reglab/housing_qa huggingface dataset:
IN Code § 12-15-41-13 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities|12-15-41-13. Criteria for Determining Effectiveness of Buy-in Program and Continued Medicaid Coverage

Sec. 13. (a) The office shall establish criteria to determine the effectiveness of:(1) the buy-in program; and(2) continued Medicaid coverage through Section 1619 of the federal Social Security Act (42 U.S.C. 1382h).(b) The criteria required under subsection (a) must include the following:(1) The number of individuals with disabilities who are:(A) enrolled in the buy-in program; or(B) receiving Medicaid through Section 1619 of the federal Social Security Act (42 U.S.C. 1382h).(2) State revenues resulting from premiums paid by participants in the buy-in program.(3) State costs incurred as a result of implementing the buy-in program, including administrative costs and costs of providing services.(c) In addition to the criteria required under subsection (b), the office may establish criteria to determine the following:(1) Comparative costs of Medicaid funded services for participants in the buy-in program and work incentives created through Section 1619 of the federal Social Security Act (42 U.S.C. 1382h) before and after employment.(2) The number of Supplemental Security Income and Social Security Disability Insurance recipients in Indiana who are no longer dependent on, or who have reduced dependence on, public assistance or health care entitlement services, other than Medicaid or the children's health insurance program, due to participation in the buy-in program or work incentives created through Section 1619 of the federal Social Security Act (42 U.S.C. 1382h).(3) The number of individuals with severe disabilities who are no longer dependent on, or who have reduced dependence on, public benefits or services, other than Medicaid or the children's health insurance program, due to income or support services received through participation in the buy-in program or work incentives created through Section 1619 of the federal Social Security Act (42 U.S.C. 1382h).(4) The change in the number of buy-in program participants or participants in work incentives created through Section 1619 of the federal Social Security Act (42 U.S.C. 1382h) who have health care needs and related services covered though employer based benefit programs.(d) In evaluating the effectiveness of the state's work incentive initiatives for individuals with disabilities, the office:(1) shall collaborate with other state agencies on data collection; and(2) may consult with an independent contractor to collect data on the criteria listed under subsection (b).As added by P.L.287-2001, SEC.9. Amended by P.L.197-2011, SEC.43.
IN Code § 12-15-41-14 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities|12-15-41-14. Funding for Program

Sec. 14. Funding for the buy-in program shall be from funds appropriated by the general assembly, premiums paid, and any federal matching funds available to the program.As added by P.L.287-2001, SEC.9.
IN Code § 12-15-41-15 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities|12-15-41-15. Adoption of Rules

Sec. 15. (a) The office shall adopt rules under IC 4-22-2 to implement this chapter.(b) The office may adopt emergency rules under IC 4-22-2-37.1 to implement this chapter on an emergency basis.As added by P.L.287-2001, SEC.9. Amended by P.L.197-2011, SEC.44.
IN Code § 12-15-43-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 43. Pace Program|12-15-43-1. Authority to Implement Pace

Sec. 1. The office may implement the Program of All-Inclusive Care for the Elderly (PACE) (42 U.S.C. 1396u-4) established under the federal Balanced Budget Act of 1997.As added by P.L.20-2003, SEC.1.
IN Code § 12-15-43-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 43. Pace Program|12-15-43-2. Rules

Sec. 2. The office may adopt rules under IC 4-22-2 necessary to implement this chapter.As added by P.L.20-2003, SEC.1.
IN Code § 12-15-44.2-20 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program|12-15-44.2-20. Premium Assistance Program

Sec. 20. (a) The office may establish a health insurance coverage premium assistance program for individuals who meet the following:(1) Have an annual household income of the following:(A) Through December 31, 2013, not more than two hundred percent (200%) of the federal income poverty level.(B) Beginning January 1, 2014, not more than one hundred thirty-three percent (133%) of the federal income poverty level, based on the adjusted gross income provisions set forth in Section 2001(a)(1) of the federal Patient Protection and Affordable Care Act.(2) Are eligible for health insurance coverage through an employer but cannot afford the health insurance coverage premiums.(b) A program established under this section must:(1) contain eligibility requirements that are similar to the eligibility requirements of the plan;(2) include a health care account as a component; and(3) provide that an individual's payment:(A) to a health care account; or(B) for a health insurance coverage premium;may not exceed five percent (5%) of the individual's annual income.(c) The office may adopt rules under IC 4-22-2 necessary to implement and administer this section.As added by P.L.3-2008, SEC.98. Amended by P.L.160-2011, SEC.13; P.L.30-2016, SEC.22.
IN Code § 12-15-44.5-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-1. "Phase Out Period"

