reglab/housing_qa huggingface dataset:
IN Code § 12-15-13.5-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.5. Medicaid Recovery Audits|12-15-13.5-1. "Office"

Sec. 1. As used in this chapter, "office" refers to the office of the secretary of family and social services.As added by P.L.134-2019, SEC.2.
IN Code § 12-15-13.5-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.5. Medicaid Recovery Audits|12-15-13.5-2. Recovery Audit; Contract; Performance

Sec. 2. (a) The office and a managed care organization that has contracted with the office under this article shall perform a recovery audit to ensure the integrity of the Medicaid program.(b) The office shall contract with a recovery auditing entity to perform the recovery audit. A contract with a recovery auditing entity must include the following services:(1) Review of claims submitted by providers or other individuals furnishing items and services for payment by the Medicaid program to determine whether overpayment or underpayment occurred.(2) Recovery of identified overpayments and payment to providers of identified underpayments.(c) A managed care organization may either perform the recovery audit internally or contract with a recovery auditing entity to perform the recovery audit. A recovery audit by a managed care organization, whether performed internally or through a contract with a recovery auditing entity, must meet the requirements of subsection (b) and section 3 of this chapter.As added by P.L.134-2019, SEC.2.
IN Code § 12-15-13.5-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.5. Medicaid Recovery Audits|12-15-13.5-3. Audit Period

Sec. 3. A recovery audit under this chapter must include the following:(1) Subject to subdivision (2), for audits initiated after June 30, 2019, the audit look back period must be three (3) years and one hundred-eighty (180) days.(2) If the office or a managed care organization discovers information that may indicate a credible allegation of fraud, abusive billing practices, or a claims process error rate greater than thirty percent (30%), the office or the managed care organization may increase the audit look back period to a total of seven (7) years.As added by P.L.134-2019, SEC.2.
IN Code § 12-15-13.5-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.5. Medicaid Recovery Audits|12-15-13.5-4. Annual Provider Education

Sec. 4. The managed care organization or the auditing entity, in conjunction with the office, shall perform educational and training programs annually for providers that include the following:(1) A summary of the managed care organization's auditing entity's past or previous audit findings that provide guidance to Medicaid providers.(2) The most common errors or issues and how a provider can avoid these errors and issues.(3) Recommended practices for providers on improving claim submissions.As added by P.L.134-2019, SEC.2.
IN Code § 12-15-13.5-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.5. Medicaid Recovery Audits|12-15-13.5-6. Recovery Audits; Development, Review, and Certification of Plans of Treatment

Sec. 6. (a) Subject to subsection (b), a recovery audit shall not require documentation, at the time of service, for services provided by a community mental health center (as defined in IC 12-7-2-38) when the documentation is part of an ongoing plan of treatment or a documentation of specific treatment methods.(b) The direct service provider shall complete documentation described in subsection (a) within a reasonable time frame, but not later than thirty (30) days from the date of service, prior to Medicaid billing.(c) Any supervising provider in a community mental health center is eligible to review documentation in order to certify a plan of treatment or review specific treatment methods at intervals not greater than ninety (90) days.(d) A supervising provider described in subsection (c) may review the documentation described in subsection (c) regardless of:(1) whether the supervising provider is providing direct supervision; and(2) the location where the service was provided.A review described under this subsection must be documented by the signature of the supervising provider.(e) In developing a plan of treatment, the following must be completed to demonstrate active treatment with a client:(1) A signed client consent form.(2) The completion of a list of requirements concerning audit compliance, as determined by the division in collaboration with community mental health centers, that verifies active participation in the development of the client's plan of treatment.(3) Either:(A) the signature of the client on the client's plan of treatment; or(B) if the direct care provider, after a good faith effort, is unable to obtain the client's signature on the client's plan of treatment:(i) the provision of documentation by the provider of the reasons the provider was unable to obtain the signature;(ii) the continuation of attempting to obtain the client's signature on the client's plan of treatment; and(iii) a determination by the division, based on the documentation in item (i), that the direct care provider has made a good faith effort to obtain the signature.As added by P.L.127-2020, SEC.3.
IN Code § 12-15-13.6-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.6. Audit of Prescription Drug Cost Sharing|12-15-13.6-1. Audit of Medicaid Prescription Drug Cost Sharing

Sec. 1. Once every three (3) state fiscal years:(1) the state board of accounts; or(2) an independent auditor with experience auditing expenses related to prescription drugs that is hired by the state board of accounts;shall conduct an audit examining prescription drug cost sharing for the Medicaid program.As added by P.L.196-2021, SEC.3.
IN Code § 12-15-13.6-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.6. Audit of Prescription Drug Cost Sharing|12-15-13.6-2. Look Back Period

