CHAPTER 39.6. LONG TERM CARE PROGRAM
IC 12-15-39.6
Chapter 39.6. Long Term Care Program
IC 12-15-39.6-1
"Long term care" defined
Sec. 1. As used in this chapter, "long term care" means theprovision of the following services in a setting other than an acutecare wing of a hospital to enable individuals whose functionalcapacities are chronically impaired to be maintained at theirmaximum level of health and well-being:
(1) Physician's services.
(2) Nursing services.
(3) Diagnostic services.
(4) Therapeutic services, including physical therapy, speechtherapy, and occupational therapy.
(5) Rehabilitative services.
(6) Maintenance services.
(7) Personal care services, including companion services andassistance in bathing, dressing, and other skills of daily living.
(8) Transportation services.
(9) Day care services.
(10) Home health care services.
(11) Respite care services.
(12) Services provided in a facility licensed under IC 16-28.
(13) Services provided by chiropractors, podiatrists, andoptometrists.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-2
"Long term care facility" defined
Sec. 2. As used in this chapter, "long term care facility" means afacility licensed under IC 16-28.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-3
"Long term care insurance" defined
Sec. 3. (a) As used in this chapter, "long term care insurance"means insurance coverage for at least twelve (12) consecutivemonths for each covered person on an expense incurred, indemnity,or prepaid basis for one (1) or more necessary long term careservices provided in a setting other than an acute care wing of ahospital.
(b) The term does not include payment:
(1) of coinsurance, deductibles, or premiums for other insurancepolicies;
(2) for services covered by other insurance policies; or
(3) for services covered by Parts A and B of the Medicareprogram (42 U.S.C. 1395 et seq.).
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-4
"Health maintenance organization" defined
Sec. 4. As used in this chapter, "health maintenance organization"has the meaning set forth in IC 27-13-1-19.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-5
"Qualified long term care policy" defined
Sec. 5. As used in this chapter, "qualified long term care policy"means an insurance policy that:
(1) provides long term care insurance;
(2) meets:
(A) the definition set forth in IC 27-8-12-5; and
(B) the standards established under IC 27-8-12-7.1; and
(3) is issued by an insurer or other person who complies withsection 9(a) of this chapter.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-6
Establishment and administration of program
Sec. 6. (a) The Indiana long term care program is established todo the following:
(1) Provide incentives for individuals to insure against the costsof providing for their long term care needs.
(2) Provide a mechanism for individuals to qualify for coverageof the costs of their long term care needs under the Medicaidprogram without first being required to substantially exhaust alltheir resources.
(3) Assist in developing methods for increasing access to andthe affordability of a long term care policy.
(4) Provide counseling services to individuals in planning fortheir long term care needs.
(5) Alleviate the financial burden on the state's medicalassistance program by encouraging the pursuit of privateinitiatives.
(b) The office of Medicaid policy and planning and thedepartment of insurance shall administer the program. Thedepartment of insurance may contract with a local office of agingservices, an area agency on aging, or other nonprofit organization toprovide counseling services under the program. The department ofinsurance shall develop and coordinate a plan to provide counselingservices under the program.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-7
Information on program; availability; assistance
Sec. 7. (a) The department of insurance or the agency with whichthe department of insurance has contracted under section 6(b) of thischapter shall make available to any individual interested inparticipating in the Indiana long term care program information
concerning the following:
(1) The Indiana long term care program.
(2) Long term care insurance policies.
(3) Medicare supplement insurance policies.
(4) Parts A and B of the Medicare program (42 U.S.C. 1395 etseq.).
(5) Health maintenance organizations under IC 27-13 that arecontracted with the Medicare program.
(6) The Medicaid program.
(b) If an individual elects to pursue any of the options undersubsection (a), the department of insurance shall assist the individualin doing so.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-8
Eligibility
Sec. 8. An individual who is either:
(1) the beneficiary of a qualified long term care policy approvedby the department of insurance; or
(2) enrolled in a health maintenance organization that bothprovides long term care services and meets the requirementsunder sections 4 and 5 of this chapter;
is eligible for assistance under the Medicaid program using the assetdisregard under section 10 of this chapter.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-9
Policy provisions
Sec. 9. (a) An insurer or other person who issues a qualified longterm care policy under this chapter must at a minimum offer to eachpolicyholder or prospective policyholder a policy that provides both:
(1) long term care facility coverage; and
(2) home and community care coverage.
(b) An insurer or other person who complies with subsection (a)may also elect to offer a qualified long term care policy that providesonly long term care facility coverage.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-10
Asset disregard adjustment
Sec. 10. (a) As used in this section, "asset disregard" means one(1) of the following:
(1) A one dollar ($1) increase in the amount of assets anindividual who:
(A) purchases a qualified long term care policy; and
(B) meets the requirements under section 8 of this chapter;
may retain under IC 12-15-3 for each one dollar ($1) of benefitpaid out under the individual's long term care policy for longterm care services.
(2) The total assets an individual owns and may retain under
IC 12-15-3 and still qualify for benefits under IC 12-15 at thetime the individual applies for benefits if the individual:
(A) is the beneficiary of a qualified long term care policythat provides maximum benefits at time of purchase of atleast one hundred forty thousand dollars ($140,000) andincludes a provision under which the daily benefit increasesby at least five percent (5%) per year, compounded at leastannually;
(B) meets the requirements under section 8 of this chapter;and
(C) has exhausted the benefits of the qualified long term carepolicy.
(b) When the office determines whether an individual is eligiblefor Medicaid under IC 12-15-3, the office shall make an assetdisregard adjustment for any individual who purchases a qualifiedlong term care policy. The asset disregard must be available afterbenefits of the long term care policy have been applied to the cost oflong term care as required under this chapter.
(c) The qualified long term care policy an individual mustpurchase to be eligible for the asset disregard under subsection (a)(2)must have maximum benefits at time of purchase equal to at least onehundred forty thousand dollars ($140,000) plus five percent (5%)interest compounded annually beginning January 1, 1999.
As added by P.L.24-1997, SEC.53. Amended by P.L.2-1998, SEC.39.
IC 12-15-39.6-11
Application of asset disregard to determination of individual'sassets
Sec. 11. A public program administered by the state that:
(1) provides long term care services; and
(2) bases eligibility upon the amount of the individual's assets;
must apply the asset disregard under section 10 of this chapter indetermining the amount of the individual's assets.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-12
Discontinuation of program
Sec. 12. If the Indiana long term care program is discontinued, anindividual who purchased a qualified long term care policy prior tothe date the program is discontinued is eligible to receive an assetdisregard as defined under section 10 of this chapter.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-13
Reciprocal agreements to extend asset disregard
Sec. 13. The office of Medicaid policy and planning may enterinto reciprocal agreements with other states to extend the assetdisregard under section 10 of this chapter to Indiana residents whohad purchased qualified long term care policies in other states.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-14
Rules
Sec. 14. The secretary of family and social services may adoptrules under IC 4-22-2 necessary to implement this chapter.
As added by P.L.24-1997, SEC.53.
IC 12-15-39.6-15
Asset disregard for long term care policyholders
Sec. 15. An individual who:
(1) owns, as of January 1, 1998, a qualified long term carepolicy; and
(2) has not exhausted the benefits of the qualified long termcare policy described in subdivision (1);
is entitled to receive an asset disregard as provided in section 10 ofthis chapter.
As added by P.L.16-2009, SEC.19.