reglab/housing_qa huggingface dataset:
IN Code § 12-15-11-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11. Provider Agreements and Competitive Bidding|12-15-11-2. Provider Agreement; Filing

Sec. 2. A provider desiring to participate in the Medicaid program by providing to individuals eligible for Medicaid services shall file a provider agreement with the office on forms provided by the office.[Pre-1992 Revision Citation: 12-1-7-15.1(b) part.]As added by P.L.2-1992, SEC.9. Amended by P.L.195-2018, SEC.3.
IN Code § 12-15-11-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11. Provider Agreements and Competitive Bidding|12-15-11-3. Provider Agreement Requirements

Sec. 3. A provider agreement must do the following:(1) Include information that the office determines necessary to facilitate carrying out of IC 12-15.(2) Prohibit the provider from requiring payment from a recipient of Medicaid, except where a copayment is required by law.(3) For providers categorized as high risk to the Medicaid program under 42 U.S.C. 1395cc(j)(2)(B) and 42 CFR 455.450, require the submission of necessary information, forms, or consents for the office to obtain a national criminal history background check or, as allowed by the office, a fingerprint-based criminal history check, through a contractor under IC 12-15-30 or the state police department under IC 10-13-3-39 of any person who:(A) holds at least a five percent (5%) ownership interest in a facility or entity; or(B) is a member of the board of directors of a nonprofit facility or entity;in which the provider applicant plans to provide Medicaid services under the provider agreement. The provider applicant is responsible for the cost of the national criminal history background check or fingerprint-based criminal history check.[Pre-1992 Revision Citation: 12-1-7-15.1(b) part.]As added by P.L.2-1992, SEC.9. Amended by P.L.197-2013, SEC.12; P.L.35-2016, SEC.38.
IN Code § 12-15-11-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11. Provider Agreements and Competitive Bidding|12-15-11-4. Provider Agreement to Provide Physician Services; Site Visit for Moderate or High Categorical Risk Designees

Sec. 4. (a) A provider desiring to participate in the Medicaid program by providing physician services as a managed care provider must enter into a provider agreement with the office or the contractor under IC 12-15-30 to provide Medicaid services.(b) Before the office may approve a provider agreement, the office shall conduct a pre-enrollment site visit for provider applicants that are designated as moderate or high categorical risks to the Medicaid program under 42 U.S.C. 1395cc(j)(2)(B) and 42 CFR 455.450.[Pre-1992 Revision Citation: 12-1-7-15.1(c).]As added by P.L.2-1992, SEC.9. Amended by P.L.197-2013, SEC.13.
IN Code § 12-15-11-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11. Provider Agreements and Competitive Bidding|12-15-11-5. Compliance With Enrollment Requirements; Centralized Credentials Verification Organization

Sec. 5. (a) A provider who participates in the Medicaid program must comply with the enrollment requirements that are established under rules adopted under IC 4-22-2 by the secretary.(b) A provider who participates in the Medicaid program may be required to use the centralized credentials verification organization established in section 9 of this chapter.[Pre-1992 Revision Citation: 12-1-7-15.1(d).]As added by P.L.2-1992, SEC.9. Amended by P.L.195-2018, SEC.4.
IN Code § 12-15-11-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11. Provider Agreements and Competitive Bidding|12-15-11-6. Prohibition on Exclusion of Medicaid Provider From Participation in Medicaid and Other Networks

Sec. 6. (a) After a provider signs a provider agreement under this chapter, the office may not exclude the provider from participating in the Medicaid program by entering into an exclusive contract with another provider or group of providers, except as provided under section 7 of this chapter.(b) The office or a managed care organization contracting with the office may not prohibit a provider from participating in a network of another insurer, managed care organization, or health maintenance organization.[Pre-1992 Revision Citation: 12-1-7-15.1(e).]As added by P.L.2-1992, SEC.9. Amended by P.L.93-2020, SEC.1.
IN Code § 12-15-11-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11. Provider Agreements and Competitive Bidding|12-15-11-7. Competitive Bids; Services and Items for Which Bids May Be Sought

Sec. 7. The office may seek competitive bids for the following items or services provided under Medicaid:(1) Prescribed drugs and services for state operated institutions.(2) Physical therapy and other therapeutic services.(3) Prescribed laboratory and x-ray services.(4) Eyeglasses and prosthetic devices.(5) Medical equipment and supplies.(6) Transportation services.[Pre-1992 Revision Citation: 12-1-7-15.1(f).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-11-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11. Provider Agreements and Competitive Bidding|12-15-11-8. Use of Provider Identification Number; Prohibition on Limiting Claims for Primary Care Services

