Shown verbatim: the complete text as captured from the official PDF posted by the Indiana General Assembly, fetched 2026-09-25. Page and line markers are part of the official record; nothing is edited or removed. This is the current version. The official bill page.
First Regular Session of the 124th General Assembly (2025)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2024 Regular Session of the General Assembly.
HOUSE ENROLLED ACT No. 1474
AN ACT to amend the Indiana Code concerning human services
and to make an appropriation.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 4-21.5-3-6, AS AMENDED BY P.L.241-2023,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 6. (a) Notice shall be given under this section
concerning the following:
(1) A safety order under IC 22-8-1.1.
(2) Any order that:
(A) imposes a sanction on a person or terminates a legal right,
duty, privilege, immunity, or other legal interest of a person;
(B) is not described in section 4 or 5 of this chapter or
IC 4-21.5-4; and
(C) by statute becomes effective without a proceeding under
this chapter if there is no request for a review of the order
within a specified period after the order is issued or served.
(3) A notice of program reimbursement or equivalent
determination or other notice regarding a hospital's
reimbursement issued by the office of Medicaid policy and
planning or by a contractor of the office of Medicaid policy and
planning regarding a hospital's year end cost settlement.
(4) A determination of audit findings or an equivalent
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determination by the office of Medicaid policy and planning or by
a contractor of the office of Medicaid policy and planning arising
from a Medicaid postpayment or concurrent audit of a hospital's
Medicaid claims.
(5) A license suspension or revocation under:
(A) IC 24-4.4-2;
(B) IC 24-4.5-3;
(C) IC 28-1-29;
(D) IC 28-7-5;
(E) IC 28-8-4.1; or
(F) IC 28-8-5.
(6) An order issued by the secretary or the secretary's designee
against providers regulated by the office of the secretary, the
division of aging, or the bureau of disabilities services and not
licensed by the Indiana department of health under IC 16-27 or
IC 16-28.
(b) When an agency issues an order described by subsection (a), the
agency shall give notice to the following persons:
(1) Each person to whom the order is specifically directed.
(2) Each person to whom a law requires notice to be given.
A person who is entitled to notice under this subsection is not a party
to any proceeding resulting from the grant of a petition for review
under section 7 of this chapter unless the person is designated as a
party in the record of the proceeding.
(c) The notice must include the following:
(1) A brief description of the order.
(2) A brief explanation of the available procedures and the time
limit for seeking administrative review of the order under section
7 of this chapter.
(3) Any other information required by law.
(d) An order described in subsection (a) is effective fifteen (15) days
after the order is served, unless a statute other than this article specifies
a different date or the agency specifies a later date in its order. This
subsection does not preclude an agency from issuing, under
IC 4-21.5-4, an emergency or other temporary order concerning the
subject of an order described in subsection (a).
(e) If a petition for review of an order described in subsection (a) is
filed within the period set by section 7 of this chapter and a petition for
stay of effectiveness of the order is filed by a party or another person
who has a pending petition for intervention in the proceeding, an
administrative law judge shall, as soon as practicable, conduct a
preliminary hearing to determine whether the order should be stayed in
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whole or in part. The burden of proof in the preliminary hearing is on
the person seeking the stay. The administrative law judge may stay the
order in whole or in part. The order concerning the stay may be issued
after an order described in subsection (a) becomes effective. The
resulting order concerning the stay shall be served on the parties and
any person who has a pending petition for intervention in the
proceeding. It must include a statement of the facts and law on which
it is based.
SECTION 2. IC 12-7-2-18.1, AS ADDED BY P.L.149-2023,
SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 18.1. "Assisted living services", for purposes of
IC 12-10-11.5, IC 12-8-1.6, has the meaning set forth in
IC 12-10-11.5-8(a). IC 12-8-1.6-1.
SECTION 3. IC 12-7-2-22, AS AMENDED BY THE TECHNICAL
CORRECTIONS BILL OF THE 2025 GENERAL ASSEMBLY, IS
AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2025]:
Sec. 22. "Board" means has the following meaning:
(1) For purposes of IC 12-8-6.5-14, the meaning set forth in
IC 12-8-6.5-14(a).
(2) For purposes of IC 12-8-6.5-14.1, the meaning set forth in
IC 12-8-6.5-14.1(a).
(3) For purposes of IC 12-8-6.5-14.3, the meaning set forth in
IC 12-8-6.5-14.3(a).
(4) For purposes of IC 12-8-6.5-15, the meaning set forth in
IC 12-8-6.5-15(a).
(2) (5) For purposes of IC 12-10-10 and IC 12-10-11, the
community and home options to institutional care for the elderly
and disabled board established by IC 12-10-11-1.
(3) (6) For purposes of IC 12-11-14, the meaning set forth in
IC 12-11-14-3.
(4) (7) For purposes of IC 12-12-7-5, the meaning set forth in
IC 12-12-7-5(a).
(5) (8) (7) For purposes of IC 12-15-35, the meaning set forth in
IC 12-15-35-2.
SECTION 4. IC 12-7-2-33.9 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 33.9. (a) "Clean claim",
for purposes of IC 12-15-13, except for IC 12-15-13-1 and
IC 12-15-13-1.5, has the meaning set forth in IC 12-15-13-0.5.
(b) "Clean claim", for purposes of IC 12-15-12.7, IC 12-15-13-1,
and IC 12-15-13-1.5, has the meaning set forth in IC 12-15-13-0.6.
SECTION 5. IC 12-7-2-48.7, AS ADDED BY P.L.131-2024,
SECTION 1 AND P.L.136-2024, SECTION 37 AND P.L.17-2024,
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SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 48.7. "Covered population", for purposes of
IC 12-15-12.7 and IC 12-15-13-1.8, has the meaning set forth in
IC 12-15-13-1.8(a).
SECTION 6. IC 12-7-2-107.7 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 107.7. "Home and community
based services waiver", for purposes of IC 12-8-1.6, has the
meaning set forth in IC 12-8-1.6-2.
SECTION 7. IC 12-7-2-117.1, AS AMENDED BY P.L.141-2006,
SECTION 20, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 117.1. (a) "Individual in need of self-directed
in-home care", for purposes of IC 12-8-1.7, has the meaning set
forth in IC 12-8-1.7-2.
(b) "Individual in need of self-directed in-home care", for purposes
of IC 12-10-17.1, has the meaning set forth in IC 12-10-17.1-6.
SECTION 8. IC 12-7-2-122.6 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 122.6. "Level of services", for
purposes of IC 12-8-1.6, has the meaning set forth in IC 12-8-1.6-3.
SECTION 9. IC 12-7-2-126.3 IS REPEALED [EFFECTIVE JULY
1, 2025]. Sec. 126.3. "Long term care services eligibility screen", for
purposes of IC 12-10-10, has the meaning set forth in IC 12-10-10-4.5.
SECTION 10. IC 12-7-2-126.9, AS ADDED BY P.L.152-2017,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 126.9. (a) Except as provided in subsection (b),
"managed care organization" means a person that has a comprehensive
risk contract with the office of Medicaid policy and planning under
IC 12-15.
(b) "Managed care organization", for purposes of IC 12-15-12.7
and IC 12-15-13-1.8, means a person that contracts with the office
of Medicaid policy and planning to provide services under a risk
based managed care program for the covered population (as
defined in IC 12-7-2-48.7).
SECTION 11. IC 12-7-2-135.3 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 135.3. (a)
"Ombudsman", for purposes of IC 12-10-13, has the meaning set forth
in IC 12-10-13-4.5.
(b) "Ombudsman", for purposes of IC 12-11-13, has the
meaning set forth in IC 12-11-13-2.
SECTION 12. IC 12-7-2-146, AS AMENDED BY P.L.146-2023,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
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JULY 1, 2025]: Sec. 146. "Program" refers to the following:
(1) For purposes of IC 12-10-5.7, the meaning set forth in
IC 12-10-5.7-2.
