All Roll Calls
Yes: 247 • No: 68
IndianaHB 1474First Regular Session 124th General Assembly (2025)HouseWALLET
FSSA matters.
Sponsored By: Brad Barrett (Republican)
Signed by Governor
Summary
Adds additional duties to a workgroup currently organized concerning the pathways for aging risk based managed care program (program). Requires the office of the secretary of family and social services (office of the secretary) to determine the base reimbursement rate structure, methodology, and reimbursement rates for provider payment by managed care organizations under the program. Allows the office of the secretary to perform claims reviews of claims under the program. Requires a managed care organization participating in the program to do the following: (1) Contract with nursing facilities if certain conditions are met under the same terms for a specified time frame. (2) Submit monthly reports for claims that had a denial rate of at least five percent in the previous month. (3) Pay minimum reimbursement rates to providers. (4) Pay interest on unpaid claims that are later determined to be clean claims. Sets forth the powers and duties of the office of the secretary concerning Medicaid home and community based services waivers. Requires a provider of services under a home and community based services waiver to follow any waiver requirements under federal law and developed by the office of the secretary. Establishes requirements for home and community based services waivers. Relocates provisions requiring reimbursement for assisted living services for individuals who are aged and disabled and receiving services under a Medicaid waiver. Specifies that: (1) these provisions apply to a home and community based services waiver that included assisted living services as an available services before July 1, 2025; (2) these provisions apply to an individual receiving services under a home and community based services waiver; and (3) reimbursement is required for certain services that are part of the individual's home and community based service plan. Relocates provisions establishing limitations concerning assisted living services provided in a home and community based services program. Relocates a provision requiring the office of the secretary to annually determine any state savings generated by home and community based services. Removes a provision allowing the division of aging to adopt rules concerning an appeals process for a housing with services establishment provider's determination that the provider is unable to meet the health needs of a resident and allows the office of the secretary to adopt rules concerning the appeals process. Requires an individual who provides attendant care services for compensation from Medicaid to register with the office of the secretary. Removes the requirement that the division of aging administer programs established under Medicaid waivers for in-home services for treatment of medical conditions. Provides that provisions of law concerning the statewide waiver ombudsman apply to an individual who has a disability and receives services administered by the bureau of disabilities services. (Current law specifies that these provisions apply to an individual who has a developmental disability and receives services under the federal home and community based services program.) Specifies that these provisions do not apply to an individual served by the long term care ombudsman program. Changes references from "statewide waiver ombudsman" to "statewide bureau of disabilities services ombudsman". Requires the unit of services for the deaf and hard of hearing and the division (rather than the unit and the board of interpreters) to adopt rules creating standings for interpreters. Removes provisions concerning the board of interpreters. Repeals a provision providing that licensed home health agencies and licensed personal services agencies are approved to provide certain services under a Medicaid waiver granted to the state under federal law that provides services for treatment of medical conditions. Repeals language concerning a long term care services eligibility screen for purposes of the Community and Home Options to Institutional Care for the Elderly and Disabled program (CHOICE). Authorizes the division of disability and rehabilitative services to charge an authorized service provider that employs a direct service professional an annual fee. Establishes the direct support professional training program fund and appropriates money in the fund.
public healththe senatehealth and provider servicesappropriations
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Bill Overview
Analyzed Economic Effects
15 provisions identified: 7 benefits, 1 costs, 7 mixed.
Medicaid home care comes with funding limits
Beginning July 1, 2025, Indiana replaces its older home-care chapter with a centralized Medicaid home and community-based services framework. Eligible people must get needed services when waiver slots and funding are available; eligibility alone does not guarantee a slot. The state sets eligibility and provider certification rules, and people denied eligibility can appeal. Services cannot cost more than care for a similar person in an institution, and total costs must stay within available funding. The state must calculate and report institutional-care savings annually and may use them to fund additional waiver slots.
Assisted living waiver payments can reach back
For waivers offering assisted living before July 1, 2025, Indiana must reimburse specified services for aged or disabled participants. Covered services are assisted living, integrated health care coordination, and transportation when included in the person’s service plan. Once the state approves a service increase, payment starts from the date the provider documents delivering that increase. The state may also reimburse home and community-based services starting on the Medicaid application date.