Sec. 8. (a) A community mental health center may use the center's provider identification number to file any Medicaid claim, including primary care health services, if the community mental health center:(1) is otherwise treating the individual for a mental health condition or an addictive disorder; and(2) meets the requirements to provide the services rendered.(b) The office may not require a community mental health center to obtain a separate provider identification number to provide services that the community mental health center meets the requirements to provide.(c) The office may not limit the filing of a Medicaid claim by a community mental health center for primary care services, mental health conditions, and addictive disorders on the same day as long as the claim is filed in accordance with the rules set forth by the office and the services are covered services and necessary to ensure coordinated care for the recipient.As added by P.L.185-2015, SEC.12.
IN Code § 12-15-11-9 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11. Provider Agreements and Competitive Bidding|12-15-11-9. Implementation of Centralized Credentials Verification Organization; Requirements; Prohibition on Requiring Additional Credentialing; Managed Care Organizations; Administrative Review; Rules

Sec. 9. (a) The office shall implement a centralized credentials verification organization and credentialing process that:(1) uses a common application, as determined by provider type;(2) issues a single credentialing decision applicable to all Medicaid programs, except as determined by the office;(3) recredentials and revalidates provider information not less than once every three (3) years;(4) requires attestation of enrollment and credentialing information every six (6) months; and(5) is certificated or accredited by the National Committee for Quality Assurance or its successor organization.(b) A managed care organization or contractor of the office may not require additional credentialing requirements in order to participate in a managed care organization's network. However, a contractor may collect additional information from the provider in order to complete a contract or provider agreement.(c) A managed care organization or contractor of the office is not required to contract with a provider.(d) A managed care organization or contractor of the office shall:(1) send representatives to meetings and participate in the credentialing process as determined by the office; and(2) not require additional credentialing information from a provider if a non-network credentialed provider is used.(e) Except when a provider is no longer enrolled with the office, a credential acquired under this chapter is valid until recredentialing is required.(f) An adverse action under this section is subject to IC 4-21.5.(g) The office may adopt rules under IC 4-22-2 to implement this section.As added by P.L.195-2018, SEC.5. Amended by P.L.32-2021, SEC.31.
IN Code § 12-15-11.5-0.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11.5. Lake County Disproportionate Share Hospitals|12-15-11.5-0.5. Nonapplicability to Certain Managed Care Organizations

Sec. 0.5. This chapter does not apply to a managed care organization that, on or before July 1, 2000, did not directly contract with a hospital (as defined in section 1 of this chapter) for the provision of services under the office's managed care program.As added by P.L.141-2001, SEC.1. Amended by P.L.152-2017, SEC.7.
IN Code § 12-15-11.5-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11.5. Lake County Disproportionate Share Hospitals|12-15-11.5-1. "Hospital"

Sec. 1. As used in this chapter, "hospital" refers to an acute care hospital provider that:(1) is licensed under IC 16-21;(2) qualifies as a disproportionate share hospital under IC 12-15-16; and(3) is the sole disproportionate share hospital in a city located in a county having a population of more than four hundred thousand (400,000) but less than seven hundred thousand (700,000).As added by P.L.142-2000, SEC.2.
IN Code § 12-15-11.5-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11.5. Lake County Disproportionate Share Hospitals|12-15-11.5-2. Hospital as Contracted Provider to Eligible Individuals

Sec. 2. The office's managed care organization shall regard a hospital as a contracted provider in the office's managed care program, which provides a capitated prepayment managed care system, for the provision of medical services to each individual who:(1) is eligible to receive services under IC 12-15 and has enrolled in the office's managed care services program;(2) resides in the same city in which the hospital is located; and(3) has selected a primary care provider who:(A) is a contracted provider with the office's managed care organization; and(B) has medical staff privileges at the hospital.As added by P.L.142-2000, SEC.2. Amended by P.L.141-2001, SEC.2; P.L.152-2017, SEC.8.
IN Code § 12-15-11.5-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11.5. Lake County Disproportionate Share Hospitals|12-15-11.5-6. Claim for Reimbursement Treated as Disputed Claim

Sec. 6. A claim for reimbursement for services shall be treated as a disputed claim under this chapter if:(1) it is submitted within one hundred twenty (120) days after the date that services are rendered;(2) it is denied by the managed care organization;(3) the hospital submits a written notice of dispute for the claim to the managed care organization not more than sixty (60) days after the receipt of the denial notice;(4) it is appealed in accordance with the managed care organization's internal appeals process; and(5) payment for the claim is denied by the managed care organization following its internal appeals process.As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.9.
IN Code § 12-15-11.5-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11.5. Lake County Disproportionate Share Hospitals|12-15-11.5-7. Conclusion of Appeal

