reglab/housing_qa huggingface dataset:
IN Code § 12-15-44.5-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-8. Requirements for Use of Money Appropriated to the Fund; Requirements for Use of the Incremental Hospital Assessment Fee; Payment for Health Care Services; Administrative Costs; Profit

Sec. 8. The following requirements apply to funds appropriated by the general assembly to the plan and the incremental fee used for purposes of IC 16-21-10-13.3:(1) At least eighty-seven percent (87%) of the funds must be used to fund payment for health care services.(2) An amount determined by the office of the secretary to fund:(A) administrative costs of; and(B) any profit made by;a managed care organization under a contract with the office to provide health coverage under the plan. The amount determined under this subdivision may not exceed thirteen percent (13%) of the funds.As added by P.L.213-2015, SEC.136. Amended by P.L.152-2017, SEC.35.
IN Code § 12-15-44.5-9 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-9. Rules

Sec. 9. (a) The office may adopt rules under IC 4-22-2 necessary to implement:(1) this chapter; or(2) a Section 1115 Medicaid demonstration waiver concerning the plan that is approved by the United States Department of Health and Human Services.(b) The office may adopt emergency rules under IC 4-22-2-37.1 to implement the plan on an emergency basis.(c) An emergency rule or an amendment to an emergency rule adopted under this section expires not later than the earlier of:(1) one (1) year after the rule is accepted for filing under IC 4-22-2-37.1(e); or(2) July 1, 2016.As added by P.L.213-2015, SEC.136.
IN Code § 12-15-44.5-10 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-10. Benefits for Adult Group; Negotiation of Plan Limitations

Sec. 10. (a) The secretary has the authority to provide benefits to individuals eligible under the adult group described in 42 CFR 435.119 only in accordance with this chapter.(b) The secretary may negotiate and make changes to the plan, except that the secretary may not negotiate or change the plan that would do the following:(1) Reduce the following:(A) Contribution amounts below the minimum levels set forth in section 4.7 of this chapter.(B) Deductible amounts below the minimum amount established in section 4.5(c) of this chapter.(2) Remove or reduce the penalties for nonpayment set forth in section 4.7 of this chapter.(3) Revise the use of the health care account requirement set forth in section 4.5 of this chapter.(4) Include noncommercial benefits or add additional plan benefits in a manner inconsistent with section 3.5 of this chapter.(5) Allow services to begin:(A) without the payment established or required by; or(B) earlier than the time frames otherwise established by;section 4.7 of this chapter.(6) Reduce financial penalties for the inappropriate use of the emergency room below the minimum levels set forth in section 5.7 of this chapter.(7) Permit members to change health plans without cause in a manner inconsistent with section 4.7(g) of this chapter.(8) 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.(c) The secretary may make changes to the plan under this chapter if the changes are required by federal law or regulation.As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.35.
IN Code § 12-16-1-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 1. Medical Services for Inmates and Patients|12-16-1-1. "Affected Agency" Defined

Sec. 1. As used in this chapter, "affected agency" means any of the following:(1) The department of correction.(2) The state department of health.(3) The division of mental health and addiction.(4) The division of disability and rehabilitative services.[Pre-1992 Revision Citation: 12-5-7-1 part.]As added by P.L.2-1992, SEC.10. Amended by P.L.40-1994, SEC.22; P.L.215-2001, SEC.46; P.L.141-2006, SEC.56.
IN Code § 12-16-1-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 1. Medical Services for Inmates and Patients|12-16-1-2. "Covered Medical Services" Defined

Sec. 2. As used in this chapter, "covered medical services" refers to medical services that meet the following qualifications:(1) Cost more than one hundred fifty dollars ($150).(2) Are provided to a committed individual or patient of an institution under the jurisdiction of an affected agency.(3) Are provided outside of an institution under the jurisdiction of an affected agency.[Pre-1992 Revision Citation: 12-5-7-1 part; 12-5-7-2.]As added by P.L.2-1992, SEC.10.
IN Code § 12-16-1-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 1. Medical Services for Inmates and Patients|12-16-1-3. Rules; Adoption; Requisites

Sec. 3. (a) The division shall, with the advice of the division's medical staff, representatives of affected agencies, and other individuals selected by the director of the division, adopt rules under IC 4-22-2 to do the following:(1) Provide for prior review and approval of covered medical services, including special review and approval procedures for emergency covered medical services.(2) Establish limitations consistent with medical necessity on the duration of services to be provided.(3) Specify the amount of and method for reimbursement for services.(4) Specify the conditions under which payments will be denied and improper payments will be recovered.(b) To the extent possible, rules adopted under this section must be consistent with Title XIX of the federal Social Security Act and with IC 12-15-21-2 and IC 12-15-21-3.[Pre-1992 Revision Citation: 12-5-7-4.]As added by P.L.2-1992, SEC.10.
IN Code § 12-16-1-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 1. Medical Services for Inmates and Patients|12-16-1-4. Contract for Services; Same Contractor Requirement

