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 the
provision of the following services in a setting other than an acute
care wing of a hospital to enable individuals whose functional
capacities are chronically impaired to be maintained at their
maximum level of health and well-being:
(1) Physician's services.
(2) Nursing services.
(3) Diagnostic services.
(4) Therapeutic services, including physical therapy, speech
therapy, and occupational therapy.
(5) Rehabilitative services.
(6) Maintenance services.
(7) Personal care services, including companion services and
assistance 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, and
optometrists. 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 a
facility 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) consecutive
months for each covered person on an expense incurred, indemnity,
or prepaid basis for one (1) or more necessary long term care
services provided in a setting other than an acute care wing of a
hospital.
(b) The term does not include payment:
(1) of coinsurance, deductibles, or premiums for other insurance
policies;
(2) for services covered by other insurance policies; or
(3) for services covered by Parts A and B of the Medicare
program (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 with
section 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 to
do the following:
(1) Provide incentives for individuals to insure against the costs
of providing for their long term care needs.
(2) Provide a mechanism for individuals to qualify for coverage
of the costs of their long term care needs under the Medicaid
program without first being required to substantially exhaust all
their resources.
(3) Assist in developing methods for increasing access to and
the affordability of a long term care policy.
(4) Provide counseling services to individuals in planning for
their long term care needs.
(5) Alleviate the financial burden on the state's medical
assistance program by encouraging the pursuit of private
initiatives.
(b) The office of Medicaid policy and planning and the
department of insurance shall administer the program. The
department of insurance may contract with a local office of aging
services, an area agency on aging, or other nonprofit organization to
provide counseling services under the program. The department of
insurance shall develop and coordinate a plan to provide counseling
services 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 which
the department of insurance has contracted under section 6(b) of this
chapter shall make available to any individual interested in
participating 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 et
seq.).
(5) Health maintenance organizations under IC 27-13 that are
contracted with the Medicare program.
(6) The Medicaid program.
(b) If an individual elects to pursue any of the options under
subsection (a), the department of insurance shall assist the individual
in 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 approved
by the department of insurance; or
(2) enrolled in a health maintenance organization that both
provides long term care services and meets the requirements
under sections 4 and 5 of this chapter;
is eligible for assistance under the Medicaid program using the asset
disregard 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 long
term care policy under this chapter must at a minimum offer to each
policyholder 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 provides
only 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 an
individual 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 benefit
paid out under the individual's long term care policy for long
term 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 the
time the individual applies for benefits if the individual:
(A) is the beneficiary of a qualified long term care policy
that provides maximum benefits at time of purchase of at
least one hundred forty thousand dollars ($140,000) and
includes a provision under which the daily benefit increases
by at least five percent (5%) per year, compounded at least
annually;
(B) meets the requirements under section 8 of this chapter;
and
(C) has exhausted the benefits of the qualified long term care
policy.
(b) When the office determines whether an individual is eligible
for Medicaid under IC 12-15-3, the office shall make an asset
disregard adjustment for any individual who purchases a qualified
long term care policy. The asset disregard must be available after
benefits of the long term care policy have been applied to the cost of
long term care as required under this chapter.
(c) The qualified long term care policy an individual must
purchase to be eligible for the asset disregard under subsection (a)(2)
must have maximum benefits at time of purchase equal to at least one
hundred 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's
assets
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 in
determining 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, an
individual who purchased a qualified long term care policy prior to
the date the program is discontinued is eligible to receive an asset
disregard 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 enter
into reciprocal agreements with other states to extend the asset
disregard under section 10 of this chapter to Indiana residents who
had 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 adopt
rules 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 care
policy; and
(2) has not exhausted the benefits of the qualified long term
care policy described in subdivision (1);
is entitled to receive an asset disregard as provided in section 10 of
this chapter. As added by P.L.16-2009, SEC.19.
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 the
provision of the following services in a setting other than an acute
care wing of a hospital to enable individuals whose functional
capacities are chronically impaired to be maintained at their
maximum level of health and well-being:
(1) Physician's services.
(2) Nursing services.
(3) Diagnostic services.
(4) Therapeutic services, including physical therapy, speech
therapy, and occupational therapy.
(5) Rehabilitative services.
(6) Maintenance services.
(7) Personal care services, including companion services and
assistance 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, and
optometrists. 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 a
facility 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) consecutive
months for each covered person on an expense incurred, indemnity,
or prepaid basis for one (1) or more necessary long term care
services provided in a setting other than an acute care wing of a
hospital.
(b) The term does not include payment:
(1) of coinsurance, deductibles, or premiums for other insurance
policies;
(2) for services covered by other insurance policies; or
(3) for services covered by Parts A and B of the Medicare
program (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 with
section 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 to
do the following:
(1) Provide incentives for individuals to insure against the costs
of providing for their long term care needs.
(2) Provide a mechanism for individuals to qualify for coverage
of the costs of their long term care needs under the Medicaid
program without first being required to substantially exhaust all
their resources.
(3) Assist in developing methods for increasing access to and
the affordability of a long term care policy.
(4) Provide counseling services to individuals in planning for
their long term care needs.
(5) Alleviate the financial burden on the state's medical
assistance program by encouraging the pursuit of private
initiatives.
(b) The office of Medicaid policy and planning and the
department of insurance shall administer the program. The
department of insurance may contract with a local office of aging
services, an area agency on aging, or other nonprofit organization to
provide counseling services under the program. The department of
insurance shall develop and coordinate a plan to provide counseling
services 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 which
the department of insurance has contracted under section 6(b) of this
chapter shall make available to any individual interested in
participating 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 et
seq.).
(5) Health maintenance organizations under IC 27-13 that are
contracted with the Medicare program.
