reglab/housing_qa huggingface dataset:
IN Code § 12-15-12-10 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-10. Selection or Assignment of Managed Care Provider; Selection of New Provider; Exception

Sec. 10. (a) A Medicaid recipient who has selected or been assigned a managed care provider under this chapter may not select a new managed care provider for twelve (12) months after the managed care provider was selected or assigned.(b) The office may make an exception to the requirement under subsection (a) if the office determines that circumstances warrant a change.[Pre-1992 Revision Citation: 12-1-7-16.1(i).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-11 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-11. Waiver From Department of Health and Human Services; Implementation of Chapter

Sec. 11. The office shall seek the necessary waiver under 42 U.S.C. 1396n(b)(1) from the United States Department of Health and Human Services to implement this chapter.[Pre-1992 Revision Citation: 12-1-7-16.1(j).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-12 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-12. Payments to Providers

Sec. 12. For a managed care program or demonstration project established or authorized by the office, or established or authorized by another entity or agency working in conjunction with or under agreement with the office, the office must provide for payment to providers in the managed care program that the office finds is reasonable and adequate to meet the costs that must be incurred by efficiently and economically operated providers in order to:(1) provide care and services in conformity with applicable state and federal laws, regulations, and quality and safety standards; and(2) ensure that individuals eligible for medical assistance under the managed care program or demonstration project have reasonable access (taking into account geographic location and reasonable travel time) to the services provided by the managed care program.As added by P.L.93-1995, SEC.3.
IN Code § 12-15-12-13 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-13. Permitted Forms

Sec. 13. (a) The office and an entity with which the office contracts for the payment of claims shall accept claims submitted on any of the following forms by an individual or organization that is a contractor or subcontractor of the office:(1) CMS-1500.(2) CMS-1450 (UB-04).(3) American Dental Association (ADA) claim form.(4) Pharmacy and compound drug form.(b) The office and an entity with which the office contracts for the payment of claims:(1) may designate as acceptable claim forms other than a form listed in subsection (a); and(2) may not mandate the use of a crossover claim form.As added by P.L.256-2001, SEC.2. Amended by P.L.208-2018, SEC.3.
IN Code § 12-15-12-15 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-15. Coverage for Emergency Services

Sec. 15. A managed care organization shall:(1) cover and pay for all medically necessary screening services provided to an individual who presents to an emergency department with an emergency medical condition; and(2) beginning July 1, 2001, neither deny nor fail to process a claim for reimbursement for emergency services on the basis that the enrollee's primary care provider's authorization code for the services was not obtained before or after the services were rendered.As added by P.L.223-2001, SEC.7. Amended by P.L.152-2017, SEC.15.
IN Code § 12-15-12-18 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-18. Payment for Emergency Services

Sec. 18. (a) Except as provided in subsection (b), this section applies to:(1) emergency services provided to an individual enrolled in a Medicaid risk based managed care program; and(2) medically necessary screening services provided to an individual enrolled in a Medicaid risk based managed care program;who presents to an emergency department with an emergency medical condition.(b) This section does not apply to emergency services or screening services provided to an individual enrolled in a Medicaid risk based managed care program by a provider who has contracted with the individual's managed care organization to provide emergency services to the individual.(c) Payment for emergency services and medically necessary screening services in the emergency department of a hospital licensed under IC 16-21 must be in an amount equal to one hundred percent (100%) of the current Medicaid fee for service reimbursement rates for such services.(d) Payment under subsection (c) is the responsibility of the enrollee's managed care organization. This subsection does not prohibit the managed care organization from entering into a subcontract with another managed care organization providing for the latter managed care organization to assume financial responsibility for making the payments required under this section.(e) This section does not limit the ability of the managed care organization to:(1) review; and(2) make a determination of;the medical necessity of the services provided in a hospital's emergency department for purposes of determining coverage for such services.As added by P.L.223-2001, SEC.9. Amended by P.L.152-2017, SEC.17.
IN Code § 12-15-12-20 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-20. Child Lead Poisoning Screening

Sec. 20. The office shall develop the following:(1) A measure to evaluate the performance of a managed care organization in screening a child who is less than six (6) years of age for lead poisoning.(2) A system to maintain the results of an evaluation under subdivision (1) in written form.(3) A performance incentive program for managed care organizations evaluated under subdivision (1).As added by P.L.135-2005, SEC.1. Amended by P.L.152-2017, SEC.19.
IN Code § 12-15-12-21 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-21. Accreditation

