summary
Introduced
01/14/2025
01/14/2025
In Committee
04/03/2025
04/03/2025
Crossed Over
02/19/2025
02/19/2025
Passed
04/09/2025
04/09/2025
Dead
Signed/Enacted/Adopted
05/01/2025
05/01/2025
Introduced Session
2025 Regular Session
Bill Summary
Medicaid matters. Requires the office of the secretary of family and social services (office) to report specified Medicaid data to the Medicaid oversight committee. Requires the office to annually prepare and present a report to the budget committee concerning the enforcement of the Medicaid five year look back period. Prohibits specified persons from advertising or otherwise marketing the Medicaid program. Provides that the office may adopt rules concerning permissible advertising or marketing indicating participation in the Medicaid program by a person that has contracted with the office. Allows the office to reimburse medical providers at the appropriate Medicaid fee schedule rate for certified medical claims prior to the beginning of benefits, provided the claims satisfy certain conditions. Repeals language allowing for marketing of the Medicaid program. Requires the office to receive and review data from specified federal and state agencies concerning Medicaid recipients to determine whether circumstances have changed that affect Medicaid eligibility for recipients and to perform a redetermination. Requires the office to establish: (1) performance standards for hospitals that make presumptive eligibility determinations and sets out action for when hospitals do not comply with the standards; and (2) an appeals procedure for hospitals that dispute the violation determination. Sets out a hospital's responsibilities when making a presumptive eligibility determination. Imposes corrective action and restrictions for failing to meet presumptive eligibility standards. Specifies requirements, allowances, and limitations for the healthy Indiana plan.
AI Summary
This bill introduces several significant changes to Indiana's Medicaid program, focusing on improving eligibility verification, reducing fraud, and establishing more stringent oversight. The bill requires the Office of the Secretary of Family and Social Services to report detailed information about Medicaid payments, including improper payments, fraud, and recovered funds, to the Medicaid oversight committee annually. It prohibits state agencies and Medicaid program contractors from advertising the program, with limited exceptions. The bill mandates comprehensive data reviews from multiple state and federal agencies to verify Medicaid recipients' ongoing eligibility, including monthly checks of income, employment, residency, and other factors that could impact eligibility. For hospitals making presumptive eligibility determinations, the bill establishes performance standards and a graduated system of corrective actions for non-compliance, potentially leading to a hospital losing its ability to make such determinations. Additionally, the bill modifies the Healthy Indiana Plan by introducing work requirements and other conditions for eligibility, and requires the secretary to limit enrollment based on available funding. The legislation aims to create a more robust and fiscally responsible Medicaid program by enhancing verification processes and reducing potential waste or inappropriate benefits.
Committee Categories
Budget and Finance, Health and Social Services
Sponsors (11)
Ed Charbonneau (R)*,
Chris Garten (R)*,
Ryan Mishler (R)*,
Brad Barrett (R),
Martin Carbaugh (R),
Mike Gaskill (R),
Tyler Johnson (R),
Jeff Raatz (R),
Linda Rogers (R),
Jeff Thompson (R),
R. Michael Young (R),
Last Action
Public Law 126 (on 05/01/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
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