Indiana General Assembly Heads into Final Days of 2019 Session
The Indiana General Assembly is anticipated to finish their work by Wednesday, April 24 or Thursday, April 25. Due to the National Rifle Association (NRA) convention being held in Indianapolis beginning April 26, the legislature will be completing the 2019 legislative session a few days ahead of the statutory deadline of April 29.
Of the remaining 226 bills still moving through the process, approximately half have been concurred upon, meaning that the original chamber agreed with the changes made in the second chamber. The other half are progressing through the conference committee process whereby House and Senate legislators will come together to try to work out the differences between the House and Senate versions.
With that timeline in mind, a few outstanding issues remain for the Indiana Hospital Association, including:
- Based on discussions within the IHA DSH Taskforce and at the direction of the IHA Board of Directors, updated DSH language will be submitted to legislators for inclusion in the state budget (House Bill 1001). The language allows for a stopgap plan to be created should the federal DSH cuts go into effect this year.
- IHA will be advocating for the creation of a tax on e-cigarette devices and e-liquids at a rate of parity to traditional tobacco products. Ideally, IHA would like to see some of that revenue dedicated to HIP in order to ease pressure on future hospital assessment fees. At this time, however, legislators have indicated they will target those dollars to the Children’s Health Insurance Program (CHIP).
Medicaid Reimbursement for Children’s Hospitals Headed to Conference Committee
It is anticipated that a conference committee will be scheduled for Monday, April 22 to iron out the differences between competing versions of House Bill 1238. The House version of the bill called for the Office of Family and Social Services (FSSA) to implement a pilot program with the University of Chicago. The bill narrowly defines the pilot to provide services for recipients less than six years of age and residents of Indiana who are either in need of a Medicaid service that is not being offered or is otherwise unavailable in Indiana; or the recipient's provider determines that it is medically necessary for the recipient to obtain the services at a children's hospital located in Chicago, Illinois. The pilot would provide Medicaid reimbursement similar to children’s hospitals located in Indiana.
The Senate version of the bill would do the following:
- Require FSSA to consult with the National Association of Medicaid Directors, review existing procedures, arrangements, and agreements of other states, including financing mechanisms, for Medicaid reimbursement for Medicaid recipients who are receiving care in a children's hospital or by a Medicaid provider who is located in a state other than the state in which the Medicaid recipient resides.
- Direct FSSA to collaborate and meet with medical directors in Indiana’s surrounding states to see what, if any, agreements may be reached to provide pediatric services to this population. This would ensure that any agreed upon arrangement accounts for Indiana children and children’s hospitals. IHA would be consulted throughout this process as part of a working group.
- The bill would grant FSSA enabling authority to enter into such an agreement if the Centers for Medicare and Medicaid Services (CMS) approves a Medicaid waiver or state plan amendment.
Future of Short-Term Health Plan Legislation Unclear
House Bill 1631 and Senate Bill 392 both address short-term health plans and their allowed duration in Indiana after a recent Trump Administration ruling granted states the ability to extend short term plans up to three years. While IHA would strongly prefer that these plans be limited greatly in Indiana, the language in HB 1631 is far more consumer-friendly than language passed in SB 392.
HB 1631 as amended in the Senate would require all short-term insurance plans to cover pre-existing medical conditions and would limit the plans to a total duration of 12 months non-renewable.
SB 392 would go far beyond the House version and would not require insurers that issue short-term insurance plans to offer plans that cover pre-existing medical conditions. In addition, the bill would extend the allowed duration of short-term health insurance plans to a maximum of 36 months. Current law allows for a maximum of six months duration.
Both bills would require insurers that offer short term insurance plans to undertake a preferred provider network that meets network adequacy standards. In addition, they would be required to offer coverage for four essential health benefits, including (1) ambulatory services, (2) hospitalization, (3) emergency services, and (4) laboratory services. Finally, short term plans would be required to meet an annual limit of at least $2 million and provide consumer disclosure regarding the limitations of these plans.
IHA has shared concerns with lawmakers that extending the plans for up to three years could undermine and potentially destabilize the Health Insurance Marketplace by concentrating the risk of less healthy individuals in those markets and consequently drive up the cost of comprehensive coverage. IHA advocated that to ensure these plans are used as they were intended – to fill short gaps in coverage – and not as a long-term solution to substitute for real coverage, the duration of these plans should be short.
The issue will be discussed in conference committee next week where the House and Senate will reconcile the differences between the two bills. IHA will advocate again for a duration of 12 months non-renewable, as originally passed in the House. Once a final version is agreed upon in conference committee, the bill will head back to the House and Senate for a final vote.
Updated Revenue Forecast Not as Rosy
Indiana budget writers will have about $100 million less to work with than previously anticipated. The forecast predicts Indiana will collect about $33 million less over the next two years than the last forecast in December projected. Combine that with more money needed for Medicaid, and state lawmakers have $100 million less to work with than they previously thought.
Both the House and Senate fiscal leaders indicated that their two different versions of the next two-year state budget weren’t that far apart, so a final version could emerge early in the week.
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