Sec. 1. As used in this chapter, "phase out period" refers to the following periods:(1) The time during which a:(A) phase out plan;(B) demonstration expiration plan; or(C) similar plan approved by the United States Department of Health and Human Services;is in effect for the plan set forth in this chapter.(2) The time beginning upon the office's receipt of written notice by the United States Department of Health and Human Services of its decision to:(A) terminate or suspend the waiver demonstration for the plan; or(B) withdraw the waiver or expenditure authority for the plan;and ending on the effective date of the termination, suspension, or withdrawal of the waiver or expenditure authority.(3) The time beginning upon:(A) the office's determination to terminate the plan; or(B) the termination of the plan under section 4(b) of this chapter;if subdivisions (1) through (2) do not apply, and ending on the effective date of the termination of the plan.As added by P.L.213-2015, SEC.136.
IN Code § 12-15-44.5-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-2. "Plan"

Sec. 2. As used in this chapter, "plan" refers to the healthy Indiana plan established by section 3 of this chapter.As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.25.
IN Code § 12-15-44.5-2.3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-2.3. "Preventative Care Services"

Sec. 2.3. As used in this chapter, "preventative care services" means care that is provided to an individual to prevent disease, diagnose disease, or promote good health.As added by P.L.30-2016, SEC.26.
IN Code § 12-15-44.5-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-3. Plan Established; Eligibility; Oversight of Marketing; Promotion of Plan; Ensure Enrollment Distribution; Consumer Protection; Provider Participation; Exemptions

Sec. 3. (a) The healthy Indiana plan is established.(b) The office shall administer the plan.(c) The following individuals are eligible for the plan:(1) The adult group described in 42 CFR 435.119.(2) Parents and caretaker relatives eligible under 42 CFR 435.110.(3) Low income individuals who are:(A) at least nineteen (19) years of age; and(B) less than twenty-one (21) years of age;and eligible under 42 CFR 435.222.(4) Individuals, for purposes of receiving transitional medical assistance.An individual must meet the Medicaid residency requirements under IC 12-15-4-4 and this article to be eligible for the plan.(d) The following individuals are not eligible for the plan:(1) An individual who participates in the federal Medicare program (42 U.S.C. 1395 et seq.).(2) An individual who is otherwise eligible and enrolled for medical assistance.(e) The department of insurance and the office of the secretary shall provide oversight of the marketing practices of the plan.(f) The office shall promote the plan and provide information to potential eligible individuals who live in medically underserved rural areas of Indiana.(g) The office shall, to the extent possible, ensure that enrollment in the plan is distributed throughout Indiana in proportion to the number of individuals throughout Indiana who are eligible for participation in the plan.(h) The office shall establish standards for consumer protection, including the following:(1) Quality of care standards.(2) A uniform process for participant grievances and appeals.(3) Standardized reporting concerning provider performance, consumer experience, and cost.(i) A health care provider that provides care to an individual who receives health coverage under the plan shall also participate in the Medicaid program under this article.(j) The following do not apply to the plan:(1) IC 12-15-6.(2) IC 12-15-12.(3) IC 12-15-13.(4) IC 12-15-14.(5) IC 12-15-15.(6) IC 12-15-21.(7) IC 12-15-26.(8) IC 12-15-31.1.(9) IC 12-15-34.(10) IC 12-15-35.(11) IC 16-42-22-10.As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.27; P.L.152-2017, SEC.32.
IN Code § 12-15-44.5-3.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-3.5. Coverage; Vision and Dental; Preventative Care Services