Sec. 21. (a) Not later than January 1, 2011, the following must be accredited by the National Committee for Quality Assurance or its successor:(1) A managed care organization that has contracted with the office before July 1, 2008, to provide Medicaid services under a risk based managed care program.(2) A behavioral health managed care organization that has contracted before July 1, 2008, with a managed care organization described in subdivision (1).(b) A:(1) managed care organization that has contracted with the office after June 30, 2008, to provide Medicaid services under a risk based managed care program; or(2) behavioral health managed care organization that has contracted after June 30, 2008, with a managed care organization described in subdivision (1);must begin the accreditation process and obtain accreditation by the National Committee for Quality Assurance or its successor at the earliest time that the National Committee for Quality Assurance allows a managed care organization to be accredited.As added by P.L.113-2008, SEC.6. Amended by P.L.152-2017, SEC.20.
IN Code § 12-15-12-22 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-22. Accepting, Receiving, and Processing Electronic Claims

Sec. 22. A:(1) managed care organization that has a contract with the office to provide Medicaid services under a risk based managed care program; or(2) behavioral health managed care organization that has contracted with a managed care organization described in subdivision (1);shall accept, receive, and process claims for payment that are filed electronically by a Medicaid provider.As added by P.L.113-2008, SEC.7. Amended by P.L.152-2017, SEC.21.
IN Code § 12-15-12-23 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-23. Psychiatrist Practicing in Community Mental Health Center

Sec. 23. A managed care organization may not require a psychiatrist who is licensed under IC 25-22.5 to be certified by the American Board of Psychiatry and Neurology for purposes of credentialing or contracting with the psychiatrist while the psychiatrist is practicing at a community mental health center.As added by P.L.264-2019, SEC.3.
IN Code § 12-15-13-0.1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-0.1. Application of Certain Amendments to Chapter

Sec. 0.1. The amendments made to this chapter apply as follows:(1) The amendments made to section 1 of this chapter by P.L.257-1996 apply to provider claims for payment under the Medicaid program under this article after March 31, 1996.(2) The addition of section 1.5 of this chapter by P.L.257-1996 applies to provider claims for payment under the Medicaid program under this article after March 31, 1996.As added by P.L.220-2011, SEC.266.
IN Code § 12-15-13-0.4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-0.4. "Office"

Sec. 0.4. As used in this chapter, "office" includes the following:(1) The office of the secretary of family and social services.(2) A managed care organization that has contracted with the office of Medicaid policy and planning under this article.(3) A person that has contracted with a managed care organization described in subdivision (2).As added by P.L.117-2008, SEC.2. Amended by P.L.109-2014, SEC.19.
IN Code § 12-15-13-0.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-0.5. "Clean Claim"

Sec. 0.5. (a) Except as provided in section 0.6 of this chapter, as used in this chapter, "clean claim" means a claim submitted by a provider for payment under the Medicaid program that can be processed without obtaining additional information from:(1) the provider of the service; or(2) a third party.(b) The definition under subsection (a):(1) includes a claim with errors originating in the state's claims processing system; and(2) does not include a claim:(A) from a provider who is under investigation for fraud or abuse (as used in 42 CFR 447.45(b); or(B) under review for medical necessity.As added by P.L.107-1996, SEC.2 and P.L.257-1996, SEC.2.
IN Code § 12-15-13-0.6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-0.6. "Clean Claim" for Purposes of Ic 12-15-14

Sec. 0.6. (a) "Clean claim", as the term applies to payments to nursing facilities under IC 12-15-14, means a claim submitted by a provider for payment that meets the following conditions:(1) Contains the following locators:(A) Type of bill.(B) Coverage dates.(C) Bill status.(D) Revenue codes.(E) Rate of payment.(F) Service units.(G) Total charges.(H) Provider number.(I) Third party prior payments.(J) Estimated amount due.(K) Recipient number.(L) Provider signature.(M) Provider name.(N) Number of covered days of service.(O) Date of admission.(P) Condition codes.(Q) Occurrence codes and dates.(R) Value codes and amounts.(S) Third party liability payor name.(T) Recipient name.(U) Admitting diagnosis.(V) Attending physician ID number.(2) Has correct and valid information for each of the locators required by subdivision (1).(3) The recipient for whom the claim is submitted is eligible for Medicaid on the date for which the service is billed.(4) The office has approved the level of care for:(A) the recipient; and(B) the facility;for the dates for which the service is billed.(5) The provider is eligible to render service on the date for which the service is billed.(6) The claim does not duplicate a claim already paid.(b) The definition under subsection (a):(1) includes a claim with errors originating in the state's claims processing system; and(2) does not include a claim:(A) from a provider who is under investigation for fraud or abuse (as used in 42 CFR 447.45(b)); or(B) under review for medical necessity.As added by P.L.107-1996, SEC.3 and P.L.257-1996, SEC.3.
IN Code § 12-15-13-0.7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-0.7. Addition, Deletion, or Modification of Locators

