IHCA/INCAL 2023 Legislative Session Accomplishments

Most Indiana laws went into effect on July 1, 2023.  The IHCA/INCAL had a successful session with many changes being implemented:

Securing Record Assisted Living Medicaid Funding and Unprecedented Reimbursement Schedule; Significant Tax Relief (HEA 1001)

• Helped secure the highest Medicaid appropriation in state history, fully funding record rates for nursing homes and home and community-based providers.
• Home and community-based providers will now be on a 4-year rate schedule per state law.
  • FSSA has committed to a 35.6% rate increase for AL A&D Waiver providers in 2023 with an annual index of 2% for each year thereafter.
• Extended the Quality Assessment Fee program at current rates from June 30, 2023, to June 30, 2025.
• Supported passthrough entity tax relief (SEA 2) that is expected to reduce employers tax liabilities by ~$50M.

Regulating Health Care Temporary Staffing Agencies (HEA 1461)

• Establishes a public complaint portal for investigations into temp agencies by the Attorney General’s Office and the Department of Health.
• Requires temporary health care services agencies to (else be subject to license discipline):
  • Provide a schedule of fees, charges, and commissions that the temporary health care services agency expects to charge and collect for services.
    • Provide 30-day notice to the Department of Health on any changes to these fees.
  • Carry a dishonesty bond for their contractors/employees to cover theft and other issues that may happen while working in a health care facility.
  • Ensure temp agency workers are properly licensed in good standing, have passed background checks, complete proper health screenings, and meet other state regulations before placement with a health care provider.
  • Ensure billing is done within 3 months.
  • Retain records for 5 years.
  • Maintain insurance coverage for worker’s compensation for each health care personnel provided or procured by the temporary health care services agency.
  • Provide 7-day notice to AG’s Office and IDOH if temp worker threatens the welfare, safety, or health of the public.
• Prohibits temporary health care services agencies from (else be subject to license discipline):
  • Charging conversion fees, buyout clauses, and other restrictive, anti-labor policies by temp agencies that were price gouging health care operators and limiting hiring opportunities for health care practitioners.
  • Recruiting health care personnel on the premise of a health care facility (i.e., poaching)
  • Intentionally giving false or misleading information to a health care facility
  • Requiring health care personnel recruit new health care personnel for the temporary health care services agency from the permanent employees of the health care facility where they are contracted.
• Allows investigations by the AG’s Office and the Department of Health, which can result in license revocation from the temp agency and civil penalties of up to $5000.
  • Reinstatement of a revoked license only possible after 5 years.

 Streamlining and Reducing Occupational Licensure Barrers for HFAs & RCAs (HEA 1461)

• Reduces the HFA AIT program by a possible 3 months (50% reduction) and reduces the hours required by a possible 360 hours (or 34.6%).
• Eliminates the RCA AIT program, which was one of the most stringent in the country.
• Eliminates administrative code for HFAs and RCAs (840 IAC 1 and 840 IAC 2) effective July 1, 2023.
• Eliminates the temporary permit for HFAs and RCAs by updating the provisional license requirements.
• Creates national license pathway for HFAs and RCAs by recognizing the National Association of Long Term Care Administrators Boards Health Services Executive license.
• Streamlines reciprocity requirements for HFAs and RCAs in alignment with universal license recognition policies implemented in other states.
• Allows preceptors to oversee multiple AITs and makes it easier to be a preceptor.

Protecting Property Tax Exemptions for Non-Profit Nursing Homes and Health Facilities (HEA 1454)

• Mandates county assessors and county auditors grant property tax exemptions for nonprofit CCRCs and health facilities (IC 16-28, e.g., SNFs, AL, etc.) for tax years 2022 through 2024 (payable in 2023-2025).

 Meeting Medicaid Residents’ Needs Where They Are (HEA 1461)

• Allows Medicaid certifications to be transferred from one facility to another within a county without also having to transfer the licenses for comprehensive care beds.
  • If only the Medicaid certification is transferred, the license for the bed is lost from the originating facility.
• Both the licensed bed and the Medicaid certification (together) can continue to be transferred to another facility in a county.

Protecting AL Medicaid Services and Rates into the Future (HEA 1461)

• Requires FSSA to continue to pay AL providers for integrated health care coordination and transportation, when provided.
• Requires FSSA to increase the AL reimbursement to providers for any additional service requirements.
• Prohibits FSSA from reducing service requirements currently in place for AL providers (as a possible rationale for a future cut in reimbursement).

 Holding State Government Accountable and Meeting Indiana’s Future Long-Term Care Needs (HEA 1461)

• Requires the Family and Social Services Administration (FSSA) to contract with an additional statewide entity for Medicaid eligibility determinations by June 30, 2025, creating competition with local Area Agencies on Aging (AAAs).
• Requires FSSA to issue a report on October 1, 2023, about the outcomes of the expedited eligibility pilot program in comparison to the timeliness of eligibility determinations made by AAAs.
• Requires FSSA to biannually issue a report to the General Assembly until 2029 about how it is improving the timeliness of Medicaid eligibility determinations with the goal of getting to a 72-hour turnaround.
• Requires the Indiana Housing and Community Development Authority, by November 1, 2023, to issue a report on ways to expand rural access to assisted living services.

Amended Bill List

• Ensured No Impact on LTC for Site of Service Legislation
• Aligned New Regulations for State Oversight of Unlicensed AL Memory Care Services with Existing Licensed AL Regulations (HEA 1457)

Bills that IHCA/INCAL Opposed and Didn’t Pass

• Adult Wrongful Death Expansion (SB 288)
• Publicly Posting Nursing Home Staffing Ratios (HB 1129)
• Nurse Overtime Prohibitions (HB 1353)

Please contact Nick Goodwin, IHCA/INCAL Director of Government Affairs, at ngoodwin@ihca.org.