Leadingage Indiana Public Policy Committee Report

LeadingAge Indiana Public Policy Committee Report

2013 Indiana General Assembly

Issues of General Concern

Medicaid Funding: Governor Pence’s proposed budget increases Medicaid $200 million to keep up with current obligations. It does not include the Affordable Care Act Medicaid expansion which he is leaving up to the General Assembly. The 5% reimbursement cuts to nursing homes and hospitals are included in the House version of the budget.

LeadingAge Indiana Position: Closely follow budget deliberations and work closely with other Medicaid providers to support elimination of the 5% cuts.

Final Result: The 5% cuts will be continued through the biennium.

Quality Assessment Extension: Currently, the Quality Assessment continues only through the first year of the biennium. There are a House and Senate bill to extend it further. The House bill puts it in place permanently, while the Senate bill extends it through state fiscal year 2017 (June 30, 2017). A permanent extension is included in the House Republican budget. We will have to watch very carefully that they do not try to further erode the percentage going to nursing home reimbursement.

LeadingAge Indiana Position: Strongly support a permanent extension to the QA and guard against efforts to reduce the nursing home share of this funding.

Final Result: The QA was extended until June 30, 2017 with no changes in the splits between the state and providers.

CCRC Exemption: The Division of Aging has stripped the CCRC exemption to the QA from three for-profit facilities which were no longer able to register as a CCRC with the Securities Commission. These facilities did not have anyone with a pre-2009 CCRC contract which paid into the CCRC Guaranty Fund and did not meet the new requirement of having 25% or more of their residents in their independent living units with contracts with entrance fees of $25,000 or more. In fact, they had not continuing care contracts. This was determined by the Securities Division from the facilities’ annual report to the Commission.

The statutory QA language says that CCRCs registered prior to January 1, 2007 are not required to meet the new CCRC requirements but that the Division of Aging is saying that they must still be registered as a CCRC and in essence meet the new requirements.

Jim Leich worked with Faith Laird, Director of the Division of Aging, and her concern was that the exemption is for CCRCs and that the three which lost their exemption no longer offered or had continuing care contracts. She indicated that facilities can remain exempt if they continue to have continuing care contracts in place that met the Securities Division requirements prior to July 1, 2009. Language to fix this problem was negotiated with The Division and the Securities Commissioner Chris Naylor and Jim worked with the LeadingAge Indiana contracted lobbyists Barnes & Thornburg to amend the language into either the budget or another bill.

LeadingAge Indiana Position: The intention of the original exemption was to protect facilities with no or limited Medicaid utilization and that the CCRC exemption was the only way to achieve this that would be approved by CMS. Changes made in 2009 were designed to stop for-profits from registering in order to get the exemption but without truly being CCRCs. We are concerned that we maintain the integrity of the CCRC definition and are hesitant to make legislative changes that would jeopardize this definition. However, losing the exemption would be significant financial hit for the handful of LeadingAge Indiana members who are most at risk. The solution is to work on language which says that the pre2007 CCRCs can remain registered and exempt if they continue to offer their pre2007 continuing care contracts.

Final result: Language agreed upon with the Division of Aging and the Securities Division was amended into HB 1358. Facilities registered prior to January 1, 2007 could remain registered and exempt if they have maintained at least one continuing care contract. These contracts do not have to meet the new requirements but rather those in effect prior to July 1, 2009.

2013 Bill of Interest

SENATE:

SB111: Health facility employee criminal background checks. Requires a health facility to obtain a national criminal history background check or an expanded criminal history check for the health facility's employees. Provides immunity to persons: (1) for denying or terminating employment because of another person's criminal history; or (2) for reporting to or participating in the proceedings of the state department of health or the registry of nurse aides.

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0111

Sponsor: Sen. Randolph (D-Gary)

Assigned to Committee on Corrections & Criminal Law; died for lack of a hearing.

LeadingAge Indiana Position: Oppose but the bill is unlikely to get a hearing.

SB 366: Proof of identification for absentee voters. Provides that a voter who votes at a licensed care facility in which the voter lives must give proof of identification. (Under current law, such a voter is exempt from the proof of identification requirement.) Requires a voter who casts an absentee ballot by mail (other than a military or overseas voter or an address confidentiality voter) to provide a photocopy of the voter's proof of identification in the mailing envelope.

