reglab/housing_qa huggingface dataset:
IN Code § 12-15-20.7-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 20.7. Payment Schedule|12-15-20.7-1. Definitions

Sec. 1. As used in this chapter:(1) "Medicaid inpatient payments for safety-net hospitals" means the payments provided for in the Medicaid state plan for inpatient services provided by hospitals that satisfy the definition of a safety-net hospital under the Medicaid state plan; and(2) "Medicaid outpatient payments for safety-net hospitals" means the payments provided for in the Medicaid state plan for outpatient services provided by hospitals that satisfy the definition of a safety-net hospital under the Medicaid state plan.As added by P.L.255-2003, SEC.23.
IN Code § 12-15-20.7-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 20.7. Payment Schedule|12-15-20.7-2. Order of Payments

Sec. 2. (a) This section does not apply during the period that the office is assessing a hospital fee authorized by IC 16-21-10. For each state fiscal year ending before July 1, 2005, and subject to section 3 of this chapter (repealed), the office shall make the payments identified in this section in the following order:(1) First, payments under IC 12-15-15-9 and IC 12-15-15-9.5.(2) Second, payments under clauses (A) and (B) of STEP FIVE of IC 12-15-15-1.5(b).(3) Third, Medicaid inpatient payments for safety-net hospitals and Medicaid outpatient payments for safety-net hospitals.(4) Fourth, payments under IC 12-15-15-1.1 and IC 12-15-15-1.3.(5) Fifth, payments under IC 12-15-19-8 for municipal disproportionate share hospitals.(6) Sixth, payments under IC 12-15-19-2.1 for disproportionate share hospitals.(7) Seventh, payments under clause (C) of STEP FIVE of IC 12-15-15-1.5(b).(b) For each state fiscal year ending after June 30, 2007, the office shall make the payments for the programs identified in IC 12-15-20-2(8)(G) in the order of priority that best utilizes available non-federal share, Medicaid supplemental payments, and Medicaid disproportionate share payments, and may change the order or priority at any time as necessary for the proper administration of one (1) or more of the payment programs listed in IC 12-15-20-2(8)(G).As added by P.L.255-2003, SEC.23. Amended by P.L.212-2007, SEC.11; P.L.218-2007, SEC.21; P.L.229-2011, SEC.141; P.L.6-2012, SEC.92; P.L.205-2013, SEC.204.
IN Code § 12-15-21-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 21. Rules|12-15-21-1. Acceptance by Provider of Medicaid Claim Payment; Agreement to Comply With Statutes and Rules

Sec. 1. A provider who accepts payment of a claim submitted under the Medicaid program is considered to have agreed to comply with the statutes and rules governing the program.[Pre-1992 Revision Citation: 12-1-7-15.7(a).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-21-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 21. Rules|12-15-21-2. Secretary to Adopt Rules; Consistency With Title Xix of Social Security Act

Sec. 2. The secretary shall, with the advice of the office's medical staff, adopt rules under IC 4-22-2 and consistent with Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.) and regulations promulgated under the federal Social Security Act.[Pre-1992 Revision Citation: 12-1-7-15.7(b) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-21-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 21. Rules|12-15-21-4. Rules Not to Eliminate Type of Provider Licensed to Provide Services

Sec. 4. The rules adopted by the secretary may not eliminate a type of provider licensed to provide Medicaid services.[Pre-1992 Revision Citation: 12-1-7-14.7 part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-21-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 21. Rules|12-15-21-5. Rules Not to Be More Restrictive Than Federal Medicaid Reimbursement Requirements

Sec. 5. (a) As used in this section, "facility" refers to an intermediate care facility for individuals with intellectual disabilities (ICF/IID) not operated by a state agency.(b) The rules adopted by the secretary may not establish eligibility criteria for Medicaid reimbursement for placement or services in a facility, including services provided under a Medicaid waiver, that are more restrictive than federal requirements for Medicaid reimbursement in a facility or under a Medicaid waiver.(c) The office may not implement a policy that may not be adopted as a rule under subsection (b).As added by P.L.78-1994, SEC.2. Amended by P.L.272-1999, SEC.41; P.L.35-2016, SEC.41.
IN Code § 12-15-21-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 21. Rules|12-15-21-6. Amendment of Prior Authorization Rule

Sec. 6. (a) IC 4-22-2 does not apply to a rulemaking procedure under this section.(b) The office may amend a rule regarding prior authorization (as defined in 405 IAC 1-6-2) that appears in the Indiana Administrative Code on January 1, 1996, to make the prior authorization rule less restrictive.(c) If the office amends a prior authorization rule under this section, the office may later amend the prior authorization rule to restore, in whole or in part, the prior authorization rule as it was in effect on January 1, 1996.(d) An amendment to a prior authorization rule under this section must comply with the notice requirements set forth in IC 12-15-13-6.As added by P.L.107-1996, SEC.11.
IN Code § 12-15-21-6.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 21. Rules|12-15-21-6.5. Family Practice Residency Program