Sec. 7. The office's managed care organization must conclude an appeal under section 6(4) of this chapter and notify the hospital of its decision not more than thirty-five (35) days after the managed care organization receives a notice from the hospital disputing the managed care organization's denial of a claim.As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.10.
IN Code § 12-15-11.5-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11.5. Lake County Disproportionate Share Hospitals|12-15-11.5-8. Dispute Resolution Procedure Requirements

Sec. 8. (a) A contract entered into by a hospital with the office's managed care organization for the provision of services under the office's managed care program must include a dispute resolution procedure for all disputed claims. Unless agreed to in writing by the hospital and the office's managed care organization, the dispute resolution procedure must include the following requirements:(1) That submission of disputed claims must be made to an independent arbitrator selected under subsection (b).(2) Each claim must set forth with specificity the issues to be arbitrated, the amount involved, and the relief sought.(3) That the hospital and the office's managed care organization shall attempt in good faith to resolve all disputed claims.(4) The hospital shall submit to the arbitrator any claims that remain in dispute sixty (60) calendar days after the hospital receives written notice as provided under section 7 of this chapter.(5) That resolution of disputes by the arbitrator must occur not later than ninety (90) calendar days after submission of disputed claims to the arbitrator, unless the parties mutually agree otherwise.(6) That determinations of the arbitrator are final and binding and not subject to any appeal or review procedure.(7) That the arbitrator does not have the authority to award any punitive or exemplary damages or to vary or ignore the terms of any contract between the parties and shall be bound by controlling law.(8) That judgment upon the award rendered by the arbitrator may be entered and enforced in and is subject to the jurisdiction of a court with jurisdiction in Indiana.(9) That the cost of the arbitrator must be shared equally by the parties, and each party must bear its own attorney and witness fees.(b) The parties to a contract described in subsection (a) shall mutually agree on an independent arbitrator, or, if the parties are unable to reach agreement on an independent arbitrator, the following procedure must be followed:(1) Each party shall select an independent representative, and the independent representatives shall select a panel of three (3) independent arbitrators who have experience in institutional and professional health care delivery practices and procedures and have had no prior dealing with either party other than as an arbitrator.(2) The parties will each strike one (1) arbitrator from the panel selected under subdivision (1), and the remaining arbitrator serves as the arbitrator of the disputed claims under subsection (a).(3) The procedures for selecting an arbitrator under this section must be completed not later than twenty (20) calendar days after the hospital provides written notice of at least one (1) disputed claim.As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.11.
IN Code § 12-15-11.5-9 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11.5. Lake County Disproportionate Share Hospitals|12-15-11.5-9. Arbitration Process for Dispute Resolution Between Hospital and Managed Care Organization

Sec. 9. The arbitration process described in section 8 of this chapter shall also be followed for resolution of disputed claims between a hospital and the office's managed care organization, if the hospital is not a contracted provider in the office's managed health care program.As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.12.
IN Code § 12-15-11.5-10 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 11.5. Lake County Disproportionate Share Hospitals|12-15-11.5-10. Arbitration of Disputed Claims

Sec. 10. A hospital and the managed care organization of the office shall use the arbitration procedure in section 8 of this chapter for the resolution of all disputed claims that have accrued as of March 17, 2000.As added by P.L.220-2011, SEC.265. Amended by P.L.152-2017, SEC.13.
IN Code § 12-15-12-0.3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-0.3. "Emergency Medical Condition"

Sec. 0.3. As used in this chapter, "emergency medical condition" means a medical condition manifesting itself by acute symptoms, including severe pain, of sufficient severity that a prudent lay person with an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in:(1) serious jeopardy to the health of:(A) the individual; or(B) in the case of a pregnant woman, the woman or her unborn child;(2) serious impairment to bodily functions; or(3) serious dysfunction of any bodily organ or part.As added by P.L.223-2001, SEC.4.
IN Code § 12-15-12-0.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-0.5. "Emergency Services"

Sec. 0.5. As used in this chapter, "emergency services" means covered inpatient and outpatient services that are:(1) furnished by a provider qualified to furnish emergency services; and(2) needed to evaluate or stabilize an emergency medical condition.As added by P.L.223-2001, SEC.5.
IN Code § 12-15-12-0.7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-0.7. "Post-Stabilization Care Services"

Sec. 0.7. As used in this chapter, "post-stabilization care services" means covered services related to an emergency medical condition that are provided after an enrollee is stabilized in order to maintain the stabilized condition or, under the circumstances described in IC 12-15-12-17(b)(3), to improve or resolve the enrollee's condition.As added by P.L.223-2001, SEC.6.
IN Code § 12-15-12-0.9 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-0.9. Applicability; Medicaid Law Controlling Over Conflicting Insurance Law