(2) For purposes of IC 12-10-7, the adult guardianship services
program established by IC 12-10-7-5.
(3) For purposes of IC 12-10-10, the meaning set forth in
IC 12-10-10-5.
(4) For purposes of IC 12-15-12.7, the meaning set forth in
IC 12-15-12.7-1.
(4) (5) For purposes of IC 12-17.2-2-14.2, the meaning set forth
in IC 12-17.2-2-14.2(a).
(5) (6) For purposes of IC 12-17.6, the meaning set forth in
IC 12-17.6-1-5.
SECTION 13. IC 12-7-2-149.1, AS AMENDED BY P.L.10-2019,
SECTION 55, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 149.1. "Provider" means the following:
(1) For purposes of IC 12-10-7, the meaning set forth in
IC 12-10-7-3.
(2) For purposes of the following statutes, an individual, a
partnership, a corporation, or a governmental entity that is
enrolled in the Medicaid program under rules adopted under
IC 4-22-2 by the office of Medicaid policy and planning:
(A) IC 12-14-1 through IC 12-14-8.
(B) IC 12-15, except IC 12-15-32, IC 12-15-33, and
IC 12-15-34.
(C) IC 12-17.6.
(3) Except as provided in subdivisions (4) and (6), for purposes
of IC 12-17.2, a person who operates a child care center or child
care home under IC 12-17.2.
(4) For purposes of IC 12-17.2-3.5, a person that:
(A) provides child care; and
(B) is directly paid for the provision of the child care under the
federal Child Care and Development Fund voucher program
administered under 45 CFR 98 and 45 CFR 99.
The term does not include an individual who provides services to
a person described in clauses (A) and (B), regardless of whether
the individual receives compensation.
(5) For purposes of IC 12-21-1 through IC 12-29-2, an
organization:
(A) that:
(i) provides mental health services, as defined under 42
U.S.C. 300x-2(c);
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(ii) provides addiction services; or
(iii) provides children's mental health services;
(B) that has entered into a provider agreement with the
division of mental health and addiction under IC 12-21-2-7 to
provide services in the least restrictive, most appropriate
setting; and
(C) that is operated by one (1) of the following:
(i) A city, town, county, or other political subdivision of the
state.
(ii) An agency of the state or of the United States.
(iii) A political subdivision of another state.
(iv) A hospital owned or operated by a unit of government
or a building authority that is organized for the purpose of
constructing facilities to be leased to units of government.
(v) A corporation incorporated under IC 23-7-1.1 (before its
repeal August 1, 1991) or IC 23-17.
(vi) An organization that is exempt from federal income
taxation under Section 501(c)(3) of the Internal Revenue
Code.
(vii) A university or college.
(6) For purposes of IC 12-17.2-2-10, the following:
(A) A person described in subdivision (4).
(B) A child care center licensed under IC 12-17.2-4.
(C) A child care home licensed under IC 12-17.2-5.
(7) For purposes of IC 12-11-13, an authorized provider entity
that delivers services administered by the bureau of
disabilities services.
SECTION 14. IC 12-8-1.6 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]:
Chapter 1.6. Medicaid Home and Community Based Services
Waivers
Sec. 1. As used in this chapter, "assisted living services" refers
to services covered under a home and community based services
waiver and provided in any of the following entities:
(1) A residential care facility licensed under IC 16-28.
(2) Any other housing with services establishment.
Sec. 2. (a) As used in this chapter, "home and community based
services waiver" refers to a federal Medicaid waiver granted to the
state under 42 U.S.C. 1396n(c) to provide home and community
based long term care services and supports to individuals with
disabilities.
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(b) The term does not include home and community services
offered as part of the approved Medicaid state plan.
Sec. 3. As used in this chapter, "level of services" means a
determination of the type of services an individual may receive
under a Medicaid waiver based on the individual's impairment and
dependence and the corresponding reimbursement rate for the
determined level of care.
Sec. 4. (a) The office of the secretary has all powers necessary
and convenient to administer a home and community based
services waiver.
(b) The office of the secretary shall do the following:
(1) Administer money appropriated or allocated to the office
of the secretary by the state, including money appropriated or
allocated for a home and community based services waiver.
(2) Take any action necessary to implement a home and
community based services waiver, including applying to the
United States Department of Health and Human Services for
approval to amend or renew the waiver, implement a new
Medicaid waiver, or amend the Medicaid state plan.
(3) Ensure that a home and community based services waiver
is subject to funding available to the office of the secretary.
(4) Ensure, in coordination with the budget agency, that the
cost of a home and community based services waiver does not
exceed the total amount of funding available by the budget
agency, including state and federal funds, for the Medicaid
programs established to provide services under a home and
community based services waiver.
(5) Establish and administer a program for a home and
community based services waiver to provide an eligible
individual with care that does not cost more than services
provided to a similarly situated individual residing in an
institution.
(6) Within the limits of available resources, provide service
coordination services to individuals receiving services under
a home and community based services waiver, including the
development of an individual service plan that:
(A) addresses an individual's needs;
(B) identifies and considers family and community
resources that are potentially available to meet the
individual's needs; and
(C) is consistent with the person centered care approach
for receiving services under a waiver.
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(7) Monitor services provided by a provider that:
(A) provides services to an individual using funds provided
by the office of the secretary or under the authority of the
office of the secretary; or
(B) entered into one (1) or more provider agreements to
provide services under a home and community based
services waiver.
(8) Establish and administer a confidential complaint process
for:
(A) an individual receiving; or
(B) a provider described in subdivision (7) providing;
services under a home and community based services waiver.
(c) The office of the secretary may do the following:
(1) At the office's discretion, delegate any of its authority
under this chapter to any division or office within the office of
the secretary.
(2) Issue administrative orders under IC 4-21.5-3-6 regarding
the provision of a home and community based services
waiver.
Sec. 5. (a) The office of the secretary shall establish:
(1) eligibility criteria for an individual to receive; and
(2) certification criteria for a provider of;
services under a home and community based services waiver.
(b) The eligibility criteria established under subsection (a) may
vary based on the targeted need of each home and community
based services waiver.
(c) An individual who is determined by the office of the
secretary to be ineligible for services under a home and community
based services waiver may appeal the determination under
IC 4-21.5.
Sec. 6. The office of the secretary shall serve as the placement
authority for individuals receiving services under a home and
community based services waiver and an individual service plan.
Sec. 7. Subject to the availability of applicable waiver slots and
funding, the office of the secretary shall provide access to home
and community based services that are appropriate and necessary
for an individual determined to be eligible by the office of the
secretary for services under a home and community based services
waiver.
Sec. 8. A provider of services under a home and community
based services waiver shall follow any waiver requirements under
federal law and developed by the office of the secretary, including
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the planning process, service plan, and home and community based
setting requirements set forth in 42 CFR 441.301.
Sec. 9. A home and community based services waiver, including
the delivery and receipt of services provided under the home and
community based services waiver, must meet the following
requirements:
(1) Be provided under public supervision.
(2) Be individualized and designed to meet the needs of
individuals eligible to receive services under the home and
community based services waiver.
(3) Meet applicable state and federal standards.
(4) Be provided by qualified personnel.
(5) Be provided, to the extent appropriate, with services
provided under the home and community based services
waiver that are provided in a home and community based
setting where nonwaiver individuals receive services.
(6) Be provided in accordance with an individual's service
plan.
Sec. 10. (a) This section applies to a home and community based
services waiver that included assisted living services as an available
service before July 1, 2025.
(b) As used in this section, "office" includes the following:
(1) The office of the secretary of family and social services.
(2) A managed care organization that has contracted with the
office of Medicaid policy and planning under IC 12-15.