Sec. 0.7. The office may adopt rules under IC 4-22-2 that add, delete, or modify the locators contained in section 0.6(a)(1) of this chapter as necessary to conform with:(1) changes in federal law or regulation; or(2) directives from the United States Centers for Medicare and Medicaid Services.As added by P.L.107-1996, SEC.4 and P.L.257-1996, SEC.4. Amended by P.L.66-2002, SEC.3.
IN Code § 12-15-13-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-1. Payment, Denial, or Suspension of Claims Submitted by Nursing Facilities; Time; Notice of Suspension or Denial

Sec. 1. (a) This section applies only to claims submitted for payment by nursing facilities.(b) The office shall pay, deny, or suspend each claim submitted by a provider for payment under the Medicaid program not more than:(1) twenty-one (21) days after the date a claim that is filed electronically; or(2) thirty (30) days after the date a claim that is filed on paper;is received by the office or, if IC 12-15-30 applies, by the contractor under IC 12-15-30.(c) The office shall pay each clean claim.(d) The office may deny or suspend a claim that is not a clean claim. If the office denies a provider's claim for payment, the office shall notify the provider of each reason the claim was denied.(e) If the office suspends a provider's claim for payment under the Medicaid program, the office shall notify the provider of each reason the claim was suspended.[Pre-1992 Revision Citation: 12-1-7-16.5.]As added by P.L.2-1992, SEC.9. Amended by P.L.10-1994, SEC.4; P.L.107-1996, SEC.5; P.L.257-1996, SEC.5.
IN Code § 12-15-13-1.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-1.5. Payment of Interest on Claims Submitted by Nursing Facilities

Sec. 1.5. (a) This section applies only to claims submitted for payment by nursing facilities.(b) If the office:(1) fails to pay a clean claim in the time required under section 1(b) of this chapter; or(2) denies or suspends a claim that is subsequently determined to have been a clean claim when the claim was filed;the office shall pay the provider interest on the Medicaid allowable amount of the claim.(c) Interest paid under subsection (b):(1) accrues beginning:(A) twenty-two (22) days after the date the claim is filed under section 1(b)(1) of this chapter; or(B) thirty-one (31) days after the date the claim is filed under section 1(b)(2) of this chapter; and(2) stops accruing on the date the office pays the claim.(d) The office shall pay interest under subsection (b) at the same rate as determined under IC 12-15-21-3(7)(A).As added by P.L.107-1996, SEC.6 and P.L.257-1996, SEC.6. Amended by P.L.42-2011, SEC.29.
IN Code § 12-15-13-1.6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-1.6. Payment, Denial, or Suspension of Claims; Notice of Suspension or Denial

Sec. 1.6. (a) This section does not apply to claims submitted for payment by nursing facilities.(b) The office shall pay or deny each clean claim in accordance with section 1.7 of this chapter.(c) The office shall deny or suspend each claim that is not a clean claim in accordance with subsection (d).(d) The office shall deny or suspend each claim that is:(1) not a clean claim; and(2) submitted by a provider for payment under the Medicaid program;not more than thirty (30) days after the date the claim is received by the office or, if IC 12-15-30 applies, by the contractor under IC 12-15-30.(e) If the office denies a provider's claim for payment under subsection (d) or section 1.7 of this chapter, the office shall notify the provider of each reason the claim was denied.(f) If the office suspends a provider's claim for payment under subsection (d), the office shall notify the provider of each reason the claim was suspended.As added by P.L.107-1996, SEC.7 and P.L.257-1996, SEC.7.
IN Code § 12-15-13-1.7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-1.7. Timing of Payment or Denial of Claims; Payment of Interest

Sec. 1.7. (a) This section does not apply to claims submitted for payment by nursing facilities.(b) The office shall pay or deny each clean claim as follows:(1) If the claim is filed electronically, within twenty-one (21) days after the date the claim is received by:(A) the office; or(B) a contractor of the office under IC 12-15-30, if IC 12-15-30 applies.(2) If the claim is filed on paper, within thirty (30) days after the date the claim is received by:(A) the office; or(B) a contractor of the office under IC 12-15-30, if IC 12-15-30 applies.(c) If:(1) the office fails to pay or deny a clean claim in the time required under subsection (b); and(2) the office or a contractor of the office under IC 12-15-30 subsequently pays the claim;the office shall pay the provider that submitted the claim interest on the Medicaid allowable amount of the claim paid under this section.(d) Interest paid under subsection (c) shall:(1) begin accruing:(A) twenty-two (22) days after the date the claim is filed under subsection (b)(1); or(B) thirty-one (31) days after the date the claim is filed under subsection (b)(2); and(2) stop accruing on the date the claim is paid.(e) In paying interest under subsection (c), the office shall use the same interest rate as provided in IC 12-15-21-3(7)(A).As added by P.L.107-1996, SEC.8 and P.L.257-1996, SEC.8.
IN Code § 12-15-13-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-2. Payments to Providers; Requirements; Federal Law or Regulations Specifying Reimbursement Criteria