Sec. 0.9. (a) This section applies only with respect to the responsibilities of a managed care organization under:(1) this article;(2) IC 12-17.6;(3) 42 CFR 438; or(4) a rule adopted under a law described in subdivision (1) or (2).(b) Except as provided in IC 27-1-37.5 after December 31, 2020, if a provision of, or rule adopted under, IC 27 conflicts with the administration of the programs under a law described in subsection (a), the law described in subsection (a) is controlling.As added by P.L.152-2017, SEC.14. Amended by P.L.265-2019, SEC.1.
IN Code § 12-15-12-1 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-1. Providers From Whom Recipients May Obtain Services Other Than Physician Services; Exceptions

Sec. 1. Except as provided in sections 6, 7, and 8 of this chapter, a Medicaid recipient may obtain any Medicaid services, with the exception of physician services, from a provider who has entered into a provider agreement under IC 12-15-11.[Pre-1992 Revision Citation: 12-1-7-16.1(b).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-2 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-2. Providers From Whom Recipients May Receive Physician Services; Exceptions

Sec. 2. Except as provided in sections 8 and 9 of this chapter, a Medicaid recipient may receive physician services from a managed care provider selected by the recipient from a list of managed care providers furnished the recipient by the office.[Pre-1992 Revision Citation: 12-1-7-16.1(c) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-3 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-3. List of Managed Care Providers Furnished Recipient; Providers Included; Exception

Sec. 3. Except as provided in section 9 of this chapter, the list of managed care providers furnished the recipient must include the names of all managed care providers who meet the following requirements:(1) Have entered into a provider agreement with the office under IC 12-15-11 to provide physician services to Medicaid recipients.(2) Provide physician services in the geographic area in which the recipient resides.[Pre-1992 Revision Citation: 12-1-7-16.1(c) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-4 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-4. Failure by Recipient to Select Managed Care Provider Within Reasonable Time; Assignment by Office; Exception

Sec. 4. Except as provided in section 9 of this chapter, if a recipient fails to select a managed care provider within a reasonable time after the list is furnished the recipient, the office may assign a managed care provider to the recipient.[Pre-1992 Revision Citation: 12-1-7-16.1(c) part.]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-4.5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-4.5. Managed Care Prescription Drug Program Requirements

Sec. 4.5. A managed care provider's contract or provider agreement with the office may include a prescription drug program, subject to IC 12-15-5-5, IC 12-15-35, and IC 12-15-35.5.As added by P.L.101-2005, SEC.2.
IN Code § 12-15-12-5 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-5. Circumstances Permitting Recipient to Receive Physician Services From Provider Other Than Managed Care Provider; Exceptions

Sec. 5. Except as provided in sections 6 and 7 of this chapter, a Medicaid recipient may not receive physician services from a provider other than the managed care provider selected by the recipient under section 2 of this chapter, except as follows:(1) In an emergency.(2) Upon the written referral of the managed care provider.(3) As provided in sections 6 through 9 of this chapter.[Pre-1992 Revision Citation: 12-1-7-16.1(d).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-6 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-6. Admission to Hospital by Physician Other Than Managed Care Provider; Notification of Managed Care Provider; Services for Which Payment Made

Sec. 6. (a) A Medicaid recipient may be admitted to a hospital by a physician other than the recipient's managed care provider if the recipient requires immediate medical treatment.(b) The admitting physician shall notify the recipient's managed care provider of the recipient's admission not more than forty-eight (48) hours after the recipient's admission.(c) Payment for services provided a recipient admitted to a hospital under this section shall be made only for services that the office or the contractor under IC 12-15-30 determines were medically reasonable and necessary.[Pre-1992 Revision Citation: 12-1-7-16.1(e).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-7 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-7. Providers From Whom Recipients May Obtain Eye Care Services Other Than Surgical Services

Sec. 7. A Medicaid recipient may obtain eye care services, except for surgical services, from any provider licensed under IC 25-22.5 or IC 25-24 who has entered into a provider agreement under IC 12-15-11.[Pre-1992 Revision Citation: 12-1-7-16.1(f).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-8 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-8. Providers From Whom Recipients May Obtain Foot Care Services

Sec. 8. A Medicaid recipient may obtain foot care services from any provider licensed under IC 25-22.5 or IC 25-29 who has entered into a provider agreement under IC 12-15-11.[Pre-1992 Revision Citation: 12-1-7-16.1(g).]As added by P.L.2-1992, SEC.9.
IN Code § 12-15-12-9 (2021)
2021 Indiana Code|Title 12. Human Services|Article 15. Medicaid|Chapter 12. Managed Care|12-15-12-9. Providers From Whom Recipients May Obtain Psychiatric Services

Sec. 9. A Medicaid recipient may obtain psychiatric services from any provider licensed under IC 25-22.5 who has entered into a provider agreement under IC 12-15-11.[Pre-1992 Revision Citation: 12-1-7-16.1(h).]As added by P.L.2-1992, SEC.9.