Sec. 4. (a) The division shall contract with the same contractor with which the office contracts under IC 12-15-30 to provide administrative and fiscal services to implement this chapter.(b) A contract for services is not subject to IC 5-22.[Pre-1992 Revision Citation: 12-5-7-5.]As added by P.L.2-1992, SEC.10. Amended by P.L.49-1997, SEC.45.
IN Code § 12-16-1-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 1. Medical Services for Inmates and Patients|12-16-1-5. Payment for Covered Medical Services; Requirements

Sec. 5. Payment for covered medical services approved by the fiscal agent shall be paid:(1) from money for the Medicaid program if the requirements of IC 12-15 are met; or(2) if a payment cannot be made under subdivision (1), from a state appropriation either made for an affected agency or for covered medical services for all affected agencies.[Pre-1992 Revision Citation: 12-5-7-6.]As added by P.L.2-1992, SEC.10.
IN Code § 12-16-2.5-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions|12-16-2.5-1. Administration of Program

Sec. 1. The division shall administer the hospital care for the indigent program under this article.As added by P.L.120-2002, SEC.18.
IN Code § 12-16-2.5-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions|12-16-2.5-4. Disproportionate Share of Low Income Patients; Calculating Allowable Disproportionate Share Additional Payments

Sec. 4. To the extent permitted under federal statutes or regulations, patient days for patients under the hospital care for the indigent program shall be included in calculating allowable disproportionate share additional payments under 42 U.S.C. 1395 ww(d).As added by P.L.120-2002, SEC.18.
IN Code § 12-16-2.5-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions|12-16-2.5-5. Program Not Applicable to Inmates and Patients of Certain Institutions

Sec. 5. The hospital care for the indigent program does not apply to inmates and patients of institutions of the department of correction, the state department of health, the division of mental health and addiction, the division of aging, or the division of disability and rehabilitative services.As added by P.L.120-2002, SEC.18. Amended by P.L.141-2006, SEC.57.
IN Code § 12-16-2.5-6.3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions|12-16-2.5-6.3. Definitions

Sec. 6.3. For purposes of this article, the following definitions apply to the hospital care for the indigent program:(1) "Assistance" means the satisfaction of a person's financial obligation under IC 12-16-7.5-1.2 for hospital items or services, physician services, or transportation services provided to the person.(2) "Claim" means a statement filed with the division by a hospital, physician, or transportation provider that identifies the health care items or services the hospital, physician, or transportation provider rendered to a person for whom an application under IC 12-16-4.5 has been filed with the division.(3) "Eligible" or "eligibility", when used in regard to a person for whom an application under IC 12-16-4.5 has been filed with the division, means the extent to which:(A) the person, for purposes of the application, satisfies the income and resource standards established under IC 12-16-3.5; and(B) the person's medical condition, for purposes of the application, satisfies one (1) or more of the medical conditions identified in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3).As added by P.L.145-2005, SEC.3.
IN Code § 12-16-3.5-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 3.5. Hospital Care for the Indigent; Eligibility for Assistance|12-16-3.5-1. Resident Eligibility; Emergency Care; Conditions

Sec. 1. (a) An Indiana resident who meets the income and resource standards established by the division under section 3 of this chapter is eligible for assistance to satisfy the resident's financial obligation for care provided to the resident in a hospital in Indiana that was necessitated after the onset of a medical condition that was manifested by symptoms of sufficient severity that the absence of immediate medical attention would probably result in any of the following:(1) Placing the individual's life in jeopardy.(2) Serious impairment to bodily functions.(3) Serious dysfunction of a bodily organ or part.(b) A qualified resident is also eligible for assistance to satisfy the resident's financial obligation for the care that is a direct consequence of the medical condition that necessitated the emergency care.As added by P.L.120-2002, SEC.19. Amended by P.L.145-2005, SEC.5.
IN Code § 12-16-3.5-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 3.5. Hospital Care for the Indigent; Eligibility for Assistance|12-16-3.5-2. Nonresident Eligibility; Emergency Care; Conditions; Qualifications