Sec. 2. For an audit conducted under section 1 of this chapter, the audit look back period must be the previous three (3) state fiscal years.As added by P.L.196-2021, SEC.3.
IN Code § 12-15-13.6-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.6. Audit of Prescription Drug Cost Sharing|12-15-13.6-3. Audit Requirements

Sec. 3. An audit conducted under section 1 of this chapter must evaluate all prescription drug cost sharing for the Medicaid program for the audit look back period, including for prescription drugs paid for directly by the Medicaid program and prescription drugs paid for by managed care organizations.As added by P.L.196-2021, SEC.3.
IN Code § 12-15-13.6-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 13.6. Audit of Prescription Drug Cost Sharing|12-15-13.6-4. Audit Results

Sec. 4. The results of an audit conducted under section 1 of this chapter must be provided to the office of the secretary.As added by P.L.196-2021, SEC.3.
IN Code § 12-15-14-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 14. Payment to Nursing Facilities|12-15-14-1. Payment Criteria; Uniformity

Sec. 1. (a) Except as provided in subsection (b), payment of services for nursing facilities shall be determined under the same criteria and in a uniform manner for all facilities providing services.(b) In addition to reimbursement under the uniform rates of payment developed for all nursing facilities under subsection (a):(1) nursing facilities that are owned and operated by a governmental entity may receive any additional payments that are permitted under applicable federal statutes and regulations; and(2) nursing facilities that are not owned and operated by a governmental entity may receive any additional payments that are permitted under applicable federal statutes and regulations.(c) Each governmental transfer or other payment mechanism that the office implements under this chapter must maximize the amount of federal financial participation that the state can obtain through the intergovernmental transfer or other payment mechanism.[Pre-1992 Revision Citation: 12-1-7-17.4.]As added by P.L.2-1992, SEC.9. Amended by P.L.160-2001, SEC.1.
IN Code § 12-15-14-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 14. Payment to Nursing Facilities|12-15-14-2. Payment of Nursing Facilities Under 42 u.s.c. 1396a(a)(13)(a); Non-Medicaid Revenue Information; Complete Balance Sheet Data

Sec. 2. (a) Payment of nursing facility services shall be determined in accordance with 42 U.S.C. 1396a(a)(13)(A) and any other applicable federal statutes or regulations governing such payments.(b) The office may not require a provider to submit non-Medicaid revenue information in the provider's annual historical financial report. Non-Medicaid revenue information obtained by Medicaid auditors in the course of their audits may not be used for public reporting purposes.(c) The office may only request complete balance sheet data that applies directly to the provider's facility. Complete balance sheet data acquired by the office under this subsection:(1) is confidential; and(2) may only be disclosed:(A) in the aggregate; or(B) for an individual facility;if the office removes all non-Medicaid data.(d) The office of the secretary shall adopt rules under IC 4-22-2 to implement the reimbursement system required by this section.[Pre-1992 Revision Citation: 12-1-7-17.6(b).]As added by P.L.2-1992, SEC.9. Amended by P.L.152-1995, SEC.11; P.L.257-1996, SEC.10; P.L.126-1998, SEC.3; P.L.160-2001, SEC.2.
IN Code § 12-15-14-2.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 14. Payment to Nursing Facilities|12-15-14-2.5. Prohibition on Reimbursement for Reservation of Bed for Hospitalized or Otherwise Absent Medicaid Recipient

Sec. 2.5. (a) The office may not reimburse a nursing facility provider for reserving a bed for a Medicaid recipient when the Medicaid recipient is not present in the nursing facility due to a hospital stay or leave of absence for therapeutic reasons.(b) Not later than September 30, 2011, the office shall submit a state Medicaid plan amendment to the federal Centers for Medicare and Medicaid Services to implement this section.As added by P.L.229-2011, SEC.127.
IN Code § 12-15-14-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 14. Payment to Nursing Facilities|12-15-14-8. Use of Rug-Iv, 48-Group Model for Payments; Public Notice if Reduction in Reimbursement

Sec. 8. (a) Beginning July 1, 2018, the office may implement an end of therapy reclassification methodology in the RUG-IV, 48-Group model for payment of nursing facility services.(b) Before the office changes a health facility service reimbursement that results in a reduction in reimbursement, the office shall provide public notice of at least one (1) year. The public notice under this subsection:(1) is not a rulemaking action or part of the administrative rulemaking process under IC 4-22; and(2) must include the fiscal impact of the proposed reimbursement change.As added by P.L.224-2017, SEC.4. Amended by P.L.165-2021, SEC.140.
IN Code § 12-15-15-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-1. Services at Hospitals Licensed Under Ic 16-21; Rates Established Under Rules