(3) A person that has contracted with a managed care
organization described in subdivision (2).
(c) Under a home and community based services waiver that
provides services to an individual who is aged or disabled, the
office shall reimburse for the following services provided to the
individual by a provider of assisted living services, if included in
the individual's home and community based service plan:
(1) Assisted living services.
(2) Integrated health care coordination.
(3) Transportation.
(d) If the office approves an increase in the level of services for
a recipient of assisted living services, the office shall reimburse the
provider of assisted living services for the level of services for the
increase as of the date that the provider has documentation of
providing the increase in the level of services.
(e) The office may reimburse for any home and community
based services provided to a Medicaid recipient beginning on the
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date of the individual's Medicaid application.
(f) The office may not do any of the following concerning
assisted living services provided in a home and community based
services program:
(1) Require the installation of a sink in the kitchenette within
any living unit of an entity that participated in the Medicaid
home and community based services program before July 1,
2018.
(2) Require all living units within a setting that provides
assisted living services to comply with physical plant
requirements that are applicable to individual units occupied
by a Medicaid recipient.
(3) Require a provider to offer only private rooms.
(4) Require a housing with services establishment provider to
provide housing when:
(A) the provider is unable to meet the health needs of a
resident without:
(i) undue financial or administrative burden; or
(ii) fundamentally altering the nature of the provider's
operations; and
(B) the resident is unable to arrange for services to meet
the resident's health needs.
(5) Require a housing with services establishment provider to
separate an agreement for housing from an agreement for
services.
(6) Prohibit a housing with services establishment provider
from offering studio apartments with only a single sink in the
unit.
(7) Preclude the use of a shared bathroom between adjoining
or shared units if the participants consent to the use of a
shared bathroom.
(8) Reduce the scope of services that may be provided by a
provider of assisted living services under the aged and
disabled Medicaid waiver in effect on July 1, 2021.
(g) The office of the secretary may adopt rules under IC 4-22-2
that establish the right, and an appeals process, for a resident to
appeal a provider's determination that the provider is unable to
meet the health needs of the resident as described in subsection
(f)(4). The process:
(1) must require an objective third party to review the
provider's determination in a timely manner; and
(2) may not be required if the provider is licensed by the
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Indiana department of health and the licensure requirements
include an appellate procedure for such a determination.
Sec. 11. (a) The office of the secretary shall annually determine
any state savings generated by home and community based services
under this chapter by reducing the use of institutional care.
(b) The office of the secretary shall annually report to the
governor, the budget agency, the budget committee, the interim
study committee on public health, behavioral health, and human
services established by IC 2-5-1.3-4, and the executive director of
the legislative services agency the savings determined under
subsection (a). A report under this subsection to the executive
director of the legislative services agency must be in an electronic
format under IC 5-14-6.
(c) Savings determined under subsection (a) may be used to fund
the state's share of additional home and community based
Medicaid waiver slots.
Sec. 12. The office of the secretary may adopt rules under
IC 4-22-2 to implement this chapter.
SECTION 15. IC 12-8-1.7 IS ADDED TO THE INDIANA CODE
AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]:
Chapter 1.7. Individuals in Need of Self-Directed In-Home Care
Sec. 1. As used in this chapter, "attendant care services" means
the basic and ancillary services that the individual chooses to direct
and supervise a personal services attendant to perform and that
enable an individual in need of self-directed in-home care to live in
the individual's home and community rather than in an institution
and to carry out functions of daily living, self-care, and mobility.
Sec. 2. As used in this chapter, "individual in need of
self-directed in-home care" means an individual with a disability,
or a person responsible for making health related decisions for the
individual with a disability, who:
(1) is approved to receive Medicaid waiver services under 42
U.S.C. 1396n(c);
(2) is in need of attendant care services because of
impairment;
(3) requires assistance to complete functions of daily living,
self-care, and mobility, including those functions included in
attendant care services;
(4) chooses to self-direct a paid personal services attendant to
perform attendant care services; and
(5) assumes the responsibility to initiate self-directed in-home
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care and exercise judgment regarding the manner in which
those services are delivered, including the decision to employ,
train, and dismiss a personal services attendant.
Sec. 3. As used in this chapter, "personal services attendant"
means an individual who is registered to provide attendant care
services under this chapter and who has entered into a contract
with an individual and acts under the individual's direction to
provide attendant care services that could be performed by the
individual if the individual were physically capable.
Sec. 4. The office of the secretary shall have self-directed care
options and services available for an eligible individual who:
(1) receives services under a home and community based
services waiver (as defined in IC 12-8-1.6-2); and
(2) chooses self-directed care services.
Sec. 5. (a) An individual may not provide attendant care services
for compensation from Medicaid for an individual in need of
self-directed in-home care services unless the individual is
registered under this chapter.
(b) Except in instances of extraordinary care, an individual who
is a legally responsible relative of an individual in need of
self-directed in-home care, including a parent of a minor individual
and a spouse, is precluded from providing attendant care services
for compensation under this chapter.
Sec. 6. (a) The office of the secretary shall register an individual
to provide services under this chapter who provides the following:
(1) A personal resume containing information concerning the
individual's qualifications, work experience, and any
credentials the individual may hold. The individual must
certify that the information contained in the resume is true
and accurate.
(2) The individual's:
(A) limited criminal history check from the Indiana central
repository for criminal history information under
IC 10-13-3;
(B) expanded criminal history check (as defined in
IC 20-26-2-1.5); or
(C) criminal history check from another source allowed by
law.
(3) If applicable, the individual's state nurse aide registry
report from the Indiana department of health. This
subdivision does not require an individual to be a nurse aide.
(4) Three (3) letters of reference.
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(5) Proof that the individual is at least eighteen (18) years of
age.
(6) Any other information required by the office of the
secretary.
(b) A registration is valid for two (2) years. A personal services
attendant may renew the personal services attendant's registration
by updating any information in the file that has changed. The
limited criminal history check and state nurse aide registry report
required under subsection (a)(2) and (a)(3) must be updated every
two (2) years.
(c) The office of the secretary shall maintain a file for each
personal services attendant that contains:
(1) comments related to the provision of attendant care
services submitted by an individual in need of self-directed
in-home care who has employed the personal services
attendant; and
(2) the items described in subsection (a)(1) through (a)(4).
(d) Upon request, the office of the secretary shall provide to an
individual in need of self-directed in-home care the following:
(1) Without charge, a list of personal services attendants who
are registered with the office of the secretary and available
within the requested geographic area.
(2) A copy of the information of a specified personal services
attendant who is on file with the office of the secretary under
subsection (c). The office of the secretary may charge a fee for
shipping, handling, and copying expenses.
(e) The limited criminal history check requirement described in
subsection (a)(2) may be satisfied by fulfilling the components of an
expanded criminal history check under IC 20-26-2-1.5 and is
subject to the conditions described in IC 16-27-2-4(c).
Sec. 7. The case manager of an individual in need of
self-directed in-home care shall maintain the written opinion of the
individual's attending physician or health care professional in a
case file that is maintained for the individual by the case manager.
Sec. 8. (a) A personal services attendant who is hired by the
individual in need of self-directed in-home care is an employee of
the individual in need of self-directed in-home care.
(b) The office of the secretary is not liable for any actions of a
personal services attendant or an individual in need of self-directed
in-home care.
(c) A personal services attendant and an individual in need of
self-directed in-home care are each liable for any negligent or
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wrongful act or omission in which the person personally
participates.
Sec. 9. (a) Except as provided in subsection (b), an individual in
need of self-directed in-home care is responsible for recruiting,
hiring, training, paying, certifying any employment related
documents, dismissing, and supervising in the individual's home
during service hours a personal services attendant who provides
attendant care services for the individual.
