reglab/statecodes huggingface dataset:
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 37. Medicaid Demonstration Projects › 12-15-37-2. Waivers From Department of Health and Human Services; Eligible Projects

Sec. 2. After completing the review under section 1 of this chapter, the office, under the guidance of the Indiana department of health, may seek waivers from the United States Department of Health and Human Services to establish one (1) or more of the following demonstration projects, the goal of each of which is to provide a more cost effective means of providing health care coverage for certain Medicaid eligible individuals:
(1) Enrolling the designated recipients in prepaid health care delivery plans.
(2) Establishing medical savings accounts for designated recipients.
(3) Purchasing a private insurance product for designated recipients.
(4) Notwithstanding IC 12-15-5, redesigning the package of Medicaid benefits and services offered to designated recipients. Any package offered to designated recipients under this subdivision must include those services that may be provided within the scope of a provider's license if the service is covered under IC 12-15-12.
(5) Integrating the designated recipients into an already established risk pool.
As added by P.L.93-1995, SEC.4. Amended by P.L.56-2023, SEC.103.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 37. Medicaid Demonstration Projects › 12-15-37-3. Affidavit

Sec. 3. The Indiana department of health and the office may not implement any of the demonstration projects under section 2 of this chapter until the office, under the guidance of the Indiana department of health, files an affidavit with the governor that attests that the federal waivers applied for under section 2 of this chapter are in effect. The Indiana department of health and the office shall file the affidavit under this section not later than five (5) days after the Indiana department of health or the office are notified that the waiver is approved.
As added by P.L.93-1995, SEC.4. Amended by P.L.56-2023, SEC.104.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 37. Medicaid Demonstration Projects › 12-15-37-4. Time Limit for Implementation

Sec. 4. If a waiver is received from the United States Department of Health and Human Services and the governor receives the affidavit filed under section 3 of this chapter, the Indiana department of health, with guidance and input from the office, shall implement the demonstration project for which the waiver was granted not more than ninety (90) days after the governor receives the affidavit.
As added by P.L.93-1995, SEC.4. Amended by P.L.56-2023, SEC.105.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 37. Medicaid Demonstration Projects › 12-15-37-5. Rules for Implementation

Sec. 5. The Indiana department of health, with guidance and input from the office, shall adopt rules under IC 4-22-2 to implement a demonstration project for which a waiver is granted under this chapter.
As added by P.L.93-1995, SEC.4. Amended by P.L.56-2023, SEC.106.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 37. Medicaid Demonstration Projects › 12-15-37-6. Waiver Restrictions

Sec. 6. If the Indiana department of health and the office seek a waiver under this chapter to establish a managed care program or other demonstration project, the Indiana department of health and the office shall not seek a waiver of:
(1) federally qualified health centers and rural health clinic services as mandatory Medicaid services under:
(A) 42 U.S.C. 1396a(10)(A);
(B) 42 U.S.C. 1396d(a)(2)(B); and
(C) 42 U.S.C. 1396d(a)(2)(C); or
(2) reasonable cost reimbursement for federally qualified health centers and rural health clinics under 42 U.S.C. 1396a(a)(13)(C).
As added by P.L.93-1995, SEC.4. Amended by P.L.14-2000, SEC.30; P.L.56-2023, SEC.107.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 37. Medicaid Demonstration Projects › 12-15-37-7. Stroke Prevention and Treatment Programs

Sec. 7. The office and the Indiana department of health may collaborate with the American Heart Association to reduce the cost of stroke treatment and improve the outcome of stroke patients in the state. The collaboration may include the following:
(1) The development and implementation of a comprehensive statewide public education program on stroke prevention that is targeted at high-risk populations and at geographical areas that have a high incidence of stroke.
(2) The recommendation and dissemination of guidelines on the treatment of stroke patients, including emergency stroke care.
(3) The development of a program that would ensure that the public and health care providers are informed concerning the most effective stroke prevention strategies.
(4) The dissemination of information concerning public and private grant opportunities available for hospitals and providers of emergency medical services for the purposes of improving stroke patient care.
As added by P.L.224-2003, SEC.82. Amended by P.L.56-2023, SEC.108.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 38. Examination of Funds › 12-15-38-1. Restrictions on Examination of Availability of Medicaid Funds for Ineligible Individuals

Sec. 1. (a) The Indiana department of health, with guidance and input from the office, shall examine and study the availability of funds that require a waiver and funds that do not require a waiver from the United States Secretary of Health and Human Services that may be:
(1) used to fund a demonstration project to provide health care to individuals who do not qualify for coverage under IC 12-15-2 on July 1, 1995; and
(2) eligible for federal financial participation, other matching funds from the federal government, or grants from the federal government.
(b) The examination of funds under this section is restricted to funding sources not used in the Medicaid program on June 30, 1995, and may not include funds authorized for planning and starting nonprofit community based primary health care centers.
As added by P.L.93-1995, SEC.5. Amended by P.L.2-1996, SEC.245; P.L.56-2023, SEC.109.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 38. Examination of Funds › 12-15-38-2. Use of Medicaid Funds for Development of Health Care Plan and Delivery System