Sec. 2. (a) Except as provided in IC 12-15-14 and IC 12-15-15, payments to Medicaid providers must be:(1) consistent with efficiency, economy, and quality of care; and(2) sufficient to enlist enough providers so that care and services are available under Medicaid, at least to the extent that such care and services are available to the general population in the geographic area.(b) If federal law or regulations specify reimbursement criteria, payment shall be made in compliance with those criteria.[Pre-1992 Revision Citation: 12-1-7-17.6(a).]As added by P.L.2-1992, SEC.9. Amended by P.L.278-1993(ss), SEC.27.
IN Code § 12-15-13-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-6. Notices or Bulletins; Timing; Noncompliance

Sec. 6. (a) Except as provided by IC 12-15-35-50, a notice or bulletin that is issued by:(1) the office;(2) a contractor of the office; or(3) a managed care organization;concerning a change to the Medicaid program, including a change to prior authorization, claims processing, payment rates, and medical policies, that does not require use of the rulemaking process under IC 4-22-2 may not become effective until thirty (30) days after the date the notice or bulletin is communicated to the parties affected by the notice or bulletin.(b) The office must provide a written notice or bulletin described in subsection (a) within five (5) business days after the date on the notice or bulletin.(c) If the office, a contractor of the office, or a managed care organization does not comply with the requirements in subsections (a) and (b):(1) the notice or bulletin is void;(2) a claim may not be denied because the claim does not comply with the void notice or bulletin; and(3) the office, a contractor of the office, or a managed care organization may not reissue the bulletin or notice for thirty (30) days unless the change is required by the federal government to be implemented earlier.As added by P.L.42-1995, SEC.22. Amended by P.L.187-2007, SEC.2; P.L.15-2009, SEC.1; P.L.153-2011, SEC.17; P.L.152-2017, SEC.22.
IN Code § 12-15-13-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-7. Permitted Forms

Sec. 7. (a) The office and an entity with which the office contracts for the payment of claims shall accept claims submitted on any of the following forms by an individual or organization that is a contractor or subcontractor of the office:(1) CMS-1500 or its subsequent form.(2) CMS-1450 (UB04) or its subsequent form.(3) American Dental Association (ADA) claim form.(4) Pharmacy and compound drug form.(b) The office and an entity with which the office contracts for the payment of claims:(1) may designate as acceptable claim forms other than a form listed in subsection (a); and(2) may not mandate the use of a crossover claim form.As added by P.L.256-2001, SEC.3. Amended by P.L.27-2011, SEC.2.
IN Code § 12-15-13-7.2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-7.2. Use of Diagnostic or Procedure Codes

Sec. 7.2. (a) As used in this section, "provider" has the meaning set forth in IC 27-8-11-1.(b) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:(1) the office shall for all purposes begin using the most current version of the:(A) current procedural terminology (CPT);(B) international classification of diseases (ICD);(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);(D) current dental terminology (CDT);(E) Healthcare common procedure coding system (HCPCS); and(F) third party administrator (TPA);codes under which the office processes claims for services provided under the Medicaid program; and(2) a provider shall begin using the most current version of the:(A) current procedural terminology (CPT);(B) international classification of diseases (ICD);(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);(D) current dental terminology (CDT);(E) Healthcare common procedure coding system (HCPCS); and(F) third party administrator (TPA);codes under which the provider submits claims for payment for services provided under the Medicaid program.(c) If a provider provides services that are covered under the Medicaid program:(1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (b); and(2) before the office begins using the most current version of the diagnostic or procedure code;the office shall reimburse the provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.As added by P.L.161-2001, SEC.2. Amended by P.L.66-2002, SEC.4; P.L.27-2011, SEC.3.
IN Code § 12-15-13-9 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13. Provider Payment; General|12-15-13-9. Reimbursement for Providers at Federally Qualified Health Centers and Rural Health Clinics

Sec. 9. (a) Subject to subsection (b), the office shall reimburse the following providers if the providers are providing Medicaid covered services at a federally-qualified health center (as defined in 42 U.S.C. 1396d(l)(2)(B)) or a rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)) within the provider's scope of practice:(1) A clinical social worker licensed under IC 25-23.6-5.(2) A marriage and family therapist licensed under IC 25-23.6-8.(3) A mental health counselor licensed under IC 25-23.6-8.5.(4) A clinical addiction counselor licensed under IC 25-23.6-10.5.(b) By July 1, 2020, the office shall apply to the United States Department of Health and Human Services to amend the state Medicaid plan to include reimbursement described in subsection (a). The office may not implement the reimbursement under subsection (a) until the office has obtained approval for the Medicaid state plan amendment requested under this subsection.As added by P.L.128-2019, SEC.2. Amended by P.L.103-2020, SEC.3.