(b) If an individual in need of self-directed in-home care is:
(1) less than twenty-one (21) years of age; or
(2) unable to direct in-home care because of a brain injury or
mental deficiency;
the individual's parent, spouse, or legal guardian or a person
possessing a valid power of attorney for the individual may make
employment, care, and training decisions and certify any
employment related documents on behalf of the individual.
(c) An individual in need of self-directed in-home care or an
individual under subsection (b) and the individual's case manager
shall develop an authorized care plan. The authorized care plan
must include a list of weekly services or tasks that must be
performed to comply with the authorized care plan.
Sec. 10. The individual in need of self-directed in-home care and
the personal services attendant must each sign a contract, in a form
approved by the office of the secretary, that includes, at a
minimum, the following provisions:
(1) The responsibilities of the personal services attendant.
(2) The frequency the personal services attendant will provide
attendant care services.
(3) The duration of the contract.
(4) The hourly wage of the personal services attendant. The
wage may not be less than the federal minimum wage or more
than the rate that the recipient is eligible to receive under a
Medicaid home and community based services waiver.
(5) Reasons and notice agreements for early termination of
the contract.
Sec. 11. (a) The office of the secretary shall amend or implement
a home and community based services waiver (as defined in
IC 12-8-1.6-2) to provide for the payment for attendant care
services provided by a personal services attendant for an
individual in need of self-directed in-home care under this chapter,
including any related record keeping and employment expenses.
(b) The office of the secretary shall not, to the extent permitted
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by federal law, consider as income money paid under this chapter
to or on behalf of an individual in need of self-directed in-home
care to enable the individual to employ registered personal services
attendants for purposes of determining the individual's income
eligibility for services under this chapter or IC 12-8-1.6.
Sec. 12. The office of the secretary shall adopt rules under
IC 4-22-2 concerning the following:
(1) The method of payment to a personal services attendant
who provides authorized services under this chapter.
(2) Record keeping requirements for personal attendant
services.
(3) The receipt, review, and investigation of complaints
concerning the:
(A) neglect;
(B) abuse;
(C) mistreatment; or
(D) misappropriation of property;
of an individual in need of self-directed in-home care by a
personal services attendant.
(4) Establishing notice and administrative hearing procedures
in accordance with IC 4-21.5.
(5) Appeal procedures, including judicial review of
administrative hearings.
(6) Procedures to place a personal services attendant who has
been determined to have been guilty of:
(A) neglect;
(B) abuse;
(C) mistreatment; or
(D) misappropriation of property;
of an individual in need of self-directed in-home care on the
state nurse aide registry.
(7) Any rules necessary to implement this chapter.
SECTION 16. IC 12-9.1-4-1, AS ADDED BY P.L.141-2006,
SECTION 38, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 1. The division shall administer money
appropriated or allocated to the division by the state, including money
appropriated or allocated from the following:
(1) The federal Older Americans Act (42 U.S.C. 3001 et seq.).
(2) The United States Department of Agriculture (7 U.S.C. 612C
et seq.).
(3) Medicaid waiver in-home services for the elderly and disabled
(42 U.S.C. 1396 et seq.) for treatment of medical conditions.
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(4) (3) Money appropriated or allocated to the division to
administer a program under this title.
(5) (4) Other funding sources that are designated by the general
assembly or available from the federal government under grants
that are consistent with the duties of the division.
SECTION 17. IC 12-9.1-4-2, AS ADDED BY P.L.141-2006,
SECTION 38, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 2. The division shall administer the following
programs:
(1) Programs established under any of the following statutes:
(A) This article.
(B) IC 12-10.
(2) Programs under IC 12-30, to the extent the division has
responsibilities for programs under IC 12-30.
(3) Medicaid waivers for in-home services for treatment of
medical conditions.
SECTION 18. IC 12-9.1-4-3 IS REPEALED [EFFECTIVE JULY
1, 2025]. Sec. 3. Notwithstanding any other law:
(1) home health agencies licensed under IC 16-27-1 are approved
to provide home health services; and
(2) personal services agencies licensed under IC 16-27-4 are
approved to provide personal services;
under any federal waiver granted to the state under 42 U.S.C. 1315 or
42 U.S.C. 1396n that provides services for treatment of medical
conditions.
SECTION 19. IC 12-10-10-1.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 1.5. As used in this
chapter, "activities of daily living" refers to an activity described in the
long term care services eligibility screen. assessment used by the
division to determine eligibility for the program.
SECTION 20. IC 12-10-10-4.5 IS REPEALED [EFFECTIVE JULY
1, 2025]. Sec. 4.5. (a) As used in this chapter, "long term care services
eligibility screen" refers to the long term care services eligibility screen
used by the division in making eligibility determinations under this
chapter.
(b) The long term care services eligibility screen must conform with
the activities of daily living standard established by this chapter.
SECTION 21. IC 12-10-10-6.3 IS REPEALED [EFFECTIVE JULY
1, 2025]. Sec. 6.3. (a) The division shall file for publication in the
Indiana Register a copy of the long term care services eligibility screen.
(b) The division shall:
(1) keep on file in the division's office; and
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(2) make available for public inspection during regular business
hours;
a copy of the long term care services eligibility screen.
(c) The division shall provide a copy of the long term care services
eligibility screen to any individual upon request.
SECTION 22. IC 12-10-11.5-6 IS REPEALED [EFFECTIVE JULY
1, 2025]. Sec. 6. (a) The office of the secretary of family and social
services shall annually determine any state savings generated by home
and community based services under this chapter by reducing the use
of institutional care.
(b) The secretary shall annually report to the governor, the budget
agency, the budget committee, the interim study committee on public
health, behavioral health, and human services established by
IC 2-5-1.3-4, and the executive director of the legislative services
agency the savings determined under subsection (a). A report under
this subsection to the executive director of the legislative services
agency must be in an electronic format under IC 5-14-6.
(c) Savings determined under subsection (a) may be used to fund the
state's share of additional home and community based Medicaid waiver
slots.
SECTION 23. IC 12-10-11.5-8 IS REPEALED [EFFECTIVE JULY
1, 2025]. Sec. 8. (a) As used in this chapter, "assisted living services"
refers to services covered under a waiver and provided in any of the
following entities:
(1) A residential care facility licensed under IC 16-28.
(2) Any other housing with services establishment.
(b) As used in this section, "level of services" means a
determination of the type of services an individual may receive under
a Medicaid waiver based on the individual's impairment and
dependence and the corresponding reimbursement rate for the
determined level of care.
(c) As used in this section, "office" includes the following:
(1) The office of the secretary of family and social services.
(2) A managed care organization that has contracted with the
office of Medicaid policy and planning under IC 12-15.
(3) A person that has contracted with a managed care organization
described in subdivision (2).
(d) Under a Medicaid waiver that provides services to an individual
who is aged or disabled, the office shall reimburse for the following
services provided to the individual by a provider of assisted living
services:
(1) Assisted living services.
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(2) Integrated health care coordination.
(3) Transportation.
(e) If the office approves an increase in the level of services for a
recipient of assisted living services, the office shall reimburse the
provider of assisted living services for the level of services for the
increase as of the date that the provider has documentation of providing
the increase in the level of services.
(f) The office may reimburse for any home and community based
services provided to a Medicaid recipient beginning on the date of the
individual's Medicaid application.
(g) The office may not do any of the following concerning assisted
living services provided in a home and community based services
program:
(1) Require the installation of a sink in the kitchenette within any
living unit of an entity that participated in the Medicaid home and
community based service program before July 1, 2018.
(2) Require all living units within a setting that provides assisted
living services to comply with physical plant requirements that
are applicable to individual units occupied by a Medicaid
recipient.
(3) Require a provider to offer only private rooms.