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0366

Sponsor: Sen. Head (R-Logansport)

Assigned to Committee on Elections; died for lack of a hearing.

LeadingAge Indiana Position: The Committee is concerned that many residents of our facilities that vote absentee may not have a photo ID and it may be difficult for them to leave the facility to obtain this ID. We should propose the use of the medical record as evidence as an alternative.

SB412: Health facility quality assessment fee. Extends the law establishing the health facility quality assessment fee until June 30, 2017. (Current law assessing the fee expires June 30, 2014.) Specifies the state fiscal year distribution methods for the assessment.

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0412

Sponsor: Sen. Miller (R-Indianapolis)

Assigned to Health and Provider Services Committee; died for lack of a hearing. The extension of the Quality Assessment until June 30, 2013 was passed in the budget bill.

LeadingAge Indiana Position: Support.

SB417: Health provider reporting of domestic violence. Requires a health care provider to: (1) implement protocols and policies for the identification of domestic violence and to offer intervention and treatment services; and (2) report an incident of domestic violence to the local law enforcement agency. Specifies information to be included in the report. Provides civil and criminal immunity for a person who is required to report an incident of domestic violence.

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0417

Sponsors: Sen. Waltz (R-Indianapolis); Sen. Randolph (D-Gary); Sen. Steele (R-Bedford); Sen Tallian, (D-Portage); Rep. McNamara (R-Evansville)

Assigned to Courts and Criminal Law; passed out of the Committee amended 8-2; Amended on second reading to remove health facilities from the requirements; passed the Senate 36—12. The bill did not get a hearing in the House and died.

LeadingAge Indiana Position: Oppose – The Committee is very concerned about this need mandate, particular for intervention and treatment since health facilities do not provide these treatment capabilities. This places significant new mandates that could have significant cost implications. The definitions are too broad and nonspecific and most health providers are not trained or equipped to comply. Fortunately, a second reading amendment supported by LeadingAge Indiana removed health facilities from the requirements. The bill died in the House.

SB516: Medicaid payments for children's nursing facilities. Requires the office of Medicaid policy and planning to reimburse children's nursing facilities in accordance with Medicare payment principles.

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0516

Sponsor: Sen. Miller (R-Indianapolis)

Assigned to Health and Provider Services Committee; died for lack of a hearing.

No position. LeadingAge Indiana does not have any children’s facilities in membership. There are only 2 or 3 in the state.

SB520: ERASER committee. Creates the eliminate, reduce, and streamline employee regulation (ERASER) committee to study professional licensing in Indiana. Provides that the office of management and budget staffs the committee. Repeals the regulated occupations evaluation committee. Creates a five year cycle for sunsetting professional licenses, registrations, and certifications.

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0520

Sponsor: Sen. Head (R-Logansport); Sen. Mrvan (D-Hammond); Sen. Banks (R-Columbia City); Sen. Holdman (R-Markle); Sen. Steele (R-Bedford); Rep. Mahan (R-Hartford City)

Assigned to Commerce and Economic Development & Technology Committee; passed out of Committee amended; passed the Senate 36-13; assigned to Select Committee on Government Reduction. The bill did not get a hearing in the House and died.

LeadingAge Indiana Position: Support. The Health Facility Administrators Licensing Board was reviewed by the Regulated Occupations Evaluation Committee. This committee would look at other health care professional licensing boards. Dieticians would be included in a report due in July 2014 and nurses and occupational therapists would be included in a report due July 2015. Pharmacists and physical therapists would be included in a report due in July 2016.

SB540: Implementation of federal Affordable Care Act. Establishes the Indiana affordable care study committee to study and make recommendations to the legislative council concerning the establishment and implementation of a health benefit exchange in Indiana and the defining of "essential health benefits" for use in Indiana. Changes Medicaid eligibility requirements as allowed under the federal Patient Protection and Affordable Care Act. Expires, on December 31, 2013, language that sets forth certain asset limitations within the Medicaid program. Requires the department of insurance to create a health benefit exchange in Indiana. Requires the legislative services agency to prepare legislation for introduction in the 2014 session to make necessary changes to statutes affected by this act. Requires the department of insurance to report annually to the study committee concerning the status and operation of the health benefit exchange established by the department of insurance.

