Indiana § 12-15-39-3 - Use of savings from conversion to expand waiver services

§ 12-15-39-3. Use of savings from conversion to expand waiver services

Sec. 3. Any savings that may result from a conversion under this chapter of an intermediate care facility for individuals with intellectual disabilities licensed under IC 16-28-2 or a state institution must be used to expand waiver services under an intermediate care facility for individuals with intellectual disabilities Medicaid waiver to individuals throughout Indiana.

As added by P.L.112-1997, SEC.4. Amended by P.L.35-2016, SEC.47.

IC 12-15-39.6Chapter 39.6. Long Term Care Program

12-15-39.6-0.5Asset disregard; date for discontinuing long term care program 12-15-39.6-1"Long term care" defined 12-15-39.6-2"Long term care facility" defined 12-15-39.6-3"Long term care insurance" defined 12-15-39.6-4"Health maintenance organization" defined 12-15-39.6-5"Qualified long term care policy" defined 12-15-39.6-6Establishment and administration of program 12-15-39.6-7Information on long term care insurance; availability; assistance 12-15-39.6-8Eligibility 12-15-39.6-9Policy provisions 12-15-39.6-10Asset disregard adjustment 12-15-39.6-11Application of asset disregard to determination of individual's assets 12-15-39.6-12Discontinuation of program 12-15-39.6-13Reciprocal agreements to extend asset disregard 12-15-39.6-14Rules 12-15-39.6-15Asset disregard for long term care policyholders

IC 12-15-39.6-0.5Asset disregard; date for discontinuing long term care program Sec. 0.5. (a) Notwithstanding IC 12-15-39.8, the asset disregard under section 10 of this chapter applies to any qualified long term care policy to which this chapter applies.

(b) This chapter does not apply to a qualified long term care policy issued after the long term care program established by this chapter is discontinued.

(c) Subject to section 12 of this chapter, the long term care program established by this chapter is discontinued on the date set forth under IC 12-15-1.3-22(b)(2)(B)(ii) in the statement published in the Indiana Register by the office of Medicaid policy and planning.

As added by P.L.196-2021, SEC.4.

IC 12-15-39.6-1"Long term care" defined Sec. 1. As used in this chapter, "long term care" means the provision of the following services in a setting other than an acute care wing of a hospital to enable individuals whose functional capacities are chronically impaired to be maintained at their maximum level of health and well-being:

(1) Physician's services.

(2) Nursing services.

(3) Diagnostic services.

(4) Therapeutic services, including physical therapy, speech therapy, and occupational therapy.

(5) Rehabilitative services.

(6) Maintenance services.

(7) Personal care services, including companion services and assistance in bathing, dressing, and other skills of daily living.

(8) Transportation services.

(9) Day care services.

(10) Home health care services.

(11) Respite care services.

(12) Services provided in a facility licensed under IC 16-28.

(13) Services provided by chiropractors, podiatrists, and optometrists.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-2"Long term care facility" defined Sec. 2. As used in this chapter, "long term care facility" means a facility licensed under IC 16-28.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-3"Long term care insurance" defined Sec. 3. (a) As used in this chapter, "long term care insurance" means insurance coverage for at least twelve (12) consecutive months for each covered person on an expense incurred, indemnity, or prepaid basis for one (1) or more necessary long term care services provided in a setting other than an acute care wing of a hospital.

(b) The term does not include payment:

(1) of coinsurance, deductibles, or premiums for other insurance policies;

(2) for services covered by other insurance policies; or

(3) for services covered by Parts A and B of the Medicare program (42 U.S.C. 1395 et seq.).

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-4"Health maintenance organization" defined Sec. 4. As used in this chapter, "health maintenance organization" has the meaning set forth in IC 27-13-1-19.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-5"Qualified long term care policy" defined Sec. 5. As used in this chapter, "qualified long term care policy" means an insurance policy that:

(1) provides long term care insurance;

(2) meets:

(A) the definition set forth in IC 27-8-12-5; and

(B) the standards established under IC 27-8-12-7.1; and

(3) is issued by an insurer or other person who complies with section 9(a) of this chapter.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-6Establishment and administration of program Sec. 6. (a) The Indiana long term care program is established to do the following:

(1) Provide incentives for individuals to insure against the costs of providing for their long term care needs.

(2) Provide a mechanism for individuals to qualify for coverage of the costs of their long term care needs under the Medicaid program without first being required to substantially exhaust all their resources.

(3) Assist in developing methods for increasing access to and the affordability of a long term care policy.

(4) Provide counseling services to individuals in planning for their long term care needs.

(5) Alleviate the financial burden on the state's medical assistance program by encouraging the pursuit of private initiatives.