Sec. 1. Payment of a service provided in a hospital licensed under IC 16-21 shall be determined in accordance with a payment rate for the service that is established under rules adopted under IC 4-22-2 by the secretary in conjunction with the office.[Pre-1992 Revision Citation: 12-1-7-17.6(c) part.]As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.11; P.L.2-1993, SEC.93.
IN Code § 12-15-15-1.2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-1.2. Reimbursement for Children's Hospital Bordering Indiana; Limitations; Expiration

Sec. 1.2. (a) This section applies only to state fiscal years beginning after June 30, 2021, and ending before July 1, 2023.(b) As used in this section, "children's hospital" means:(1) a freestanding general acute care hospital that:(A) is designated by the Medicare program as a children's hospital; or(B) furnishes inpatient and outpatient health care services to patients who are predominantly individuals less than nineteen (19) years of age; or(2) a facility located within a freestanding general acute care hospital that:(A) is designated by the Medicare program as a children's hospital; or(B) furnishes inpatient and outpatient health care services to patients who are predominately individuals less than nineteen (19) years of age.(c) This section applies to reimbursement for inpatient Medicaid services and outpatient Medicaid services provided to a Medicaid recipient who is less than nineteen (19) years of age at a children's hospital that is located in a state bordering Indiana. This section does not apply to reimbursement for non-emergency medical transportation.(d) Subject to subsection (a), the office shall reimburse a children's hospital for covered services provided to a Medicaid recipient that is described in subsection (c) at a rate set by the secretary that is based on a reimbursement formula that is:(1) comparable to the current federal Medicare reimbursement rate for the service provided by the children's hospital; or(2) one hundred thirty percent (130%) of the Medicaid reimbursement rate for a service that does not have a Medicare reimbursement rate.(e) Before September 1, 2021, the office shall apply to the United States Department of Health and Human Services for any state plan amendment or Medicaid waiver necessary to implement and administer this section.(f) The office may adopt rules under IC 4-22-2 necessary for the implementation of this section.(g) This section expires July 1, 2023.As added by P.L.132-2021, SEC.2.
IN Code § 12-15-15-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-2. Rates Adopted for Hospital Licensed Under Ic 16-21; Prospective or Retrospective Application

Sec. 2. The rates adopted under this chapter for a hospital licensed under IC 16-21 may be the following:(1) Prospective.(2) Retroactive.(3) A combination of prospective and retroactive.[Pre-1992 Revision Citation: 12-1-7-17.6(c) part.]As added by P.L.2-1992, SEC.9. Amended by P.L.2-1993, SEC.94.
IN Code § 12-15-15-2.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-2.5. Payment for Physician Services in Emergency Department

Sec. 2.5. (a) Payment for physician services provided in the emergency department of a hospital licensed under IC 16-21 must be at a rate of one hundred percent (100%) of rates payable under the Medicaid fee structure.(b) The payment under subsection (a) must be calculated using the same methodology used for all other physicians participating in the Medicaid program.(c) For services rendered and documented in an individual's medical record, physicians must be reimbursed for federally required medical screening exams that are necessary to determine the presence of an emergency using the appropriate Current Procedural Terminology (CPT) codes 99281, 99282, or 99283 described in the Current Procedural Terminology Manual published annually by the American Medical Association, without authorization by the enrollee's primary medical provider.(d) This section does not apply to a person enrolled in a Medicaid risk based managed care program.As added by P.L.153-1995, SEC.10. Amended by P.L.119-1997, SEC.5; P.L.245-1999, SEC.1; P.L.223-2001, SEC.10; P.L.152-2017, SEC.23.
IN Code § 12-15-15-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-3. Services Provided at Hospitals Operating Under Ic 16-24-1; Prospective Payment Rate

Sec. 3. Payment of a service provided in a hospital operating under IC 16-24-1 shall be determined in accordance with a prospective payment rate for the service.[Pre-1992 Revision Citation: 12-1-7-17.6(c) part.]As added by P.L.2-1992, SEC.9. Amended by P.L.2-1993, SEC.95.
IN Code § 12-15-15-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-4. Per Diem Rate for Services Provided in Hospitals Operating Under Ic 16-24-1

Sec. 4. The office shall establish a per diem rate for the service provided in a hospital operating under IC 16-24-1 under rules adopted under IC 4-22-2 by the secretary.[Pre-1992 Revision Citation: 12-1-7-17.6(c) part.]As added by P.L.2-1992, SEC.9. Amended by P.L.2-1993, SEC.96.
IN Code § 12-15-15-4.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-4.5. Payment for HIV Test; Limitation