Sec. 2. (a) An individual who is not an Indiana resident is eligible for assistance to satisfy the individual's financial obligation for the care provided to the individual in a hospital in Indiana that was necessitated after the onset of a medical condition that was manifested by symptoms of sufficient severity that the absence of immediate medical attention would probably result in any of the following:(1) Placing the individual's life in jeopardy.(2) Serious impairment to bodily functions.(3) Serious dysfunction of any bodily organ or part.(b) An individual is eligible for assistance under subsection (a) only if the following qualifications exist:(1) The individual meets the income and resource standards established by the division under section 3 of this chapter.(2) The onset of the medical condition that necessitated medical attention occurred in Indiana.As added by P.L.120-2002, SEC.19. Amended by P.L.145-2005, SEC.6.
IN Code § 12-16-3.5-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 3.5. Hospital Care for the Indigent; Eligibility for Assistance|12-16-3.5-3. Rules Establishing Income and Resource Eligibility Standards; Adoption; Conditions

Sec. 3. (a) The division shall adopt rules under IC 4-22-2 to establish income and resource eligibility standards for patients whose care is to be paid under the hospital care for the indigent program.(b) To the extent possible and subject to this article, rules adopted under this section must meet the following conditions:(1) Be consistent with IC 12-15-21-2 and IC 12-15-21-3.(2) Be adjusted at least one (1) time every two (2) years.(c) The income and eligibility standards established under this section do not include any spend down provisions available under IC 12-15-21-2 or IC 12-15-21-3.(d) In addition to the conditions imposed under subsection (b), rules adopted under this section must exclude a Holocaust victim's settlement payment received by an eligible individual from the income and eligibility standards for patients whose care is to be paid for under the hospital care for the indigent program.As added by P.L.120-2002, SEC.19. Amended by P.L.145-2005, SEC.7.
IN Code § 12-16-3.5-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 3.5. Hospital Care for the Indigent; Eligibility for Assistance|12-16-3.5-4. Statement of Eligibility and Benefit Standards; Requirement

Sec. 4. A provider may provide a patient, and if the patient is not able to understand the statement, the patient's representative, with a statement of the eligibility and benefit standards adopted by the division if at least one (1) of the following occurs:(1) The provider has reason to believe that the patient may be indigent.(2) The patient requests a statement of the standards.As added by P.L.120-2002, SEC.19. Amended by P.L.212-2007, SEC.12; P.L.218-2007, SEC.23.
IN Code § 12-16-4.5-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 4.5. Hospital Care for the Indigent; Application for Assistance|12-16-4.5-2. Time Period for Provider Filing Application

Sec. 2. A provider must file the application with the division not more than forty-five (45) days after the person has been released or discharged from the hospital, unless the person is medically unable and the next of kin or legal representative is unavailable.As added by P.L.120-2002, SEC.20. Amended by P.L.255-2003, SEC.26; P.L.145-2005, SEC.9; P.L.212-2007, SEC.14; P.L.218-2007, SEC.25.
IN Code § 12-16-4.5-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 4.5. Hospital Care for the Indigent; Application for Assistance|12-16-4.5-3. Rules

Sec. 3. Subject to this article, the division shall adopt rules under IC 4-22-2 prescribing the following:(1) The form of an application.(2) The establishment of procedures for applications.(3) The time for submitting and processing claims.As added by P.L.120-2002, SEC.20. Amended by P.L.145-2005, SEC.10.
IN Code § 12-16-4.5-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 4.5. Hospital Care for the Indigent; Application for Assistance|12-16-4.5-5. Assistance in Preparing Application

Sec. 5. A hospital or an attending physician may assist the patient in the preparation of an application for assistance under the hospital care for the indigent program.As added by P.L.120-2002, SEC.20.
IN Code § 12-16-4.5-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 4.5. Hospital Care for the Indigent; Application for Assistance|12-16-4.5-6. Civil or Criminal Liability Arising From Assistance in Preparation of Application; Immunity

Sec. 6. A person who in good faith provides assistance in the completion of an application under this chapter is immune from civil or criminal liability arising from the assistance.As added by P.L.120-2002, SEC.20.
IN Code § 12-16-4.5-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 4.5. Hospital Care for the Indigent; Application for Assistance|12-16-4.5-7. Signing of Application; Requirements

Sec. 7. (a) A patient must sign an application if the patient is medically able to sign.(b) If a patient is medically unable to sign an application, the patient's next of kin or a legal representative, if available, may sign the application.(c) If no person under subsections (a) and (b) is able to sign the application to file a timely application, a provider's representative may sign the application instead of the patient.As added by P.L.120-2002, SEC.20. Amended by P.L.212-2007, SEC.15; P.L.218-2007, SEC.26.
IN Code § 12-16-4.5-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 4.5. Hospital Care for the Indigent; Application for Assistance|12-16-4.5-8. Filing Application by Patient or Patient's Representative

