Bill Text: IN HB1277 | 2010 | Regular Session | Amended
Bill Title: Reporting requirements on health information.
Spectrum: Bipartisan Bill
Status: (Enrolled - Dead) 2010-03-01 - Senate advisor appointed: Becker and Breaux [HB1277 Detail]
Download: Indiana-2010-HB1277-Amended.html
Citations Affected: IC 2-5; IC 5-22; IC 12-7; IC 12-15; noncode.
Synopsis: Health disparities in Medicaid. Requires a managed care
organization (MCO) that contracts with the office of Medicaid policy
and planning (OMPP) to provide Medicaid services to do the
following: (1) Report to the select joint commission on Medicaid
oversight concerning the MCO's culturally and linguistically
appropriate services standards plan and the progress in implementing
these standards. (2) Measure health disparities using certain measures.
(3) Implement standards concerning culturally and linguistically
appropriate services (CLAS), and encourage practices that are more
culturally and linguistically accessible. (4) Develop and administer a
community based health disparities advisory council. Requires OMPP
to, beginning January 1, 2011, withhold a percentage of reimbursement
from a managed care organization under specified circumstances.
Requires the inclusion of criteria evaluating the MCO's cultural
competency in working with minority populations in a request for
proposal, and requires preferences to be awarded to an MCO that
shows evidence of cultural competency. Requires OMPP to: (1)
annually report specified information to the legislative council; (2)
Include as part of the member's pharmacy benefits prescription drug
labeling in the member's preferred language; and (3) establish
standards and guidelines and ensure continuity of care for Medicaid
recipients who transfer from an MCO. Requires a pharmacy that
participates in the Medicaid program to provide prescription drug
labels in the Medicaid recipient's preferred language upon request.
Requires Medicaid vendors to establish specified quality initiatives.
Effective: Upon passage; July 1, 2010.
January 12, 2010, read first time and referred to Committee on Public Health.
January 25, 2010, reported _ Do Pass.
February 1, 2010, read second time, amended, ordered engrossed.
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A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
(b) Before October 1 of each year, a managed care organization that has contracted with the office of Medicaid policy and planning to provide Medicaid services under the risk-based managed care program shall report to the commission concerning the following:
(1) The managed care organization's culturally and linguistically appropriate services (CLAS) standards plan, including the managed care organization's progress in implementing the standards.
(2) The progress of a contractor of the managed care organization in implementing a culturally and linguistically appropriate services standards plan.
1, 2010]: Sec. 2.5. In a request for proposal or a request for services
by the office of Medicaid policy and planning concerning managed
care organizations (as defined in IC 12-7-2-126.9) providing
services for the risk-based managed care Medicaid program under
IC 12-15, the office of Medicaid policy and planning shall:
(1) include as criteria that will be used in evaluating the
proposal information concerning the managed care
organization's cultural competency in working with minority
populations in Indiana; and
(2) award preferences to a managed care organization that
provides evidence of cultural competency in working with
minority populations.
(1) A health maintenance organization established under IC 27-13-2 with which the office of Medicaid policy and planning has entered into a contract to provide services under the risk-based managed care program.
(2) A person that contracts with the office or a person described in subdivision (1) to provide the administration or coordination of managed services, including a pharmacy benefit manager, case management coordinator, or behavioral health services coordinator.
(1) The number and demographic characteristics of the individuals receiving Medicaid during the preceding fiscal year.
(2) The number of births during the preceding fiscal year.
(3) The number of infant deaths during the preceding fiscal year.
(4) The improvement in the number of low birth weight babies for the preceding fiscal year.
(5) The total cost of providing Medicaid during the preceding fiscal year.
(6) The total cost savings during the preceding fiscal year that are realized in other state funded programs because of providing Medicaid.
(7) The number of Medicaid recipients who transfer from a managed care organization to a different managed care
organization under the Medicaid program, including the
following:
(A) The number of Medicaid recipients transferring out of
each managed care organization.
(B) The number of Medicaid recipients transferring into
each managed care organization.
(C) The following information regarding the transferring
recipient:
(i) Race.
(ii) Reason for transfer.
(iii) The health outcomes for each recipient during the
six (6) months after the recipient transfers.
(9) The information required to be reported in
IC 12-15-12-23.
The report must be in an electronic format under IC 5-14-6.
(b) The office shall report the information required in
subsection (a) in the aggregate and in a manner that protects
individual identifiable health information.
(c) The legislative council may request that the office also
submit the information reported under IC 12-15-12-23 in an
electronic format under IC 5-14-6.
(1) Collect data on race and primary languages as a part of the application and enrollment process.
