§ 12-15-5-17.5 — Report on implementation of risk based managed care program; request for proposal; budget committee review

Indiana § 12-15-5-17.5

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 5: Services Provided

Text

5. (a) The office shall report on its progress
on the development of a risk based managed care program or capitated
managed care program for Medicaid recipients who are eligible to
participate in the Medicare program (42 U.S.C. 1395 et seq.) and
receive nursing facility services to the interim study committee on
public health, behavioral health, and human services before November
1, 2021.
(b) Not later than February 1, 2022, the office shall report the
following information and analysis to the legislative council and budget
committee (in an electronic format under IC 5-14-6) regarding the
implementation of a risk based managed care program or capitated
managed care program for Medicaid recipients who are eligible to
participate in the Medicare program (42 U.S.C. 1395 et seq.) and
receive nursing facility services, as follows:
(1) The projected utilization of home and community based
services and institutional services for the four (4) years following
implementation, and including, but not limited to, information on:
(A) provider network adequacy;
(B) family caregiver programming; and
(C) costs and funding sources associated with creating and
maintaining adequate provider networks and family caregiving
programming.
(2) How administrative processes, including service approval and
billing processes, between managed care entities and providers of
services will be addressed or streamlined in a risk based managed
care program or capitated managed care program, with specific
discussion of uniform provider credentialing, the potential of a
single claims processing portal, and prior authorization processes.
(3) Projected total spending for a risk based managed care
program or capitated managed care program for the four (4) years
following implementation. Such information shall include the
identification of and impact on each source of state matching
funds and overall impact on the state general fund.
(4) The expected financial impacts of a risk based managed care
program or capitated managed care program on the available
amounts and use of the nursing facility quality assessment fee and
supplemental payments to nursing facilities that are owned and
operated by a governmental entity. Such information shall include
an analysis on whether either of these funding streams will be
diverted for uses other than the uses prior to implementation of a
risk based managed care program or capitated managed care
program and the effects on access to acute and post-acute care
services due to the expected financial impacts.
(c) A request for proposal for the procurement of a Medicaid
program to enroll a Medicaid recipient who is eligible to participate in
the Medicare program (42 U.S.C. 1395 et seq.) and receives nursing
facility services in a risk based managed care program or capitated
managed care program may not be issued until the request for proposal
has been reviewed by the budget committee.
(d) After the review of a request for proposal by the budget
committee under subsection (c), the office may not enter into a final
contract that would implement a program described in subsection (c)
before January 31, 2023.

Legislative History

As added by P.L.165-2021, SEC.138. Amended by P.L.138-2022, SEC.18.