Sec. 4.5. Payment to a hospital for a test required under IC 16-41-6-4 must be in an amount equal to the hospital's actual cost of performing the test and may not reduce or replace the reimbursement of other services that are provided to the patient under the state Medicaid program. The total cost to the state may not be more than twenty-four thousand dollars ($24,000) in a state fiscal year.As added by P.L.237-2003, SEC.2.
IN Code § 12-15-15-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-6. Fees in Addition to Infant Delivery Fees

Sec. 6. (a) In addition to a payment due to a hospital for the delivery of a newborn infant, the office shall tender a payment to the hospital for the hospital's collection, handling, and delivery of a specimen for testing under IC 16-41-17-2(a)(10).(b) Payment to a hospital required under subsection (a) must be in an amount equal to the total of the following costs:(1) The cost incurred by the hospital to collect, handle, and deliver the specimen obtained for testing under IC 16-41-17-2(a)(10).(2) Any fee assessed against the hospital for a laboratory's testing of the specimen under IC 16-41-17-2(a)(10).(3) Any newborn screening fee or other fee assessed against the hospital by the state department of health in connection with the testing of the specimen under IC 16-41-17-2(a)(10).As added by P.L.149-2001, SEC.2.
IN Code § 12-15-15-9.6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-9.6. Limitation on Total Amount of Payments

Sec. 9.6. For state fiscal years beginning after June 30, 2007, the total amount of payments to hospitals under sections 9 and 9.5 of this chapter may not exceed the amount paid to hospitals under sections 9 and 9.5 of this chapter for the state fiscal year ending June 30, 2007.As added by P.L.255-2003, SEC.21. Amended by P.L.212-2007, SEC.6; P.L.218-2007, SEC.16.
IN Code § 12-15-15-10 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-10. Payments to Providers Under Medicaid Disproportionate Share Provider Program

Sec. 10. (a) This section applies to a hospital that:(1) is licensed under IC 16-21; and(2) qualifies as a provider under IC 12-15-16, IC 12-15-17, or IC 12-15-19 of the Medicaid disproportionate share provider program.(b) The office may, after consulting with affected providers, do one (1) or more of the following:(1) Establish a nominal charge hospital payment program.(2) Establish any other permissible payment program.(c) A program expanded or established under this section is subject to the availability of:(1) intergovernmental transfers;(2) funds certified as being eligible for federal financial participation; or(3) other permissible sources of non-federal share dollars.(d) The office may not implement a program under this section until the federal Centers for Medicare and Medicaid Services approves the provisions regarding the program in the amended state plan for medical assistance.(e) The office may determine not to continue to implement a program established under this section if federal financial participation is not available.As added by P.L.113-2000, SEC.4. Amended by P.L.66-2002, SEC.6; P.L.212-2007, SEC.7; P.L.218-2007, SEC.17.
IN Code § 12-15-15-11 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-11. Nominal Charge Hospitals

Sec. 11. Hospitals licensed under IC 16-21 that are established and operated under IC 16-22, IC 16-22-8, or IC 16-23 are nominal charge hospitals for purposes of the Medicaid program.As added by P.L.283-2001, SEC.21.
IN Code § 12-15-15-12 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 15. Payment to Hospitals; General|12-15-15-12. Budget Committee Review of Medicaid Reimbursement to Children's Hospitals Bordering Indiana; Provision of Information; Expiration

Sec. 12. (a) By November 1, 2022, and by November 1, 2023, the budget committee shall review the Medicaid reimbursements provided under section 1.2 of this chapter for children's hospitals that are located in a state bordering Indiana. The budget committee's review shall include the following for patients who are less than nineteen (19) years of age:(1) For the state fiscal year most recently ended:(A) the total number of inpatients served;(B) the total number of outpatients served;(C) the total amount of state funding expended for inpatient services; and(D) the total amount of state funding expended for outpatient services.(2) In the case of the first review by November 1, 2022, for the current state fiscal year:(A) an estimate of the total number of inpatients expected to be served;(B) an estimate of the total number of outpatients expected to be served;(C) an estimate of the total amount of state funding expected to be expended for inpatient services; and(D) an estimate of the total amount of state funding expected to be expended for outpatient services.(b) Each children's hospital located in a state bordering Indiana that receives state funding under section 1.2 of this chapter shall provide the information required by subsection (a) to the family and social services administration not later than August 1, 2022, and August 1, 2023.(c) This section expires January 1, 2024.As added by P.L.132-2021, SEC.3.