(b) The office of Medicaid policy and planning and the department of insurance shall administer the program. The department of insurance may contract with a local office of aging services, an area agency on aging, or other nonprofit organization to provide counseling services under the program. The department of insurance shall develop and coordinate a plan to provide counseling services under the program.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-7Information on long term care insurance; availability; assistance Sec. 7. (a) The department of insurance or the agency with which the department of insurance has contracted under section 6(b) of this chapter shall make available to any individual interested in participating in a long term care program information concerning the following:

(1) The Indiana long term care program established under this chapter.

(2) The Indiana long term care insurance partnership program established under IC 12-15-39.8.

(3) Long term care insurance policies, including:

(A) qualified long term care policies that meet the definition set forth in section 5 of this chapter; and

(B) qualified long term care insurance policies that meet the definition set forth in IC 12-15-39.8-3.

(4) Medicare supplement insurance policies.

(5) Parts A and B of the Medicare program (42 U.S.C. 1395 et seq.).

(6) Health maintenance organizations under IC 27-13 that are contracted with the Medicare program.

(7) The Medicaid program.

(b) If an individual elects to pursue any of the options under subsection (a), the department of insurance shall assist the individual in doing so.

As added by P.L.24-1997, SEC.53. Amended by P.L.196-2021, SEC.5.

IC 12-15-39.6-8Eligibility Sec. 8. An individual who is either:

(1) the beneficiary of a qualified long term care policy approved by the department of insurance; or

(2) enrolled in a health maintenance organization that both provides long term care services and meets the requirements under sections 4 and 5 of this chapter;

is eligible for assistance under the Medicaid program using the asset disregard under section 10 of this chapter.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-9Policy provisions Sec. 9. (a) An insurer or other person who issues a qualified long term care policy under this chapter must at a minimum offer to each policyholder or prospective policyholder a policy that provides both:

(1) long term care facility coverage; and

(2) home and community care coverage.

(b) An insurer or other person who complies with subsection (a) may also elect to offer a qualified long term care policy that provides only long term care facility coverage.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-10Asset disregard adjustment Sec. 10. (a) As used in this section, "asset disregard" means one (1) of the following:

(1) A one dollar ($1) increase in the amount of assets an individual who:

(A) purchases a qualified long term care policy; and

(B) meets the requirements under section 8 of this chapter;

may retain under IC 12-15-3 for each one dollar ($1) of benefit paid out under the individual's long term care policy for long term care services.

(2) The total assets an individual owns and may retain under IC 12-15-3 and still qualify for benefits under IC 12-15 at the time the individual applies for benefits if the individual:

(A) is the beneficiary of a qualified long term care policy that provides maximum benefits at time of purchase of at least one hundred forty thousand dollars ($140,000) and includes a provision under which the daily benefit increases by at least five percent (5%) per year, compounded at least annually;

(B) meets the requirements under section 8 of this chapter; and

(C) has exhausted the benefits of the qualified long term care policy.

(b) When the office determines whether an individual is eligible for Medicaid under IC 12-15-3, the office shall:

(1) make an asset disregard adjustment for any individual who purchases a qualified long term care policy; and

(2) if the assets owned by the individual's spouse are included in the individual's eligibility determination, include the assets of the individual's spouse in the asset disregard adjustment.

The asset disregard must be available after benefits of the long term care policy have been applied to the cost of long term care as required under this chapter.

(c) The qualified long term care policy an individual must purchase to be eligible for the asset disregard under subsection (a)(2) must have maximum benefits at time of purchase equal to at least one hundred forty thousand dollars ($140,000) plus five percent (5%) interest compounded annually beginning January 1, 1999.

As added by P.L.24-1997, SEC.53. Amended by P.L.2-1998, SEC.39; P.L.146-2015, SEC.1.

IC 12-15-39.6-11Application of asset disregard to determination of individual's assets Sec. 11. A public program administered by the state that:

(1) provides long term care services; and

(2) bases eligibility upon the amount of the individual's assets;

must apply the asset disregard under section 10 of this chapter in determining the amount of the individual's assets.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-12Discontinuation of program Sec. 12. If the Indiana long term care program is discontinued, an individual who purchased a qualified long term care policy prior to the date the program is discontinued is eligible to receive an asset disregard as defined under section 10 of this chapter.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-13Reciprocal agreements to extend asset disregard Sec. 13. The office of Medicaid policy and planning may enter into reciprocal agreements with other states to extend the asset disregard under section 10 of this chapter to Indiana residents who had purchased qualified long term care policies in other states.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-14Rules Sec. 14. The secretary of family and social services may adopt rules under IC 4-22-2 necessary to implement this chapter.

As added by P.L.24-1997, SEC.53.

IC 12-15-39.6-15Asset disregard for long term care policyholders Sec. 15. An individual who:

(1) owns, as of January 1, 1998, a qualified long term care policy; and

(2) has not exhausted the benefits of the qualified long term care policy described in subdivision (1);

is entitled to receive an asset disregard as provided in section 10 of this chapter.

As added by P.L.16-2009, SEC.19.