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0540

Sponsor: Sen. Tallian (D-Portage) with co-sponsors Sen. Breaux (D-Indianapolis); Sen. Stoops (D-Bloomington); Sen. Randolph (D-East Chicago); Sen. Lanane (D-Anderson)

Assigned to Appropriations Committee; died for lack of a hearing.

LeadingAge Indiana position: This is the Democratic Affordable Care Act bill which would set up a state based insurance exchange and expand Medicaid eligibility as defined in the ACA. SB 551 is the Republican version. The Committee recognizes that the Medicaid expansion would provide a source of coverage for a significant portion of our members’ employees, but feels that this is so controversial that we should watch and remain informed but not actively support of oppose.

SB551: Federal health care reform. Defines populations that may be subject to Medicaid resource requirements. Eliminates certain Medicaid eligibility resource requirements. Specifies Medicaid recipients who are eligible to receive payments related to certain Medicare premium and cost sharing amounts. Provides for negotiations between the office of Medicaid policy and planning (office) and the United States Department of Health and Human Services (HHS) concerning a block grant system related to Medicaid. Requires the office to apply to HHS to amend the state Medicaid plan to require Medicaid recipient cost sharing. Provides for implementation of the federal Patient Protection and Affordable Care Act with respect to a health benefit exchange (exchange) in Indiana. Specifies requirements for health plans issued through an exchange, including application of Indiana insurance law. Requires certification of navigators and registration of application organizations related to an exchange. Provides for dissolution of the Indiana comprehensive health insurance association. Requires the office to present specified information to the health finance commission (commission) before August 1, 2013. Requires certain state agencies to report to the commission related to an exchange in Indiana.http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0551

Sponsor: Sen. Miller (R-Indianapolis); Sen. Kenley (R-Noblesville); Sen. Tallian (D-Portage); Sen. Charbonneau (R-Valparaiso); Rep. T. Brown (R-Crawfordsville); Rep. Clere (R-New Albany); Rep. C. Brown (D-Gary)

Assigned to Health and Provider Services Committee; passed Committee amended; passed by Senate 44-6; the bill passed out of the House Public Health Committee but did not get a vote on the House floor and died.

LeadingAge Indiana Position: This is the Republican version of the ACA bill and sets Department of Insurance standards for plans that are part of the federal health insurance exchange and other state provisions required under ACA. It does include a Medicaid expansion. The bill was amended to require a study of managed care for the aged, blind, and disabled Medicaid population.

SB 554: Telehealth services under Medicaid. Requires the office of Medicaid policy and planning to reimburse specified providers for telehealth services under the Medicaid program.

Sponsor: Sen. Becker (R-Evansville); Sen. Breaux (D-Indianapolis); Sen. Leising (R-Oldenburg); Sen. Miller (R-Indianapolis); Sen. Charbonneau (R-Valparaiso); Sen. Randolph (D-East Chicago); Sen. Hershman (R-Buck Creek); Sen. Grooms (R-Jeffersonville); Rep. Bacon (R-Chandler); Rep. T. Brown (R-Crawfordsville); Rep. C. Brown (D-Gary); Rep. Porter (D-Indianapolis)

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0554

Assigned to Health and Provider Services Committee; passed out of the Committee amended; passed the Senate 50-0. Passed the House 94-0 with amendments. The conference committee report passed both houses and the bill awaits the Governor’s signature.

LeadingAge Indiana Position: Support - this bill has been developed by the home care association but would benefit members with home health agencies and residents of our member low income housing members.

SB597: Brain injury services. Establishes the division of brain injury and cognitive rehabilitative services (division) within the office of the secretary of family and social services and sets forth the division's duties. Establishes the office of client rights and protections within the division. Establishes the program and policy review advisory committee. Requires Medicaid to include traumatic brain injury services. Requires the office of Medicaid policy and planning to apply to the United States Department of Health and Human Services for a Medicaid waiver to provide brain injury services to individuals with traumatic brain injuries and other acquired brain injuries.

http://www.state.in.us/apps/lsa/session/billwatch/billinfo?year=2013&session=1&request=getBill&doctype=SB&docno=0597

Sponsor: Sen. Becker (R-Evansville)

Assigned to Health and Provider Services; died for lack of a hearing.