the provider of behavior analysis services that provides behavior analysis services to an enrollee at a rate of not less than 110% of the Medicaid reimbursement rate for behavior analysis services under certain circumstances.