Sec. 6.5. A family practice residency program may choose to have the name of the residency program, the primary medical provider, or both, appear on the Medicaid identification card of a recipient who is enrolled in a Medicaid managed care program instead of just the name of the individual primary medical provider in the residency program to whom the recipient has been assigned.As added by P.L.107-1996, SEC.12 and P.L.257-1996, SEC.11.
IN Code § 12-15-21-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 21. Rules|12-15-21-7. Rules Not to Be More Stringent Than Prior Authorization Rule Effective January 1, 1996

Sec. 7. The office may not amend a prior authorization rule to make it more stringent than the prior authorization rule as it was in effect on January 1, 1996, unless the office changes the rule through the rulemaking process.As added by P.L.107-1996, SEC.13.
IN Code § 12-15-22-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-1. Sanctions for Violations

Sec. 1. If after investigation the office determines that a provider has violated a Medicaid statute or rule adopted under a Medicaid statute, the office may impose at least one (1) of the following sanctions:(1) Denial of payment to the provider for Medicaid services provided during a specified time.(2) Rejection of a prospective provider's application for participation in the Medicaid program.(3) Termination of a provider agreement permitting a provider's participation in the Medicaid program.(4) Assessment of a civil penalty against the provider in an amount not to exceed three (3) times the amount paid to the provider in excess of the amount that was legally due.(5) Assessment of an interest charge, at a rate not to exceed the rate established by IC 24-4.6-1-101(2) for judgments on money, on the amount paid to the provider in excess of the amount that was legally due. The interest charge accrues from the date of the overpayment to the provider.(6) Exclusion from the Medicaid program for a period of time consistent with 42 U.S.C. 1320a-7 et seq.[Pre-1992 Revision Citation: 12-1-7-15.3(a).]As added by P.L.2-1992, SEC.9. Amended by P.L.195-2018, SEC.6.
IN Code § 12-15-22-1.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-1.5. Ineligibility After Conviction

Sec. 1.5. In addition to any sanction imposed on a provider under section 1 of this chapter, a provider convicted of an offense under IC 35-43-5 for fraud relating to Medicaid is ineligible to participate in the Medicaid program for ten (10) years after the conviction.As added by P.L.46-1995, SEC.40. Amended by P.L.174-2021, SEC.10.
IN Code § 12-15-22-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-2. Administrative Appeals; Rules

Sec. 2. A provider may appeal a sanction under section 1 of this chapter under rules concerning appeal that are adopted by the secretary under IC 4-22-2.[Pre-1992 Revision Citation: 12-1-7-15.3(b) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-22-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-3. Judicial Review

Sec. 3. After exhausting all administrative remedies, a provider may obtain judicial review of a sanction under IC 4-21.5-5.[Pre-1992 Revision Citation: 12-1-7-15.3(b) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-22-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-4. Denial of Payment or Termination of Provider Agreement; Obligation of Provider to Inform Individual Services Recipients

Sec. 4. A final directive made by the office that:(1) denies payment to a provider for medical services provided during a specified period of time; or(2) terminates a provider agreement permitting a provider's participation in the Medicaid program;must direct the provider to inform each eligible individual recipient of services, before services are provided, that the office or the office's contractor under IC 12-15-30 will not pay for those services if provided.[Pre-1992 Revision Citation: 12-1-7-15.3(c).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-22-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-5. Denial of Payment, Rejection of Participation Application or Provider Agreement Termination; Time to Correct Deficiencies

Sec. 5. Subject to section 6 of this chapter, a final directive:(1) denying payment to a provider;(2) rejecting a prospective provider's application for participation in the Medicaid program; or(3) terminating a provider agreement permitting a provider's participation in the Medicaid program;must be for a sufficient time, in the opinion of the administrator, to allow for the correction of all deficiencies or to prevent further abuses.[Pre-1992 Revision Citation: 12-1-7-15.3(d) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-22-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-6. Eligibility; Repayment of Excess Payments; Payment of Penalties

Sec. 6. A provider may not be declared to be eligible until the office has received the following:(1) Full repayment of the amount paid to the provider in excess of the proper and legal amount due, including any interest charge assessed by the office.(2) Full payment of a civil penalty assessed under section 1(4) of this chapter.[Pre-1992 Revision Citation: 12-1-7-15.3(d) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-22-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-7. Provider Subjected to Sanction; Agreement as Provided in Ic 12-15-11