IC 12-15-39.8Chapter 39.8. Long Term Care Insurance Partnership Program

12-15-39.8-1Applicability of chapter 12-15-39.8-2"Program" 12-15-39.8-3"Qualified long term care insurance policy" 12-15-39.8-4Establishment and administration of program 12-15-39.8-5Applying asset disregard 12-15-39.8-6Training program for insurance producers 12-15-39.8-7Reporting requirements 12-15-39.8-8Rules

IC 12-15-39.8-1Applicability of chapter Sec. 1. This chapter applies to qualified long term care insurance policies that are entered into, issued, or renewed after June 30, 2022.

As added by P.L.196-2021, SEC.6.

IC 12-15-39.8-2"Program" Sec. 2. As used in this chapter, "program" means the Indiana long term care insurance partnership program established by section 4(a) of this chapter.

As added by P.L.196-2021, SEC.6.

IC 12-15-39.8-3"Qualified long term care insurance policy" Sec. 3. As used in this chapter, "qualified long term care insurance policy" means an insurance policy that meets the following requirements:

(1) The policy covers an individual who was a resident of the state when the coverage first became effective under the policy.

(2) The policy was not issued before the effective date of the state plan amendment applied for under IC 12-15-1.3-22.

(3) The policy meets the definition of a qualified long term care insurance contract under 26 U.S.C. 7702B.

(4) The policy meets the model regulations and requirements of the model act of the National Association of Insurance Commissioners provided in 42 U.S.C. 1396p(b)(5).

(5) The policy includes inflation protection as follows:

(A) If the policy is sold to an individual who was less than sixty-one (61) years of age as of the date of purchase, the policy must provide compound inflation protection.

(B) If the policy is sold to an individual who was at least sixty-one (61) years of age but less than seventy-six (76) years of age as of the date of purchase, the policy must provide some level of inflation protection.

(C) If the policy is sold to an individual who is at least seventy-six (76) years of age, the policy may, but is not required to, provide some level of inflation protection.

(6) The department of insurance certifies that the policy meets the requirements of subdivisions (3), (4), and (5).

As added by P.L.196-2021, SEC.6.

IC 12-15-39.8-4Establishment and administration of program Sec. 4. (a) The Indiana long term care insurance partnership program is established.

(b) The office of Medicaid policy and planning and the department of insurance shall administer the program in accordance with Section 6021 of the federal Deficit Reduction Act of 2005.

As added by P.L.196-2021, SEC.6.

IC 12-15-39.8-5Applying asset disregard Sec. 5. Under the program, the office of Medicaid policy and planning must exclude and disregard an amount equal to the amount of benefits an individual receives under a qualified long term care insurance policy when determining the following:

(1) The individual's resources for purposes of determining eligibility for Medicaid under IC 12-15-3.

(2) The amount to be recovered from the individual's estate under IC 12-15-9 if the individual is eligible for Medicaid.

As added by P.L.196-2021, SEC.6.

IC 12-15-39.8-6Training program for insurance producers Sec. 6. (a) The department of insurance shall develop a training program for insurance producers who sell qualified long term care insurance policies that includes a certified prelicensing course and continuing education courses. The courses must cover, at a minimum, the following topics:

(1) State and federal regulations and requirements and the relationship between qualified long term care insurance policies and other public and private coverage of long term care services, including Medicaid.

(2) Available long term care services and providers.

(3) Changes or improvements in long term care services or providers.

(4) Alternatives to the purchase of private long term care insurance.

(5) The effect of inflation on benefits and the importance of inflation protection.

(6) Consumer suitability standards and guidelines.

(b) An insurance producer must:

(1) complete the certified prelicensing course established under subsection (a) before the insurance producer may sell, solicit, or negotiate a qualified long term care insurance policy; and

(2) attend a continuing education course established under subsection (a) at least once every twenty-four (24) months to continue to sell, solicit, or negotiate a qualified long term care insurance policy.

As added by P.L.196-2021, SEC.6.

IC 12-15-39.8-7Reporting requirements Sec. 7. An insurer that issues a qualified long term care insurance policy shall provide regular reports to:

(1) the Secretary of the United States Department of Health and Human Services, as required by federal regulations; and

(2) the office of Medicaid policy and planning and the department of insurance, as required by those entities.

As added by P.L.196-2021, SEC.6.

IC 12-15-39.8-8Rules Sec. 8. The secretary of family and social services and the department of insurance may adopt rules under IC 4-22-2 necessary to implement this chapter.

As added by P.L.196-2021, SEC.6.

IC 12-15-40Chapter 40. Payment for Hospice Services

12-15-40-1Applicability of chapter 12-15-40-2"Hospice" defined 12-15-40-3"Hospice program" defined 12-15-40-4"Hospice program patient" defined 12-15-40-5"Hospice services" defined 12-15-40-6Payment rate 12-15-40-7Conditions of payment 12-15-40-8Adoption of rules