(4) Require a housing with services establishment provider to
provide housing when:
(A) the provider is unable to meet the health needs of a
resident without:
(i) undue financial or administrative burden; or
(ii) fundamentally altering the nature of the provider's
operations; and
(B) the resident is unable to arrange for services to meet the
resident's health needs.
(5) Require a housing with services establishment provider to
separate an agreement for housing from an agreement for
services.
(6) Prohibit a housing with services establishment provider from
offering studio apartments with only a single sink in the unit.
(7) Preclude the use of a shared bathroom between adjoining or
shared units if the participants consent to the use of a shared
bathroom.
(8) Reduce the scope of services that may be provided by a
provider of assisted living services under the aged and disabled
Medicaid waiver in effect on July 1, 2021.
(h) The division may adopt rules under IC 4-22-2 that establish the
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right, and an appeals process, for a resident to appeal a provider's
determination that the provider is unable to meet the health needs of
the resident as described in subsection (g)(4). The process:
(1) must require an objective third party to review the provider's
determination in a timely manner; and
(2) may not be required if the provider is licensed by the Indiana
department of health and the licensure requirements include an
appellate procedure for such a determination.
SECTION 24. IC 12-10-17.1-6, AS AMENDED BY P.L.99-2007,
SECTION 68, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 6. As used in this chapter, "individual in need of
self-directed in-home care" means an individual with a disability, or
person responsible for making health related decisions for the
individual with a disability, who:
(1) is approved to receive Medicaid waiver services under 42
U.S.C. 1396n(c), or is a participant in the community and home
options to institutional care for the elderly and disabled program
under IC 12-10-10;
(2) is in need of attendant care services because of impairment;
(3) requires assistance to complete functions of daily living,
self-care, and mobility, including those functions included in
attendant care services;
(4) chooses to self-direct a paid personal services attendant to
perform attendant care services; and
(5) assumes the responsibility to initiate self-directed in-home
care and exercise judgment regarding the manner in which those
services are delivered, including the decision to employ, train, and
dismiss a personal services attendant.
SECTION 25. IC 12-10-17.1-10, AS ADDED BY P.L.141-2006,
SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 10. (a) An individual may not provide attendant
care services for compensation from Medicaid or the community and
home options to institutional care for the elderly and disabled program
for an individual in need of self-directed in-home care services unless
the individual is registered under section 12 of this chapter.
(b) An individual who is a legally responsible relative of an
individual in need of self-directed in-home care, including a parent of
a minor individual and a spouse, is precluded from providing attendant
care services for compensation under this chapter.
SECTION 26. IC 12-10-17.1-17, AS ADDED BY P.L.141-2006,
SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 17. The individual in need of self-directed
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in-home care and the personal services attendant must each sign a
contract, in a form approved by the division, that includes, at a
minimum, the following provisions:
(1) The responsibilities of the personal services attendant.
(2) The frequency the personal services attendant will provide
attendant care services.
(3) The duration of the contract.
(4) The hourly wage of the personal services attendant. The wage
may not be less than the federal minimum wage or more than the
rate that the recipient is eligible to receive under a Medicaid
home and community based services waiver or the community
and home options to institutional care for the elderly and disabled
program for attendant care services.
(5) Reasons and notice agreements for early termination of the
contract.
SECTION 27. IC 12-10-17.1-18, AS ADDED BY P.L.141-2006,
SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 18. (a) The office shall amend the home and
community based services waiver program under the state Medicaid
plan to provide for the payment for attendant care services provided by
a personal services attendant for an individual in need of self-directed
in-home care under this chapter, including any related record keeping
and employment expenses.
(b) The office shall not, to the extent permitted by federal law,
consider as income money paid under this chapter to or on behalf of an
individual in need of self-directed in-home care to enable the
individual to employ registered personal services attendants, for
purposes of determining the individual's income eligibility for services
under this chapter.
SECTION 28. IC 12-10-17.1-20, AS ADDED BY P.L.141-2006,
SECTION 44, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 20. (a) The division and office may adopt rules
under IC 4-22-2 that are necessary to implement this chapter.
(b) The office shall apply for any federal waivers necessary to
implement this chapter.
SECTION 29. IC 12-10-19 IS REPEALED [EFFECTIVE JULY 1,
2025]. (Home and Community Based Services).
SECTION 30. IC 12-11-1.1-1, AS AMENDED BY P.L.241-2023,
SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 1. (a) The bureau of disabilities services is
established within the division.
(b) The bureau shall plan, coordinate, and administer the provision
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of individualized, integrated community based services for individuals
with a developmental disability and their families, within the limits of
available resources. The planning and delivery of services must be
based on future plans of the individual with a developmental disability
rather than on traditional determinations of eligibility for discrete
services, with an emphasis on the preferences of the individual with a
developmental disability and that individual's family.
(c) Services for individuals with a developmental disability must be
services that meet the following conditions:
(1) Are provided under public supervision.
(2) Are designed to meet the developmental needs of individuals
with a developmental disability.
(3) Meet all required state and federal standards.
(4) Are provided by qualified personnel.
(5) To the extent appropriate, are provided in home and
community based settings in which individuals without
disabilities participate.
(6) Are provided in conformity with a service plan developed
under IC 12-11-2.1-2.
(d) The bureau shall approve entities to provide community based
services and supports as follows:
(1) The bureau shall ensure that an entity approved to provide day
services, identified day habilitation, including facility based or
community based habilitation, prevocational services, or
employment services under home and community based services
waivers (as defined in IC 12-8-1.6-2) is accredited by an
approved national accrediting body described in subsection (j).
(2) The bureau shall ensure that an entity approved to provide
residential habilitation and support services under home and
community based services waivers (as defined in IC 12-8-1.6-2)
is accredited by an approved national accrediting body.
(e) Subject to subsection (k), the bureau shall initially approve,
reapprove, and monitor community based residential, habilitation, and
employment service providers that provide alternatives to placement of
individuals with a developmental disability in state institutions and
health facilities licensed under IC 16-28 for individuals with a
developmental disability. The services must simulate, to the extent
feasible, patterns and conditions of everyday life that are as close as
possible to the conditions in which individuals without disabilities
participate. The community based service categories include the
following:
(1) Supervised group living programs, which serve at least four
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(4) individuals and not more than eight (8) individuals, are funded
by Medicaid, and are licensed by the division.
(2) Supported living service arrangements to meet the unique
needs of individuals in integrated settings. Supported living
service arrangements providing residential services may not serve
more than four (4) unrelated individuals in any one (1) setting.
However, a program that:
(A) is in existence on January 1, 2013, as a supervised group
living program described in subdivision (1); and
(B) has more than four (4) individuals residing as part of the
program;
may convert to a supported living service arrangement under this
subdivision and continue to provide services to up to the same
number of individuals in the supported living setting.
(f) To the extent that services described in subsection (e) are
available and meet the individual's needs, an individual is entitled to
receive services in the least restrictive environment possible.
(g) Community based services under subsection (e)(1) or (e)(2)
must consider the needs of and provide choices and options for:
(1) individuals with a developmental disability; and
(2) families of individuals with a developmental disability.
(h) The bureau shall administer a system of service coordination to
carry out this chapter.
(i) The bureau may issue orders under IC 4-21.5-3-6 against a
provider that violates rules issued by the bureau for programs in which
the provider is providing services in accordance with section 11 of this
chapter.
(j) For purposes of subsections (d) and (k), "approved national
accrediting body" means any of the following:
(1) The Commission on Accreditation of Rehabilitation Facilities
(CARF), or its successor.
(2) The Council on Quality and Leadership In Supports for People
with Disabilities, or its successor.
(3) The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO), or its successor.
(4) The ISO-9001 human services QA system.
(5) The Council on Accreditation, or its successor.
(6) An independent national accreditation organization approved
by the secretary.