Sec. 7. Except as provided in section 8 of this chapter, a provider who has been subjected to a sanction under section 1 of this chapter may file an agreement as provided in IC 12-15-11.[Pre-1992 Revision Citation: 12-1-7-15.5(a).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-22-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 22. Provider Sanctions|12-15-22-8. Eligibility to Submit Medicaid Claims; Criminal Convictions; Repeated Imposition of Sanctions

Sec. 8. A provider who:(1) has been convicted of a crime relating to the provision of services under this chapter; or(2) has been subjected to a sanction under section 1 of this chapter on three (3) separate occasions by directive of the administrator;is ineligible to submit claims for Medicaid.[Pre-1992 Revision Citation: 12-1-7-15.5(b).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-23-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-1. Reasonable Grounds to Suspect That Provider Has Received Payments to Which It Is Not Entitled; Certification of Evidence to Medicaid Fraud Control Unit; Exception

Sec. 1. Except as provided in section 2 of this chapter, if the administrator of the office determines that there are reasonable grounds to suspect that a provider has received payments that the provider is not entitled to under Medicaid, the administrator shall certify the evidence of the suspected activity to the state Medicaid fraud control unit established under IC 4-6-10.[Pre-1992 Revision Citation: 12-1-7-15.8.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-23-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-2. Agreement for Overpayment to Be Deducted From Subsequent Payments; Authorization

Sec. 2. (a) If the office of the secretary of family and social services or administrator of the office determines that a provider has received payments the provider is not entitled to, the administrator may enter into an agreement with the provider stating that the amount of the overpayment shall be deducted from subsequent payments to the provider.(b) If the office of the secretary of family and social services or the administrator of the office and the provider cannot come to an agreement within sixty (60) days after it is determined that a provider has received payments that the provider is not entitled to, the administrator may recoup the amount of overpayment to the provider claimed by the state from subsequent payments to the provider.[Pre-1992 Revision Citation: 12-1-7-15.9(a) part.]As added by P.L.2-1992, SEC.9. Amended by P.L.229-2011, SEC.142.
IN Code § 12-15-23-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-3. Agreements to Deduct Overpayments From Subsequent Payments; Interest Provisions; Other Provisions

Sec. 3. An agreement under section 2 of this chapter:(1) must include a provision for the collection of any interest due from the provider on the amount of the overpayment; and(2) may include any other provisions agreed to by the administrator and the provider.[Pre-1992 Revision Citation: 12-1-7-15.9(a) part.]As added by P.L.2-1992, SEC.9. Amended by P.L.8-2005, SEC.3.
IN Code § 12-15-23-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-4. Rules

Sec. 4. The secretary may adopt rules under IC 4-22-2 that provide procedures for the calculation of overpayments under this chapter.[Pre-1992 Revision Citation: 12-1-7-15.9(a) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-23-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-5. Discovery of Overpayment; Time for Entering Into Agreement; Certification of Facts to Medicaid Fraud Control Unit

Sec. 5. If the administrator and a provider fail to enter into an agreement not more than sixty (60) days after the administrator's discovery of an overpayment, the administrator shall immediately certify the facts of the case to the Medicaid fraud control unit established under IC 4-6-10.[Pre-1992 Revision Citation: 12-1-7-15.9(a) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-23-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-6. Determination by Medicaid Fraud Control Unit; Certification of Facts to Prosecuting Attorney; Reference of Matter to Attorney General

Sec. 6. (a) If the state Medicaid fraud control unit determines that an action based on the state Medicaid fraud control unit's investigations under the unit's authority under IC 4-6-10-1.5 is meritorious, the unit shall certify the facts drawn from the investigation to the prosecuting attorney of the judicial circuit in which the crime may have been committed.(b) The state Medicaid fraud control unit shall assist the prosecuting attorney in prosecuting an action under this section.(c) A prosecuting attorney to whom facts are certified under subsection (a) may refer the matter to the attorney general.(d) If a matter has been referred to the attorney general under subsection (c), the attorney general may:(1) file an information in a court with jurisdiction over the matter in the county in which the offense is alleged to have been committed; and(2) prosecute the alleged offense.[Pre-1992 Revision Citation: 12-1-7-15.9(b).]As added by P.L.2-1992, SEC.9. Amended by P.L.10-1994, SEC.5; P.L.73-2003, SEC.3; P.L.149-2006, SEC.1.
IN Code § 12-15-23-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-7. Action by Attorney General; Reference to Administrator

Sec. 7. The attorney general may do either of the following:(1) Bring a civil action upon the facts certified to the attorney general by the state Medicaid fraud control unit.(2) Refer the matter to the administrator for appropriate action under IC 12-15-22.[Pre-1992 Revision Citation: 12-1-7-15.9(c).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-23-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-8. Civil Action; Finding in Favor of Attorney General; Treble Damages; Civil Penalties; Reimbursement of Investigation Costs