Sec. 8. (a) A person or a person's representative may file an application directly with the division if the application is filed not more than forty-five (45) days after the person has been released or discharged from the hospital.(b) Reimbursement for the costs incurred in providing care to an eligible person may only be made to the providers of the care.As added by P.L.120-2002, SEC.20. Amended by P.L.255-2003, SEC.27; P.L.145-2005, SEC.11.
IN Code § 12-16-4.5-8.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 4.5. Hospital Care for the Indigent; Application for Assistance|12-16-4.5-8.5. Provider Claim Filing Deadline

Sec. 8.5. A claim for services must be filed with the division not more than one hundred eighty (180) days after the person who received the care has been released or discharged from the hospital. For good cause as determined by the division, this one hundred eighty (180) day limit may be extended or waived for a claim.As added by P.L.145-2005, SEC.12. Amended by P.L.212-2007, SEC.16; P.L.218-2007, SEC.27.
IN Code § 12-16-5.5-1.2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations|12-16-5.5-1.2. Prompt Review of Claim; Calculation of Claim

Sec. 1.2. (a) The division shall, upon receipt of a claim pertaining to a person:(1) who was provided care by an eligible provider; and(2) whose medical condition satisfies one (1) or more of the medical conditions identified in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3);promptly review the claim to determine if the health care items or services identified in the claim were necessitated by the person's medical condition or, if applicable, if the items or services were a direct consequence of the person's medical condition.(b) In conducting the review of a claim referenced in subsection (a), the division shall calculate the amount of the claim. For purposes of this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, and IC 12-16-7.5, the amount of a claim shall be calculated in a manner described in IC 12-16-7.5-2.5(c).As added by P.L.145-2005, SEC.14. Amended by P.L.212-2007, SEC.18; P.L.218-2007, SEC.29.
IN Code § 12-16-5.5-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations|12-16-5.5-2. Disclosure of Information by Provider; Immunity

Sec. 2. (a) The provider of medical care to a patient shall provide information the provider has that would assist in the verification of indigency of a patient.(b) A provider that provides information under subsection (a) is immune from civil and criminal liability for divulging the information.As added by P.L.120-2002, SEC.21. Amended by P.L.212-2007, SEC.19; P.L.218-2007, SEC.30.
IN Code § 12-16-5.5-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations|12-16-5.5-3. Denial of Eligibility Claim; Notice; Eligibility Information

Sec. 3. (a) Subject to subsection (b) and IC 12-16-6.5-1.5, if the division is unable after prompt and diligent efforts to verify information contained in the application that is reasonably necessary to determine eligibility, the division may deny assistance under the hospital care for the indigent program. The pending expiration of the period specified in IC 12-16-6.5-1.5 is not a valid reason for denying a person's eligibility for the hospital care for the indigent program.(b) Before denying assistance under the hospital care for the indigent program, the division must provide the person and the provider who submitted a claim under IC 12-16-4.5-8.5 written notice of:(1) the specific information or verification needed to determine eligibility;(2) the specific efforts undertaken to obtain the information or verification; and(3) the statute or rule requiring the information or verification identified under subdivision (1).(c) The division must provide the provider who submitted a claim under IC 12-16-4.5-8.5 a period of time, not less than ten (10) days beyond the deadline established under IC 12-16-6.5-1.5, to submit to the division information concerning the person's eligibility. If the division does not make a determination of the person's eligibility within ten (10) days after receiving the information under this subsection, the person is eligible without the division's determination of the person's eligibility for the hospital care for the indigent care program under this article.As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003, SEC.29; P.L.145-2005, SEC.15; P.L.212-2007, SEC.20; P.L.218-2007, SEC.31.
IN Code § 12-16-5.5-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations|12-16-5.5-4. Notification to Person and Provider; Requirements

Sec. 4. The division shall notify in writing the person and the provider of the following:(1) A decision concerning eligibility.(2) The reasons for a denial of eligibility.(3) That either party has the right to appeal the decision.As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003, SEC.30; P.L.212-2007, SEC.21; P.L.218-2007, SEC.32.
IN Code § 12-16-6.5-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 16. Payment for Health Services Other Than Medicaid|Chapter 6.5. Hospital Care for the Indigent; Denial of Eligibility; Appeals; Judicial Review|12-16-6.5-1. Ineligibility Determination; Appeal to Division

Sec. 1. If the division determines that a person is not eligible for assistance for services, an affected person, or provider may appeal to the division not later than ninety (90) days after the mailing of notice of that determination to the affected person or provider to the last known address of the person or provider.As added by P.L.120-2002, SEC.22. Amended by P.L.255-2003, SEC.31; P.L.145-2005, SEC.17; P.L.212-2007, SEC.22; P.L.218-2007, SEC.33.