(k) An entity that is accredited by an approved national accrediting
body is not subject to reapproval surveys or routine monitoring surveys
by the division or bureau, including any reapproval survey under a
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home and community based services waiver (as defined in
IC 12-8-1.6-2). However, the bureau may perform validation surveys
and complaint investigations of an entity accredited by an approved
national accrediting body.
(l) The bureau shall monitor services provided by the following:
(1) An entity that provides services to an individual with funds
provided by the bureau or under the authority of the bureau.
(2) An entity that has entered into a provider agreement under
IC 12-15-11 to provide Medicaid in-home waiver services.
(m) The bureau shall establish and administer a complaint process
for the following:
(1) An individual who receives services from an entity with funds
provided through the bureau or under the authority of the bureau.
(2) An entity that has entered into a provider agreement under
IC 12-15-11 to provide Medicaid in-home waiver services.
SECTION 31. IC 12-11-13-1 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 1. (a) Except as
provided in subsection (b), this chapter applies only to an individual
who:
(1) has a developmental disability; and
(2) receives services under a waiver under the federal home and
community based services program. administered by the
bureau.
(b) This chapter does not apply to an individual served by the
long term care ombudsman program established under
IC 12-10-13.
SECTION 32. IC 12-11-13-2 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 2. As used in this
chapter, "ombudsman" refers to the statewide waiver bureau of
disabilities services ombudsman established by section 3 of this
chapter. The term includes individuals approved to act in the capacity
of ombudsmen by the statewide waiver bureau of disabilities services
ombudsman.
SECTION 33. IC 12-11-13-3 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 3. The statewide waiver
bureau of disabilities services ombudsman position is established
within the division.
SECTION 34. IC 12-11-13-7 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 7. (a) An ombudsman
must be provided access to the following:
(1) An individual described in section 1 of this chapter.
(2) An entity that provides waiver services to an individual
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described in section 1 of this chapter.
(3) Records of an individual described in section 1 of this chapter,
including records held by an entity that provides services to the
individual.
(4) If an individual described in section 1 of this chapter is
incapable of giving consent, as determined by the attending
physician or as otherwise determined under state law, the name,
address, and telephone number of the individual's legal
representative.
Except as provided in subsections (c) and (d), the ombudsman must
obtain consent under subsection (b) before having access to the records
described in subdivision (3).
(b) Consent to have access to an individual's records shall be given
in one (1) of the following forms:
(1) In writing by the individual.
(2) Orally by the individual in the presence of a witness.
(3) In writing by the legal representative of the individual if:
(A) the individual is incapable of giving consent, as
determined by the attending physician or as otherwise
determined under state law; and
(B) the legal representative has the authority to give consent.
(c) If consent to have access to an individual's records cannot be
obtained under subsection (b), an ombudsman may inspect the records
of the individual if the individual is incapable of giving consent, as
determined by the attending physician or as otherwise determined
under state law, and:
(1) has no legal representative;
(2) has a legal representative but the legal representative cannot
be contacted within three (3) days; or
(3) has a legal representative but the legal representative does not
have the authority to give consent to have access to the records.
(d) If an ombudsman has:
(1) been denied access to an individual's records by the
individual's legal representative;
(2) reasonable cause to believe that the individual's legal
representative is not acting in the best interests of the individual;
and
(3) received written approval from the state ombudsman;
the ombudsman may inspect the records of the individual.
SECTION 35. IC 12-11-13-8 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 8. A provider of waiver
services or an employee of a provider of waiver services is immune
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from:
(1) civil or criminal liability; and
(2) actions taken under a professional disciplinary procedure;
for the release or disclosure of records to the ombudsman under this
chapter.
SECTION 36. IC 12-11-13-10, AS AMENDED BY P.L.99-2007,
SECTION 86, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 10. The ombudsman shall do the following:
(1) Promote effective coordination among the following:
(A) Programs that provide legal services for individuals with
a developmental disability.
(B) The division.
(C) Providers of waiver services to individuals with
developmental disabilities.
(D) Providers of other necessary or appropriate services.
(2) Ensure that the identity of an individual described in section
1 of this chapter will not be disclosed without:
(A) the individual's written consent; or
(B) a court order.
SECTION 37. IC 12-11-13-15 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 15. The division shall:
(1) establish a statewide toll free telephone line continuously open
to receive complaints regarding individuals described in section
1 of this chapter; and
(2) forward all complaints received from the toll free telephone
line to the statewide waiver ombudsman.
SECTION 38. IC 12-11-16-7 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 7. (a) Subject to subsections (b)
and (c), the division may charge each authorized service provider
that employs a direct service professional an annual fee.
(b) The division shall do the following:
(1) Develop a fee structure that accounts for variances in an
authorized service provider's direct support professional
workforce.
(2) Determine the amount of a fee described in subsection (a)
using the fee structure developed by the division under
subdivision (1).
(c) The division may not charge an authorized service provider
described in subsection (a) a total amount for annual fees that
exceeds two thousand dollars ($2,000).
(d) Fees collected under this section shall be deposited in the
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direct support professional training program fund established by
section 8 of this chapter.
(e) The division may adopt rules under IC 4-22-2 necessary to
implement this section.
SECTION 39. IC 12-11-16-8 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 8. (a) The direct support
professional training program fund is established for the purpose
of providing funding for the training program established under
this chapter. The division shall administer the fund.
(b) The fund consists of the following:
(1) Money deposited in the fund under section 7 of this
chapter.
(2) All earnings on investments in the fund.
(c) Money in the fund may only be used for the following:
(1) Costs associated with:
(A) operating the training program established under this
chapter; and
(B) operating or making changes to the direct support
professional registry established under section 2 of this
chapter.
(2) Costs to make changes to the training curriculum
described in section 3 of this chapter.
(3) Expenses of administering the fund.
(d) 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 funds may be invested. Interest that
accrues from these investments shall be deposited in the fund.
(e) Money in the fund at the end of a state fiscal year does not
revert to the state general fund.
(f) Money in the fund is continuously appropriated for the
purposes specified in this section.
SECTION 40. IC 12-12-7-5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 5. (a) As used in this
section, "board" refers to the board of interpreter standards.
(b) The unit shall establish a board of interpreter standards.
(c) The unit and the board division shall adopt rules under
IC 4-22-2 creating standards (including ethical standards and grievance
procedures) for interpreters and an enforcement mechanism for the
interpreter standards.
(d) Funding for the board must come solely from the unit's existing
budget.
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SECTION 41. IC 12-15-12.7 IS ADDED TO THE INDIANA
CODE AS A NEW CHAPTER TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]:
Chapter 12.7. Pathways for Aging Risk Based Managed Care
Program
Sec. 1. As used in this chapter, "program" refers to the
pathways for aging risk based managed care program established
under IC 12-15-13-1.8 for a covered population.
Sec. 2. (a) The office of the secretary shall determine the base
reimbursement rate structure, methodology, and reimbursement
rates that may be paid to a provider for the services rendered
under the program.
(b) A managed care organization may not pay a provider less
than the reimbursement rates established by the office of the
secretary under this section.
Sec. 3. (a) A managed care organization shall contract with any
nursing facility that is:
(1) licensed under IC 16-28;
(2) certified by:
(A) the United States Department of Health and Human
Services to provide services under the Medicare program;
or
(B) the office of the secretary to provide services under the
Medicaid program; and
(3) willing to contract with the managed care organization to
provide the services under the same terms and conditions that
are offered by the managed care organization to any other
participating provider that has contracted with the managed
care organization to provide that service for the program
through June 30, 2029.
(b) A contract between a managed care organization and a
provider to provide services under the program must include the
reimbursement rates established by the office of the secretary
under section 2 of this chapter.
Sec. 4. (a) On a monthly basis, a managed care organization
shall provide a report to the office of the secretary concerning the
denial of claims. The report must specify denials by claim type for
the previous month if the denials for the claim type total at least
five percent (5%).