Care plans and complaints for Medicaid recipients
Beginning July 1, 2025, Indiana must coordinate waiver recipients’ care within available resources, using plans centered on each person’s needs. Plans must consider family and community resources, and the Secretary’s office serves as placement authority for recipients with plans. Providers must follow federal and state standards, use qualified workers, and deliver supervised care that follows each person’s plan. When appropriate, services must include settings shared with people who do not receive waiver services. The office must monitor providers using its funds or holding waiver agreements and offer recipients and providers a confidential complaint process.
Medicaid recipients can choose self-directed care
Beginning July 1, 2025, Indiana must offer self-directed care to eligible waiver recipients who choose it. The state must amend or implement a waiver to pay for personal attendants and related employment and recordkeeping costs. To the extent federal law allows, money provided to hire registered attendants does not count as the recipient’s income. That protection applies when deciding eligibility for self-directed care and home and community-based waiver services. The law replaces an older waiver-payment directive with this requirement; it sets no payment amount.
Assisted living rules allow more flexibility
For waivers offering assisted living before July 1, 2025, Indiana cannot require only private rooms, separate housing and service agreements, or specified building features. The ban on requiring kitchenette sinks covers entities participating in the Medicaid waiver program before July 1, 2018. Adjoining or shared units may share bathrooms with participants’ consent. The state cannot require housing when a provider cannot meet health needs without undue burden or fundamentally changing operations, and the resident cannot arrange needed services. Provider-capability decisions must have an appeal process with objective third-party review; Department of Health licensing provides another appeal route.
Paid Medicaid attendants face registration limits
Beginning July 1, 2025, paid Medicaid attendants under the new chapter must register with the Secretary’s office. Applicants must be at least 18 and submit a resume, an allowed criminal-history check, three reference letters, and other required information. A nurse aide registry report is required when applicable; registration lasts two years, with specified checks updated every two years. Legally responsible relatives, including spouses and parents of minors, cannot receive attendant pay except for extraordinary care. Existing registrants who provide waiver services count as registered under the new system from July 1, 2025, until the transition expires July 1, 2027.
Self-directed care gives control and employer duties
Beginning July 1, 2025, self-directed care recipients employ their attendants and handle hiring, training, supervision, payroll, paperwork, and dismissal. They must plan weekly care tasks with a case manager and sign a state-approved contract covering duties, service frequency, duration, wages, and early termination. Pay must reach the federal minimum wage but cannot exceed the applicable waiver rate, or CHOICE rate where applicable. A parent, spouse, guardian, or valid power-of-attorney holder may make specified decisions for someone under 21 or unable to direct care because of a brain injury or mental deficiency. The state office is not liable for recipient or attendant actions; each person remains liable for wrongful or negligent conduct they personally join.
Separate attendant care rules for CHOICE participants
Beginning July 1, 2025, the older self-directed care chapter requires participation in Indiana’s CHOICE home-care program. Participants must need attendant help with daily living, self-care, and mobility because of an impairment, choose a paid attendant, and direct care. Medicaid waiver approval alone no longer qualifies someone under that chapter; Medicaid self-directed care has a separate framework. CHOICE-paid attendants must remain registered under the older chapter, whose registration rule no longer covers Medicaid-paid care. Contracts retain the federal minimum wage floor, but the recipient’s CHOICE rate replaces the Medicaid waiver rate as the wage ceiling.
Interpreter rules must include complaint procedures
Beginning July 1, 2025, the designated Indiana unit and division must adopt interpreter standards. Their rules must include ethics, complaint procedures, and enforcement. The law assigns rulemaking responsibility but does not itself set the detailed standards or decide complaints.
Aging care claims get deadlines and oversight
Beginning July 1, 2025, Pathways for Aging plans must pay, deny, or suspend participating nursing facility claims within 21 days electronically or 30 days on paper. Late payment of clean claims requires interest at the Medicare overpayment and underpayment rate, from day 22 or 31 until payment. This includes denied or suspended claims later found to have been clean when filed. Indiana must externally review claim denials at least annually and may review other claims for covered members. The claims workgroup uses director-appointed plan and provider representatives to improve submission and processing policies and advise on claims problems, replacing earlier testing-related duties.
Aging plans must meet provider payment floors
Beginning July 1, 2025, Indiana sets provider payment rates for Pathways for Aging, and managed care plans cannot pay less. Plans must also contract with qualifying nursing facilities willing to accept the same terms offered to other participating providers. Facilities must hold an Indiana license and the required Medicare or Medicaid certification. Contracts must include state-established reimbursement rates. The nursing facility contracting requirement expires June 30, 2029; the law gives no specific payment rates.