(2) Provide the data collected under subdivision (1) to the office or managed care organization providing the care to the recipient.
recipients, the office or a contractor of the office shall require a
pharmacy filling a prescription for a recipient to provide the label
for the prescription drug in the recipient's preferred language.
(b) Upon request, a pharmacy that participates in and receives
reimbursement from the Medicaid program shall provide the label
for a prescription drug in the recipient's preferred language.
(1) Measure health disparities using HEDIS standards.
(2) Implement standards concerning culturally and linguistically appropriate services (CLAS) issued by the federal Office of Minority Health within the United States Department of Health and Human Services to encourage practices that are more culturally and linguistically accessible, including:
(A) establishing and administering a written plan; and
(B) reporting annually on the progress of the plan.
(3) Develop and administer a community based health disparities advisory council as described in subsection (c). A managed care organization may partner with other managed care organizations in the establishment of the council required under this subdivision.
(4) Complete two (2) health risk assessments for each recipient who has transferred from another managed care organization to assist in measuring health outcomes of the recipient as required by IC 12-15-1-14(a)(8)(C)(iii). The health risk assessments must be completed as follows:
(A) The first health risk assessment must be completed not later than fifteen (15) days after the transfer date.
(B) The second health risk assessment must be completed not later than six (6) months after the transfer date.
(b) The managed care organization shall:
(1) provide the culturally and linguistically appropriate services (CLAS) standards report required by subsection (a) to the interagency state council on black and minority health established by IC 16-46-6-3; and
(2) make the report available to the public upon request.
(c) The community based health disparities advisory council
developed by managed care organizations as required in subsection
(a)(3) must include the following:
(1) At least two (2) members who are minority (as defined in
IC 16-46-6-2) Medicaid recipients.
(2) Seventy-five percent (75%) of the members must be
individuals who are not employed by the managed care
organization, representing the following:
(A) Health care professionals.
(B) Advocates in the health and human services area.
(C) Individuals who provide direct services to risk-based
managed care recipients.
(3) At least one (1) member representing each of the
following:
(A) The Indiana Minority Health Coalition.
(B) The commission on Hispanic/Latino affairs established
by IC 4-23-28-2.
(C) American Indian Center of Indiana.
(D) Asian Help Services.
(E) The Arc of Indiana.
(F) The Central Indiana Council on Aging.
(G) An entity that provides direct services to risk-based
managed care recipients.
The council membership must reflect the population served.
(d) A community based health disparities advisory council shall
do the following:
(1) Provide input and assist the managed care organization in
the development and implementation of the culturally and
linguistically appropriate services (CLAS) standards.
(2) Review the annual assessment and evaluate whether the
plan is improving minority health outcomes.
(3) Review the final report required by subsection (a)(1).
(4) Approve stipend reimbursement for travel expenses,
including mileage for council members who reside in a city
other than where the council meeting is being held to travel to
attend a council meeting.
(e) A managed care organization shall pay for the costs of the
managed care organization's community based health disparities
advisory council.
(f) Beginning January 1, 2011, the office shall withhold a
percentage of reimbursement from a managed care organization
based on a lack of progress by the managed care organization in
improving health disparity outcomes.
(1) Prepare requirements, including qualifications, for bidders offering to contract with the state to perform the functions under section 3 of this chapter.
(2) Assist the Indiana department of administration in preparing bid specifications in conformity with requirements.
(b) The office shall comply with the requirements of IC 5-22-9-2.5 in preparing a bid for managed care organization services under the risk-based managed care program.
(1) contracts with the office to provide direct services, including pharmacy vendors; and
(2) receives reimbursement under Medicaid;
shall implement at least two (2) quality improvement initiatives to reduce health disparities, at least one (1) of which addresses race, ethnic, or other geographic disparities.
(b) The initiatives required in subsection (a) must do the following:
(1) Include baseline data on individuals who receive services from the contractor.
(2) Include measurable goals and outcomes.
(3) Use a third party source to evaluate the contractor's initiatives.
(4) Be in one (1) of the following categories:
(A) Obstetrics.
(B) Asthma.
(C) Diabetes.
(D) Immunizations.
(E) Healthcare effectiveness data and information set.
(b) If the office of Medicaid policy and planning has a request for proposal or a request for services that:
(1) is already in progress upon the passage of this act; and
(2) is affected by the requirements of IC 5-22-9-2.5, as added by this act;
the office shall communicate the requirements of IC 5-22-9-2.5, as
added by this act, and the culturally and linguistically appropriate
services (CLAS) standards to a person that has submitted a
proposal for the request.
(c) This SECTION expires December 31, 2010.