Sec. 3.5. (a) The plan must include the following in a manner and to the extent determined by the office:(1) Mental health care services.(2) Inpatient hospital services.(3) Prescription drug coverage, including coverage of a long acting, nonaddictive medication assistance treatment drug if the drug is being prescribed for the treatment of substance abuse.(4) Emergency room services.(5) Physician office services.(6) Diagnostic services.(7) Outpatient services, including therapy services.(8) Comprehensive disease management.(9) Home health services, including case management.(10) Urgent care center services.(11) Preventative care services.(12) Family planning services:(A) including contraceptives and sexually transmitted disease testing, as described in federal Medicaid law (42 U.S.C. 1396 et seq.); and(B) not including abortion or abortifacients.(13) Hospice services.(14) Substance abuse services.(15) Pregnancy services.(16) A service determined by the secretary to be required by federal law as a benchmark service under the federal Patient Protection and Affordable Care Act.(b) The plan may not permit treatment limitations or financial requirements on the coverage of mental health care services or substance abuse services if similar limitations or requirements are not imposed on the coverage of services for other medical or surgical conditions.(c) The plan may provide vision services and dental services only to individuals who regularly make the required monthly contributions for the plan as set forth in section 4.7(c) of this chapter.(d) The benefit package offered in the plan:(1) must be benchmarked to a commercial health plan described in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and(2) may not include a benefit that is not present in at least one (1) of these commercial benchmark options.(e) The office shall provide to an individual who participates in the plan a list of health care services that qualify as preventative care services for the age, gender, and preexisting conditions of the individual. The office shall consult with the federal Centers for Disease Control and Prevention for a list of recommended preventative care services.(f) The plan shall, at no cost to the individual, provide payment of preventative care services described in 42 U.S.C. 300gg-13 for an individual who participates in the plan.(g) The plan shall, at no cost to the individual, provide payments of not more than five hundred dollars ($500) per year for preventative care services not described in subsection (f). Any additional preventative care services covered under the plan and received by the individual during the year are subject to the deductible and payment requirements of the plan.As added by P.L.30-2016, SEC.28.
IN Code § 12-15-44.5-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-4. Scope of the Plan; Termination of Plan; Obligation of State; Report to Budget Committee

Sec. 4. (a) The plan:(1) is not an entitlement program; and(2) serves as an alternative to health care coverage under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).(b) If either of the following occurs, the office shall terminate the plan in accordance with section 6(b) of this chapter:(1) The:(A) percentages of federal medical assistance available to the plan for coverage of plan participants described in Section 1902(a)(10)(A)(i)(VIII) of the federal Social Security Act are less than the percentages provided for in Section 2001(a)(3)(B) of the federal Patient Protection and Affordable Care Act; and(B) hospital assessment committee (IC 16-21-10), after considering the modification and the reduction in available funding, does not alter the formula established under IC 16-21-10-13.3(b)(1) to cover the amount of the reduction in federal medical assistance.For purposes of this subdivision, "coverage of plan participants" includes payments, contributions, and amounts referred to in IC 16-21-10-13.3(b)(1)(A), IC 16-21-10-13.3(b)(1)(C), and IC 16-21-10-13.3(b)(1)(D), including payments, contributions, and amounts incurred during a phase out period of the plan.(2) The:(A) methodology of calculating the incremental fee set forth in IC 16-21-10-13.3 is modified in any way that results in a reduction in available funding;(B) hospital assessment fee committee (IC 16-21-10), after considering the modification and reduction in available funding, does not alter the formula established under IC 16-21-10-13.3(b)(1) to cover the amount of the reduction in fees; and(C) office does not use alternative financial support to cover the amount of the reduction in fees.(c) If the plan is terminated under subsection (b), the secretary may implement a plan for coverage of the affected population in a manner consistent with the healthy Indiana plan (IC 12-15-44.2 (before its repeal)) in effect on January 1, 2014:(1) subject to prior approval of the United States Department of Health and Human Services; and(2) without funding from the incremental fee set forth in IC 16-21-10-13.3.(d) The office may not 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.(e) The office of the secretary shall submit annually to the budget committee an actuarial analysis of the plan that reflects a determination that sufficient funding is reasonably estimated to be available to operate the plan.As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.29.
IN Code § 12-15-44.5-4.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-4.5. Required Health Care Account; Payments

Sec. 4.5. (a) An individual who participates in the plan must have a health care account to which payments may be made for the individual's participation in the plan.(b) An individual's health care account must be used to pay the individual's deductible for health care services under the plan.(c) An individual's deductible must be at least two thousand five hundred dollars ($2,500) per year.(d) An individual may make payments to the individual's health care account as follows:(1) An employer withholding or causing to be withheld from an employee's wages or salary, after taxes are deducted from the wages or salary, the individual's contribution under this chapter and distributed equally throughout the calendar year.(2) Submission of the individual's contribution under this chapter to the office to deposit in the individual's health care account in a manner prescribed by the office.(3) Another method determined by the office.As added by P.L.30-2016, SEC.30.
IN Code § 12-15-44.5-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-5. Managed Care Organization Responsibilities; Reimbursement; Cultural Competency Standards