Care providers get order review notices
Beginning July 1, 2025, covered care providers must receive notice explaining certain state orders and available review procedures. This covers orders from the Secretary or a designee against providers regulated by the Secretary’s office, Division of Aging, or Bureau of Disabilities Services. Orders generally take effect 15 days after service unless another date applies. Providers licensed by the Department of Health under Indiana’s home health or health facility licensing chapters are excluded.
Emergency Medicaid provider aid requirement ends
Indiana removes the requirement for temporary emergency aid to providers facing financial emergencies caused by managed-care claims-payment problems. The former requirement covered the first 210 days after the covered managed-care program began. Its eligibility, payment, and reconciliation requirements are also removed. The law states no aid amount.
Disability ombudsman access expands with record sharing
Beginning July 1, 2025, the statewide disability ombudsman covers people with developmental disabilities receiving Bureau of Disabilities Services programs. Coverage is no longer limited to federal waiver recipients, but excludes people served by the long-term care ombudsman. Mental health records may be shared with the Bureau’s ombudsman without patient consent when needed to perform the ombudsman’s duties.
Provider fees support care worker training
Beginning July 1, 2025, Indiana creates a fund for direct support professional training, a registry, curriculum, and administration. Provider fees and investment earnings support the fund; its money is continuously available for these purposes and does not expire at year-end. The Division may charge authorized service providers employing direct service professionals annual fees totaling no more than $2,000 per provider. The fee structure must account for workforce size or variation. This funds training operations, not direct household payments.
Sponsors & Cosponsors
Sponsor
Brad Barrett
Republican • House
Cosponsors
Ed Charbonneau
Republican • Senate
Liz Brown
Republican • Senate
Lonnie Randolph
Democratic • Senate
Maureen Bauer
Democratic • House
Robb Greene
Republican • House
Tony Isa
Republican • House
Roll Call Votes
House vote • 4/17/2025
House concurred with Senate amendments
Yes: 85 • No: 0
Senate vote • 4/15/2025
Third reading: passed
Yes: 47 • No: 1
Senate vote • 4/10/2025
Amendment #3 (Qaddoura) failed
Yes: 10 • No: 34
Senate vote • 4/10/2025
Amendment #2 (Qaddoura) failed
Yes: 12 • No: 33
House vote • 2/17/2025
Third reading: passed
Yes: 93 • No: 0
Actions Timeline
Public Law 174
5/1/2025HouseSigned by the Governor
5/1/2025HouseSigned by the President of the Senate
4/23/2025SenateSigned by the President Pro Tempore
4/22/2025SenateSigned by the Speaker
4/21/2025HouseHouse concurred with Senate amendments; Roll Call 497: yeas 85, nays 0
4/17/2025HouseMotion to concur filed
4/17/2025HouseReturned to the House with amendments
4/16/2025SenateThird reading: passed; Roll Call 443: yeas 47, nays 1
4/15/2025SenateAmendment #1 (Jackson L) prevailed; voice vote
4/10/2025SenateAmendment #7 (Charbonneau) prevailed; voice vote
4/10/2025SenateAmendment #2 (Qaddoura) failed; Roll Call 375: yeas 12, nays 33
4/10/2025SenateAmendment #3 (Qaddoura) failed; Roll Call 376: yeas 10, nays 34
4/10/2025SenateSecond reading: amended, ordered engrossed
4/10/2025SenateSenator Randolph added as cosponsor
4/7/2025SenateSenator Brown L added as cosponsor
4/7/2025SenateCommittee report: do pass, adopted
4/3/2025SenateCommittee report: amend do pass adopted; reassigned to Committee on Appropriations
3/27/2025SenateFirst reading: referred to Committee on Health and Provider Services
3/3/2025SenateReferred to the Senate
2/18/2025HouseSenate sponsor: Senator Charbonneau
2/17/2025HouseThird reading: passed; Roll Call 183: yeas 93, nays 0
2/17/2025HouseRepresentatives Greene, Isa, Bauer added as coauthors
2/17/2025HouseSecond reading: ordered engrossed
2/13/2025HouseCommittee report: amend do pass, adopted
2/11/2025House
Bill Text
Engrossed House Bill (H)
Enrolled House Bill (H)
House Bill (S)
Introduced House Bill (H)
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