Indiana Code 12-15-44.5-4. Scope of the plan; termination of plan; obligation of state; report to budget committee
(1) is not an entitlement program; and
Terms Used In Indiana Code 12-15-44.5-4
- Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
- phase out period: refers to the following periods:
Indiana Code 12-15-44.5-1
- plan: refers to the healthy Indiana plan established by section 3 of this chapter. See Indiana Code 12-15-44.5-2
- Population: has the meaning set forth in Ind. See Indiana Code 1-1-4-5
- United States: includes the District of Columbia and the commonwealths, possessions, states in free association with the United States, and the territories. See Indiana Code 1-1-4-5
(b) If either of the following occurs, the office shall terminate the plan in accordance with section 6(b) of this chapter:
(1) The:
(A) percentages of federal medical assistance available to the plan for coverage of plan participants described in Section 1902(a)(10)(A)(i)(VIII) of the federal Social Security Act are less than the percentages provided for in Section 2001(a)(3)(B) of the federal Patient Protection and Affordable Care Act; and
(B) hospital assessment committee (IC 16-21-10), after considering the modification and the reduction in available funding, does not alter the formula established under IC 16-21-10-13.3(b)(1) to cover the amount of the reduction in federal medical assistance.
For purposes of this subdivision, “coverage of plan participants” includes payments, contributions, and amounts referred to in IC 16-21-10-13.3(b)(1)(A), IC 16-21-10-13.3(b)(1)(C), and IC 16-21-10-13.3(b)(1)(D), including payments, contributions, and amounts incurred during a phase out period of the plan.
(2) The:
(A) methodology of calculating the incremental fee set forth in IC 16-21-10-13.3 is modified in any way that results in a reduction in available funding;
(B) hospital assessment fee committee (IC 16-21-10), after considering the modification and reduction in available funding, does not alter the formula established under IC 16-21-10-13.3(b)(1) to cover the amount of the reduction in fees; and
(C) office does not use alternative financial support to cover the amount of the reduction in fees.
(c) If the plan is terminated under subsection (b), the secretary may implement a plan for coverage of the affected population in a manner consistent with the healthy Indiana plan (IC 12-15-44.2 (before its repeal)) in effect on January 1, 2014:
(1) subject to prior approval of the United States Department of Health and Human Services; and
(2) without funding from the incremental fee set forth in IC 16-21-10-13.3.
(d) The office may not operate the plan in a manner that would obligate the state to financial participation beyond the level of state appropriations or funding otherwise authorized for the plan.
(e) The office of the secretary shall submit annually to the budget committee an actuarial analysis of the plan that reflects a determination that sufficient funding is reasonably estimated to be available to operate the plan.
As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.29.