(b) The office of the secretary shall post the reports submitted
under subsection (a) to the office of the secretary's website.
Sec. 5. The office of the secretary may conduct a claims review
HEA 1474 — Concur
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of claims submitted to a managed care organization for the covered
population under the program.
Sec. 6. The office of the secretary shall at least annually conduct
external reviews of claim denials in the program by a managed
care organization.
Sec. 7. (a) This section applies to claims submitted for payment
under the program by a nursing facility participating in the
program.
(b) The managed care organization shall pay, deny, or suspend
each claim submitted by a nursing facility provider for payment
under the program not later than:
(1) twenty-one (21) days after the claim was electronically
filed; or
(2) thirty (30) days after a claim has been filed on paper;
from receipt by the managed care organization.
(c) If the managed care organization:
(1) fails to pay a clean claim in the time required under this
section; or
(2) denies or suspends a claim that is subsequently determined
to have been a clean claim when the claim was filed;
the managed care organization shall pay the provider interest on
the Medicaid allowable amount of the claim as set forth in this
section.
(d) Interest paid under subsection (c):
(1) accrues beginning:
(A) twenty-two (22) days from the date the claim is filed
under subsection (b)(1); or
(B) thirty-one (31) days from the date the claim is filed
under subsection (b)(2); and
(2) stops accruing on the date the managed care organization
pays the claim.
(e) A managed care organization shall pay interest under
subsection (c) to a provider at the rate established for Medicare
overpayments and underpayments, as set forth in 42 CFR 405.378.
SECTION 42. IC 12-15-13-1.8, AS ADDED BY P.L.131-2024,
SECTION 10 AND P.L.136-2024, SECTION 38 AND P.L.17-2024,
SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 1.8. (a) As used in this section, "covered
population" means all Medicaid recipients who meet the criteria set
forth in subsection (b).
(b) An individual is a member of the covered population if the
individual:
HEA 1474 — Concur
29
(1) is eligible to participate in the federal Medicare program (42
U.S.C. 1395 et seq.) and receives nursing facility services; or
(2) is:
(A) at least sixty (60) years of age;
(B) blind, aged, or disabled; and
(C) receiving services through one (1) of the following:
(i) The aged and disabled Medicaid waiver.
(ii) A risk based managed care program for aged, blind, or
disabled individuals who are not eligible to participate in the
federal Medicare program.
(iii) The state Medicaid plan.
(c) The office of the secretary may implement a risk based managed
care program for the covered population.
(d) The office of Medicaid policy and planning and the managed
care organizations that intend to participate in the risk based managed
care program established under subsection (c) shall conduct a claims
submission testing period before the risk based managed care program
is implemented under subsection (c).
(e) (d) The office of Medicaid policy and planning shall convene a
workgroup for purposes of this section. The members of the workgroup
shall consist of the fiscal officer of the office of Medicaid policy and
planning, representatives of managed care organizations that intend to
participate in the risk based managed care program established under
subsection (c) who are appointed by the director, and provider
representatives appointed by the director. The workgroup shall do the
following:
(1) Develop a uniform billing format to be used by the managed
care organizations participating in the risk based managed care
program established under subsection (c).
(2) Seek and receive feedback on the claims submission testing
period conducted under subsection (d).
(3) (2) Advise the office of Medicaid policy and planning on
claim submission education and training needs of providers
participating in the risk based managed care program established
under subsection (c).
(4) Develop a policy for defining "claims submitted
appropriately" for the purposes of subsection (g)(1) and (g)(2).
(3) Develop policies to improve claims submission and claims
processing for the risk based manage care program
established under subsection (c).
(4) Advise the office of Medicaid policy and planning on
claims submission issues for the risk based managed care
HEA 1474 — Concur
30
program established under subsection (c).
(5) Advise the office of Medicaid policy and planning on
improving the risk based managed care program established
under subsection (c).
(f) Subsections (g) through (k) apply during the first two hundred
ten (210) days after the risk based managed care program for the
covered population is implemented under subsection (c).
(g) The office of Medicaid policy and planning shall establish a
temporary emergency financial assistance program for providers that
experience financial emergencies due to claims payment issues while
participating in the risk based managed care program established under
subsection (c). For purposes of the program established under this
subsection, a financial emergency exists:
(1) when the rate of denial of claims submitted in one (1) billing
period by the provider to a managed care organization exceeds
fifteen percent (15%) of claims submitted appropriately by the
provider to the managed care organization under the risk based
managed care program;
(2) when the provider, twenty-one (21) days after appropriately
submitting claims to a managed care organization under the risk
based managed care program, has not received payment for at
least twenty-five thousand dollars ($25,000) in aggregate claims
from the managed care organization;
(3) when, in the determination of the director, the claim
submission system of a managed care organization with which the
provider is contracted under the risk based managed care program
experiences failure or overload; or
(4) upon the occurrence of other circumstances that, in the
determination of the director, constitute a financial emergency for
a provider.
(h) To be eligible for a payment of temporary emergency financial
assistance under the program established under subsection (g), a
provider:
(1) must have participated in the claims submission testing period
conducted under subsection (d) for all managed care
organizations with which the provider is contracted under the risk
based managed care program established under subsection (c);
and
(2) must submit to the office of Medicaid policy and planning a
written request that includes all of the following:
(A) Documentation providing evidence of the provider's
financial need for emergency assistance.
HEA 1474 — Concur
31
(B) Evidence that the provider's billing staff participated in
claims submission education and training offered through the
risk based managed care program established under subsection
(c).
(C) Evidence that the provider participated in the claims
submission testing period conducted under subsection (d) for
all managed care organizations with which the provider is
contracted under the risk based managed care program
established under subsection (c).
(D) Evidence of a consistent effort by the provider to submit
claims in accordance with the uniform billing requirements
developed under subsection (e)(1).
(i) The office of Medicaid policy and planning:
(1) shall determine whether a provider is experiencing a financial
emergency based upon the provider's submission of a written
request that meets the requirements of subsection (h)(2); and
(2) shall make a determination whether a provider is experiencing
a financial emergency not more than seven (7) calendar days after
it receives a written request submitted by a provider under
subsection (h)(2).
(j) If the office of Medicaid policy and planning determines that a
provider is experiencing a financial emergency for purposes of the
program established under subsection (g), it shall direct each managed
care organization with which the provider is contracted under the risk
based managed care program established under subsection (c) to
provide a temporary emergency assistance payment to the provider. A
managed care organization directed to provide a temporary emergency
assistance payment to a provider under this subsection shall provide the
payment in not more than seven (7) calendar days after the office
directs the managed care organization to provide the payment. The
amount of the temporary emergency assistance payment that a managed
care organization shall make to a provider under this subsection is
equal to seventy-five percent (75%) of the monthly average of the
provider's long-term services and supports Medicaid claims for the six
(6) month period immediately preceding the implementation of the risk
based managed care program under subsection (c), adjusted in
proportion to the ratio of the managed care organization's covered
population membership to the total covered population membership of
the risk based managed care program established under subsection (c).
(k) Upon issuing any payment of a temporary emergency assistance
to a provider under subsection (j), a managed care organization shall
set up a receivable to reconcile the temporary emergency assistance
HEA 1474 — Concur
32
funds with actual claims payment amounts. A managed care
organization shall reconcile the temporary emergency assistance
payment funds with actual claims payment amounts on the first day of
the month that is more than thirty-one (31) days after the managed care
organization issues the temporary emergency assistance funds to the
provider. If a temporary emergency assistance payment is issued to a
provider, managed care organizations are still required to meet contract
obligations for reviewing and paying claims, specifically claims that
total a payment in excess of the temporary emergency assistance
payment reconciliation. However, if a managed care organization fails
to comply with a directive of the office of Medicaid policy and
planning under subsection (j) to provide a temporary emergency
assistance payment to a provider, the failure of the managed care
organization:
(1) is a violation of the claim processing requirements of the
managed care organization's contract; and
(2) makes the managed care organization subject to the penalties
set forth in the contract, including payment of interest on the
amount of the unpaid temporary emergency assistance at the rate
set forth in IC 12-15-21-3(7)(A).
