This text of Indiana § 16-21-10-13.3 (Incremental fees; uses; requirements before collection can occur;
deposit of incremental fees; limitations on use of incremental fees to
fund the state share of expenses) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
3.
(a)This section is effective beginning
February 1, 2015. As used in this section, "plan" refers to the healthy
Indiana plan established in IC 12-15-44.5.
(b)Subject to subsections (c) through (e), the incremental fee under
this section may be used to fund the state share of the expenses
specified in this subsection if, after January 31, 2015, but before the
collection of the fee under this section, the following occur:
(1)The office establishes a fee formula to be used to fund the
state share of the Medicaid program or the following expenses
described in this subdivision:
(A)The state share of the capitated payments made to a
managed care organization that contracts with the office to
provide health coverage under the plan to plan enrollees other
than plan enrollees who are eligible
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3. (a) This section is effective beginning
February 1, 2015. As used in this section, "plan" refers to the healthy
Indiana plan established in IC 12-15-44.5.
(b) Subject to subsections (c) through (e), the incremental fee under
this section may be used to fund the state share of the expenses
specified in this subsection if, after January 31, 2015, but before the
collection of the fee under this section, the following occur:
(1) The office establishes a fee formula to be used to fund the
state share of the Medicaid program or the following expenses
described in this subdivision:
(A) The state share of the capitated payments made to a
managed care organization that contracts with the office to
provide health coverage under the plan to plan enrollees other
than plan enrollees who are eligible for the plan under Section
1931 of the federal Social Security Act, including portions of
the capitation attributed to a state directed payment program
under section 8.5 of this chapter.
(B) The state share of capitated payments described in clause
(A) for plan enrollees who are eligible for the plan under
Section 1931 of the federal Social Security Act that are limited
to the difference between:
(i) the capitation rates effective September 1, 2014,
developed using Medicaid reimbursement rates; and
(ii) the capitation rates applicable for the plan developed
using the plan's Medicare reimbursement rates described in
IC 12-15-44.5-5(a)(2), or higher reimbursement amounts for
any state fiscal year for which the state directed payment
program established under section 8.5 of this chapter is in
effect.
(C) The state share of the state's contributions to plan enrollee
accounts.
(D) The state share of amounts used to pay premiums for a
premium assistance plan implemented under IC 12-15-44.2-20.
(E) The state share of the costs of increasing reimbursement
rates for physician services provided to individuals enrolled in
Medicaid programs other than the plan, but not to exceed the
difference between the Medicaid fee schedule for a physician
service that was in effect before the implementation of the plan
and the amount equal to seventy-five percent (75%) of the
previous year federal Medicare reimbursement rate for a
physician service. The incremental fee may not be used for the
amount that exceeds seventy-five percent (75%) of the federal
Medicare reimbursement rate for a physician service.
(F) The state share of the state's administrative costs that, for
purposes of this clause, may not exceed one hundred seventy
dollars ($170) per person per plan enrollee per year, and
adjusted annually by the Consumer Price Index.
(2) The office approves a process to be used for reconciling:
(A) the state share of the costs of the plan;
(B) the amounts used to fund the state share of the costs of the
plan; and
(C) the amount of fees assessed for funding the state share of
the costs of the plan.
For purposes of this subdivision, "costs of the plan" includes the
costs of the expenses listed in subdivision (1)(A) through (1)(F).
The fees collected for the purposes of subdivision (1)(A) through (1)(F)
shall be deposited into the incremental hospital fee fund established by
section 13.5 of this chapter.
(c) For each state fiscal year for which the fee authorized by this
section is used to fund the state share of the expenses described in
subsection (b)(1), the amount of fees shall be reduced by:
(1) the amount of funds annually designated by the general
assembly to be deposited in the healthy Indiana plan trust fund
established by IC 12-15-44.2-17; less
(2) the annual cigarette tax funds annually appropriated by the
general assembly for childhood immunization programs under IC 12-15-44.2-17(a)(3).
(d) The incremental fee described in this section may not:
(1) be assessed before July 1, 2016; and
(2) be assessed or collected on or after the termination of the plan.
(e) This section is not intended to and may not be construed to
change or affect any component of the programs established under
section 8 of this chapter.