(6) The Medicaid program.
(b) If an individual elects to pursue any of the options under
subsection (a), the department of insurance shall assist the individual
in 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 approved
by the department of insurance; or
(2) enrolled in a health maintenance organization that both
provides long term care services and meets the requirements
under sections 4 and 5 of this chapter;
is eligible for assistance under the Medicaid program using the asset
disregard 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 long
term care policy under this chapter must at a minimum offer to each
policyholder 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 provides
only 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 an
individual 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 benefit
paid out under the individual's long term care policy for long
term 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 the
time the individual applies for benefits if the individual:
(A) is the beneficiary of a qualified long term care policy
that provides maximum benefits at time of purchase of at
least one hundred forty thousand dollars ($140,000) and
includes a provision under which the daily benefit increases
by at least five percent (5%) per year, compounded at least
annually;
(B) meets the requirements under section 8 of this chapter;
and
(C) has exhausted the benefits of the qualified long term care
policy.
(b) When the office determines whether an individual is eligible
for Medicaid under IC 12-15-3, the office shall make an asset
disregard adjustment for any individual who purchases a qualified
long term care policy. The asset disregard must be available after
benefits of the long term care policy have been applied to the cost of
long term care as required under this chapter.
(c) The qualified long term care policy an individual must
purchase to be eligible for the asset disregard under subsection (a)(2)
must have maximum benefits at time of purchase equal to at least one
hundred 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's
assets
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 in
determining 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, an
individual who purchased a qualified long term care policy prior to
the date the program is discontinued is eligible to receive an asset
disregard 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 enter
into reciprocal agreements with other states to extend the asset
disregard under section 10 of this chapter to Indiana residents who
had 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 adopt
rules 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 care
policy; and
(2) has not exhausted the benefits of the qualified long term
care policy described in subdivision (1);
is entitled to receive an asset disregard as provided in section 10 of
this chapter. As added by P.L.16-2009, SEC.19.
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 the
provision of the following services in a setting other than an acute
care wing of a hospital to enable individuals whose functional
capacities are chronically impaired to be maintained at their
maximum level of health and well-being:
(1) Physician's services.
(2) Nursing services.
(3) Diagnostic services.
(4) Therapeutic services, including physical therapy, speech
therapy, and occupational therapy.
(5) Rehabilitative services.
(6) Maintenance services.
(7) Personal care services, including companion services and
assistance 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, and
optometrists. 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 a
facility 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) consecutive
months for each covered person on an expense incurred, indemnity,
or prepaid basis for one (1) or more necessary long term care
services provided in a setting other than an acute care wing of a
hospital.
(b) The term does not include payment:
(1) of coinsurance, deductibles, or premiums for other insurance
policies;
(2) for services covered by other insurance policies; or
(3) for services covered by Parts A and B of the Medicare
program (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 with
section 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 to
do the following:
(1) Provide incentives for individuals to insure against the costs
of providing for their long term care needs.
(2) Provide a mechanism for individuals to qualify for coverage
of the costs of their long term care needs under the Medicaid
program without first being required to substantially exhaust all
their resources.
(3) Assist in developing methods for increasing access to and
the affordability of a long term care policy.
(4) Provide counseling services to individuals in planning for
their long term care needs.
(5) Alleviate the financial burden on the state's medical
assistance program by encouraging the pursuit of private
initiatives.
(b) The office of Medicaid policy and planning and the
department of insurance shall administer the program. The
department of insurance may contract with a local office of aging
services, an area agency on aging, or other nonprofit organization to
provide counseling services under the program. The department of
insurance shall develop and coordinate a plan to provide counseling
services 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 which
the department of insurance has contracted under section 6(b) of this
chapter shall make available to any individual interested in
participating 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 et
seq.).
(5) Health maintenance organizations under IC 27-13 that are
contracted with the Medicare program.
(6) The Medicaid program.
(b) If an individual elects to pursue any of the options under
subsection (a), the department of insurance shall assist the individual
in 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 approved
by the department of insurance; or
(2) enrolled in a health maintenance organization that both
provides long term care services and meets the requirements
under sections 4 and 5 of this chapter;
is eligible for assistance under the Medicaid program using the asset
disregard 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 long
term care policy under this chapter must at a minimum offer to each
policyholder 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 provides
only 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 an
individual 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 benefit
paid out under the individual's long term care policy for long
term 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 the
time the individual applies for benefits if the individual:
(A) is the beneficiary of a qualified long term care policy
that provides maximum benefits at time of purchase of at
least one hundred forty thousand dollars ($140,000) and
includes a provision under which the daily benefit increases
by at least five percent (5%) per year, compounded at least
annually;
(B) meets the requirements under section 8 of this chapter;
and
(C) has exhausted the benefits of the qualified long term care
policy.
(b) When the office determines whether an individual is eligible
for Medicaid under IC 12-15-3, the office shall make an asset
disregard adjustment for any individual who purchases a qualified
long term care policy. The asset disregard must be available after
benefits of the long term care policy have been applied to the cost of
long term care as required under this chapter.
(c) The qualified long term care policy an individual must
purchase to be eligible for the asset disregard under subsection (a)(2)
must have maximum benefits at time of purchase equal to at least one
hundred 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's
assets
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 in
determining 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, an
individual who purchased a qualified long term care policy prior to
the date the program is discontinued is eligible to receive an asset
disregard 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 enter
into reciprocal agreements with other states to extend the asset
disregard under section 10 of this chapter to Indiana residents who
had 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 adopt
rules 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 care
policy; and
(2) has not exhausted the benefits of the qualified long term
care policy described in subdivision (1);
is entitled to receive an asset disregard as provided in section 10 of
this chapter. As added by P.L.16-2009, SEC.19.