Sec. 5. (a) A managed care organization that contracts with the office to provide health coverage, dental coverage, or vision coverage to an individual who participates in the plan:(1) is responsible for the claim processing for the coverage;(2) shall reimburse providers at a rate that is not less than the rate established by the secretary. The rate set by the secretary must be based on a reimbursement formula that is:(A) comparable to the federal Medicare reimbursement rate for the service provided by the provider; or(B) one hundred thirty percent (130%) of the Medicaid reimbursement rate for a service that does not have a Medicare reimbursement rate; and(3) may not deny coverage to an eligible individual who has been approved by the office to participate in the plan.(b) A managed care organization that contracts with the office to provide health coverage under the plan must incorporate cultural competency standards established by the office. The standards must include standards for non-English speaking, minority, and disabled populations.As added by P.L.213-2015, SEC.136. Amended by P.L.152-2017, SEC.34.
IN Code § 12-15-44.5-5.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-5.5. Workforce Training and Job Search Program Referral

Sec. 5.5. The office shall refer any member of the plan who:(1) is employed for less than twenty (20) hours per week; and(2) is not a full-time student;to a workforce training and job search program.As added by P.L.30-2016, SEC.33.
IN Code § 12-15-44.5-5.7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-5.7. Nonemergency Services Received in an Emergency Room; Copayment

Sec. 5.7. Subject to appeal to the office, an individual may be held responsible under the plan for receiving nonemergency services in an emergency room setting, including prohibiting the individual from using funds in the individual's health care account to pay for the nonemergency services and paying a copayment for the services of at least eight dollars ($8) for the nonemergency use of a hospital emergency department. However, an individual may not be prohibited from using funds in the individual's health care account to pay for nonemergency services provided in an emergency room setting for a medical condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to:(1) place an individual's health in serious jeopardy;(2) result in serious impairment to the individual's bodily functions; or(3) result in serious dysfunction of a bodily organ or part of the individual.As added by P.L.30-2016, SEC.34. Amended by P.L.114-2018, SEC.7.
IN Code § 12-15-44.5-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-6. Phase Out Funds Deposited From Incremental Hospital Assessment Fees; Notice and Phase Out if Plan Is Terminated

Sec. 6. (a) For a state fiscal year beginning July 1, 2018, or thereafter, the office, after review by the state budget committee, may determine that no incremental fees collected under IC 16-21-10-13.3 are required to be deposited into the phase out trust fund established under section 7 of this chapter.(b) If the plan is to be terminated for any reason, the office shall:(1) if required, provide notice of termination of the plan to the United States Department of Health and Human Services and begin the process of phasing out the plan; or(2) if notice and a phase out plan is not required under federal law, notify the hospital assessment fee committee (IC 16-21-10) of the office's intent to terminate the plan and the plan shall be phased out under a procedure approved by the hospital assessment fee committee.The office may not submit any phase out plan to the United States Department of Health and Human Services or accept any phase out plan proposed by the Department of Health and Human Services without the prior approval of the hospital assessment fee committee.(c) Before submitting:(1) an extension of; or(2) a material amendment to;the plan to the United States Department of Health and Human Services, the office shall inform the Indiana Hospital Association of the extension or material amendment to the plan.As added by P.L.213-2015, SEC.136. Amended by P.L.108-2019, SEC.198.
IN Code § 12-15-44.5-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 44.5. Healthy Indiana Plan 2.0|12-15-44.5-7. Phase Out Trust Fund Established; Purpose of the Fund; Uses; Administration; Fund Is Considered a Trust Fund

Sec. 7. (a) The phase out trust fund is established for the purpose of holding the money needed during a phase out period of the plan. Funds deposited under this section shall be used only:(1) to fund the state share of the expenses described in IC 16-21-10-13.3(b)(1)(A) through IC 16-21-10-13.3(b)(1)(F) incurred during a phase out period of the plan;(2) after funds from the healthy Indiana trust fund (IC 12-15-44.2-17) are exhausted; and(3) to refund hospitals in the manner described in subsection (h).The fund is separate from the state general fund.(b) The fund shall be administered by the office.(c) The expenses of administering the fund shall be paid from money in the fund.(d) The trust fund must consist of:(1) the funds described in section 6 of this chapter; and(2) any interest accrued under this section.(e) The treasurer of state shall invest the money in the fund not currently needed to meet the obligations of the fund in the same manner as other public money may be invested. Interest that accrues from these investments shall be deposited in the fund.(f) Money in the fund does not revert to the state general fund at the end of any fiscal year.(g) The fund is considered a trust fund for purposes of IC 4-9.1-1-7. Money may not be transferred, assigned, or otherwise removed from the fund by the state board of finance, the budget agency, or any other state agency unless specifically authorized under this chapter.(h) At the end of the phase out period, any remaining funds and accrued interest shall be distributed to the hospitals on a pro rata basis based on the fees authorized by IC 16-21-10 that were paid by each hospital for the state fiscal year that ended immediately before the beginning of the phase out period.As added by P.L.213-2015, SEC.136.