SECTION 43. IC 16-39-2-6, AS AMENDED BY P.L.137-2021,
SECTION 27, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 6. (a) Without the consent of the patient, the
patient's mental health record may only be disclosed as follows:
(1) To individuals who meet the following conditions:
(A) Are employed by:
(i) the provider at the same facility or agency;
(ii) a managed care provider (as defined in IC 12-7-2-127);
or
(iii) a health care provider or mental health care provider, if
the mental health records are needed to provide health care
or mental health services to the patient.
(B) Are involved in the planning, provision, and monitoring of
services.
(2) To the extent necessary to obtain payment for services
rendered or other benefits to which the patient may be entitled, as
provided in IC 16-39-5-3.
(3) To the patient's court appointed counsel and to the Indiana
protection and advocacy services commission.
(4) For research conducted in accordance with IC 16-39-5-3 and
the rules of the division of mental health and addiction, the rules
of the division of disability and rehabilitative services, the rules
HEA 1474 — Concur
33
of the provider, or the rules of the Indiana archives and records
administration and the oversight committee on public records.
(5) To the division of mental health and addiction for the purpose
of data collection, research, and monitoring managed care
providers (as defined in IC 12-7-2-127) who are operating under
a contract with the division of mental health and addiction.
(6) To the extent necessary to make reports or give testimony
required by the statutes pertaining to admissions, transfers,
discharges, and guardianship proceedings.
(7) To a law enforcement agency if any of the following
conditions are met:
(A) A patient escapes from a facility to which the patient is
committed under IC 12-26.
(B) The superintendent of the facility determines that failure
to provide the information may result in bodily harm to the
patient or another individual.
(C) A patient commits or threatens to commit a crime on
facility premises or against facility personnel.
(D) A patient is in the custody of a law enforcement officer or
agency for any reason and:
(i) the information to be released is limited to medications
currently prescribed for the patient or to the patient's history
of adverse medication reactions; and
(ii) the provider determines that the release of the
medication information will assist in protecting the health,
safety, or welfare of the patient.
Mental health records released under this clause must be
maintained in confidence by the law enforcement agency
receiving them.
(8) To a coroner or medical examiner, in the performance of the
individual's duties.
(9) To a school in which the patient is enrolled if the
superintendent of the facility determines that the information will
assist the school in meeting educational needs of the patient.
(10) To the extent necessary to satisfy reporting requirements
under the following statutes:
(A) IC 12-10-3-10.
(B) IC 12-24-17-5.
(C) IC 16-41-2-3.
(D) IC 16-50-1-8.
(E) IC 31-25-3-2.
(F) IC 31-33-5-4.
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34
(G) IC 34-30-16-2.
(H) IC 35-46-1-13.
(11) To the extent necessary to satisfy release of information
requirements under the following statutes:
(A) IC 12-24-11-2.
(B) IC 12-24-12-3, IC 12-24-12-4, and IC 12-24-12-6.
(C) IC 12-26-11.
(12) To another health care provider in a health care emergency.
(13) For legitimate business purposes as described in
IC 16-39-5-3.
(14) Under a court order under IC 16-39-3.
(15) With respect to records from a mental health or
developmental disability facility, to the United States Secret
Service if the following conditions are met:
(A) The request does not apply to alcohol or drug abuse
records described in 42 U.S.C. 290dd-2 unless authorized by
a court order under 42 U.S.C. 290dd-2(b)(2)(c).
(B) The request relates to the United States Secret Service's
protective responsibility and investigative authority under 18
U.S.C. 3056, 18 U.S.C. 871, or 18 U.S.C. 879.
(C) The request specifies an individual patient.
(D) The director or superintendent of the facility determines
that disclosure of the mental health record may be necessary
to protect a person under the protection of the United States
Secret Service from serious bodily injury or death.
(E) The United States Secret Service agrees to only use the
mental health record information for investigative purposes
and not disclose the information publicly.
(F) The mental health record information disclosed to the
United States Secret Service includes only:
(i) the patient's name, age, and address;
(ii) the date of the patient's admission to or discharge from
the facility; and
(iii) any information that indicates whether or not the patient
has a history of violence or presents a danger to the person
under protection.
(16) To the statewide waiver bureau of disabilities services
ombudsman established under IC 12-11-13, in the performance
of the ombudsman's duties.
(b) If a licensed mental health professional, a licensed paramedic,
a representative of a mobile integrated healthcare program (as
described in IC 16-31-12), or a representative of a mental health
HEA 1474 — Concur
35
community paramedicine program in the course of rendering a
treatment intervention, determines that a patient may be a harm to
himself or herself or others, the licensed mental health professional, the
licensed paramedic, the representative of the mobile integrated
healthcare program (as described in IC 16-31-12), or the representative
of the mental health community paramedicine program may request a
patient's individualized mental health safety plan from a psychiatric
crisis center, psychiatric inpatient unit, or psychiatric residential
treatment provider. Each psychiatric crisis center, psychiatric inpatient
unit, and psychiatric residential treatment provider shall, upon request
and without the consent of the patient, share a patient's individualized
mental health safety plan that is in the standard format established by
the division of mental health and addiction under IC 12-21-5-6 with the
following individuals who demonstrate proof of licensure and commit
to protecting the information in compliance with state and federal
privacy laws:
(1) A licensed mental health professional.
(2) A licensed paramedic.
(3) A representative of a mobile integrated healthcare program (as
described in IC 16-31-12).
(4) A representative of a mental health community paramedicine
program.
An individualized mental health safety plan disclosed under this
subsection may be used only to support a patient's welfare and safety
and is considered otherwise confidential information under applicable
state and federal laws.
(c) After information is disclosed under subsection (a)(15) and if the
patient is evaluated to be dangerous, the records shall be interpreted in
consultation with a licensed mental health professional on the staff of
the United States Secret Service.
(d) A person who discloses information under subsection (a)(7),
(a)(15), or (b) in good faith is immune from civil and criminal liability.
SECTION 44. IC 34-30-2.1-129.4 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 129.4. IC 12-8-1.7-8(b)
(Concerning actions of a personal services attendant or an
individual in need of self-directed in-home care).
SECTION 45. IC 34-30-2.1-137, AS ADDED BY P.L.105-2022,
SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 137. IC 12-11-13-8 (Concerning disclosure of
records to the statewide waiver bureau of disabilities services
ombudsman by providers of waiver services and employees of
HEA 1474 — Concur
36
providers).
SECTION 46. IC 34-30-2.1-138, AS ADDED BY P.L.105-2022,
SECTION 12, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 138. IC 12-11-13-12 (Concerning the statewide
waiver bureau of disabilities services ombudsman).
SECTION 47. IC 35-52-12-2, AS ADDED BY P.L.169-2014,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 2. IC 12-11-13-16 defines a crime concerning
statewide waiver bureau of disabilities services ombudsman.
SECTION 48. [EFFECTIVE JULY 1, 2025] (a) An individual
who:
(1) is registered under IC 12-10-17.1, before its amendment by
this act; and
(2) provides services under a home and community based
services waiver;
is deemed registered under IC 12-8-1.7, as added by this act.
(b) This SECTION expires July 1, 2027.
HEA 1474 — Concur
Speaker of the House of Representatives
President of the Senate
President Pro Tempore
Governor of the State of Indiana
Date: Time:
HEA 1474 — ConcurEvery fact on this page links to its source, starting with the official bill record.