Sec. 8. (a) Subject to subsection (b), if the court finds in favor of the attorney general in a civil action brought by the attorney general under section 7 of this chapter, the court may do the following:(1) Award damages against the provider of not more than three (3) times the amount paid to the provider in excess of the amount that was legally due.(2) Assess a civil penalty against the provider of not more than five hundred dollars ($500) for each instance of overpayment found by the court.(3) Order the provider to reimburse the attorney general for the reasonable costs of the attorney general's investigation and enforcement action.(4) Take any combination of the actions described in subdivisions (1), (2), and (3).(b) The court may only take action under subsection (a)(2) and (a)(3) if the provider knew or had reason to know that an item or a service was not provided as claimed.[Pre-1992 Revision Citation: 12-1-7-15.9(d).]As added by P.L.2-1992, SEC.9. Amended by P.L.73-2003, SEC.4.
IN Code § 12-15-23-9 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-9. Meritorious Action; Money Recoverable Exceeding Cost of Action

Sec. 9. In determining whether an action is meritorious, the attorney general may consider whether the amount of money recoverable under the action would exceed the cost of the action.[Pre-1992 Revision Citation: 12-1-7-15.9(e) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-23-10 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23. Improper Payments|12-15-23-10. Action by Attorney General; Compromise

Sec. 10. An action brought under section 7 of this chapter may be compromised in the manner prescribed by IC 4-6-2-11.[Pre-1992 Revision Citation: 12-1-7-15.9(e) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-23.5-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23.5. Coordination of Benefits Study|12-15-23.5-1. "Covered Entity"

Sec. 1. As used in this chapter, "covered entity" has the meaning set forth in 45 CFR 160.103.As added by P.L.187-2007, SEC.3.
IN Code § 12-15-23.5-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23.5. Coordination of Benefits Study|12-15-23.5-2. Examination and Recovery of Medicaid Claims

Sec. 2. (a) Before January 1, 2008, the office shall:(1) examine all Medicaid claims paid after January 1, 2001, and before July 1, 2007;(2) determine which claims examined under subdivision (1) were eligible for payment by a third party other than Medicaid; and(3) recover the claims that were determined under subdivision (2) to be eligible for payment by a third party other than Medicaid.(b) The office shall require through an eligibility and benefit request, and a covered entity shall provide, any information necessary for the office to complete the examination required by this section. The office, after notice and hearing, may impose a fine not to exceed one thousand dollars ($1,000) for each refusal by a covered entity to provide information concerning an eligibility and benefit request for a Medicaid recipient requested by the office under this section.As added by P.L.187-2007, SEC.3.
IN Code § 12-15-23.5-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23.5. Coordination of Benefits Study|12-15-23.5-3. Coordination of Benefits Procedures

Sec. 3. If at least one percent (1%) of the claims were determined under section 2 of this chapter to be eligible for payment by a third party other than Medicaid, the office shall develop and implement a procedure to improve the coordination of benefits between:(1) the Medicaid program; and(2) any other third party source of health care coverage provided to a recipient.As added by P.L.187-2007, SEC.3.
IN Code § 12-15-23.5-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 23.5. Coordination of Benefits Study|12-15-23.5-4. Procedure Requirements

Sec. 4. If a procedure is developed and implemented under section 3 of this chapter, the procedure:(1) must be automated; and(2) must provide a system for determining whether a Medicaid claim is eligible for payment by another third party before the claim is paid under the Medicaid program.As added by P.L.187-2007, SEC.3.
IN Code § 12-15-24-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 24. Theft; Kickbacks and Bribes|12-15-24-1. Intent to Deprive State of Money or Benefits; Prima Facie Evidence for Purposes of Ic 35-43-4-2

Sec. 1. Evidence that a person or provider received money or other benefits as a result of a violation of:(1) a provision of this article; or(2) a rule established by the secretary under this article;constitutes prima facie evidence, for purposes of IC 35-43-4-2, that the person or provider intended to deprive the state of a part of the value of the money or benefits.[Pre-1992 Revision Citation: 12-1-7-27.9.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-24-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 24. Theft; Kickbacks and Bribes|12-15-24-2. Soliciting, Offering, or Receiving Kickbacks, Bribes, or Fee or Charge Rebates; Classification of Violation

Sec. 2. A person who furnishes items or services to an individual for which payment is or may be made under this chapter and who solicits, offers, or receives a:(1) kickback or bribe in connection with the furnishing of the items or services or the making or receipt of the payment; or(2) rebate of a fee or charge for referring the individual to another person for the furnishing of items or services;commits a Class A misdemeanor.[Pre-1992 Revision Citation: 12-1-7-28.2.]As added by P.L.2-1992, SEC.9.