Sec. 2. If the Indiana department of health, with guidance and input from the office, identifies funds under section 1 of this chapter, the Indiana department of health may develop a health care plan and delivery system that uses the funds under the Medicaid program to provide health insurance for individuals who would not qualify for coverage under IC 12-15-2. The plan may include providing insurance through the private health insurance system.
As added by P.L.93-1995, SEC.5. Amended by P.L.56-2023, SEC.110.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 38. Examination of Funds › 12-15-38-3. Authority to Apply for Waiver

Sec. 3. If the Indiana department of health and the office develop a plan that requires a waiver from federal Medicaid law, the office may apply for the necessary waiver from the appropriate authority to implement the program under section 2 of this chapter.
As added by P.L.93-1995, SEC.5. Amended by P.L.56-2023, SEC.111.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 38. Examination of Funds › 12-15-38-4. Reports

Sec. 4. Before July 1, 1996, the Indiana department of health and the office shall submit a report to the general assembly summarizing the study conducted under section 1 of this chapter and any health care plans developed under section 2 of this chapter.
As added by P.L.93-1995, SEC.5. Amended by P.L.56-2023, SEC.112.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 38. Examination of Funds › 12-15-38-5. Interagency Agreement Permitted for Indiana Department of Health to Act in Accordance With Federal Requirements

Sec. 5. The Indiana department of health and the office shall enter into an interagency agreement to allow the Indiana department of health to carry out the department's responsibilities under this chapter in accordance with federal requirements.
As added by P.L.93-1995, SEC.5. Amended by P.L.56-2023, SEC.113.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39. Intermediate Care Facilities for Individuals With Intellectual Disabilities Medicaid Waiver Expansion › 12-15-39-1. "Conversion"

Sec. 1. As used in this section, "conversion" means:
(1) the permanent closure of a Medicaid funded intermediate care facility for individuals with intellectual disabilities bed, including intermediate care facilities for individuals with intellectual disabilities licensed under IC 16-28-2, facilities licensed under IC 12-28-5 and certified under Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) as an intermediate care facility for individuals with intellectual disabilities, and state institutions; and
(2) the use of the state funds that paid the state share of Medicaid funding for the beds described in subdivision (1) to fund the expansion of the number of individuals receiving waiver services under an intermediate care facility for individuals with intellectual disabilities Medicaid waiver.
As added by P.L.112-1997, SEC.4. Amended by P.L.35-2016, SEC.45.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39. Intermediate Care Facilities for Individuals With Intellectual Disabilities Medicaid Waiver Expansion › 12-15-39-2. Duties of Division

Sec. 2. The division shall do the following:
(1) Assist providers who provide for the voluntary conversion of Medicaid funded intermediate care facility for individuals with intellectual disabilities beds.
(2) Assist in securing appropriate placements for individuals who reside in the intermediate care facility for individuals with intellectual disabilities beds that are converted. However, an individual may not be moved from an intermediate care facility for individuals with intellectual disabilities bed until an appropriate alternative placement is available.
As added by P.L.112-1997, SEC.4. Amended by P.L.35-2016, SEC.46.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39. Intermediate Care Facilities for Individuals With Intellectual Disabilities Medicaid Waiver Expansion › 12-15-39-3. Use of Savings From Conversion to Expand Waiver Services

Sec. 3. Any savings that may result from a conversion under this chapter of an intermediate care facility for individuals with intellectual disabilities licensed under IC 16-28-2 or a state institution must be used to expand waiver services under an intermediate care facility for individuals with intellectual disabilities Medicaid waiver to individuals throughout Indiana.
As added by P.L.112-1997, SEC.4. Amended by P.L.35-2016, SEC.47.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-0.5. Asset Disregard; Date for Discontinuing Long Term Care Program

Sec. 0.5. (a) Notwithstanding IC 12-15-39.8, the asset disregard under section 10 of this chapter applies to any qualified long term care policy to which this chapter applies.
(b) This chapter does not apply to a qualified long term care policy issued after the long term care program established by this chapter is discontinued.
(c) Subject to section 12 of this chapter, the long term care program established by this chapter is discontinued on the date set forth under IC 12-15-1.3-22(b)(2)(B)(ii) in the statement published in the Indiana Register by the office of Medicaid policy and planning.
As added by P.L.196-2021, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-1. "Long Term Care" Defined

Sec. 1. As used in this chapter, "long term care" means the provision of the following services in a setting other than an acute care wing of a hospital to enable individuals whose functional capacities are chronically impaired to be maintained at their maximum level of health and well-being:
(1) Physician's services.
(2) Nursing services.
(3) Diagnostic services.
(4) Therapeutic services, including physical therapy, speech therapy, and occupational therapy.
(5) Rehabilitative services.
(6) Maintenance services.
(7) Personal care services, including companion services and assistance in bathing, dressing, and other skills of daily living.
(8) Transportation services.
(9) Day care services.
(10) Home health care services.
(11) Respite care services.
(12) Services provided in a facility licensed under IC 16-28.
(13) Services provided by chiropractors, podiatrists, and optometrists.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-3. "Long Term Care Insurance" Defined

Sec. 3. (a) As used in this chapter, "long term care insurance" means insurance coverage for at least twelve (12) consecutive months for each covered person on an expense incurred, indemnity, or prepaid basis for one (1) or more necessary long term care services provided in a setting other than an acute care wing of a hospital.
(b) The term does not include payment:
(1) of coinsurance, deductibles, or premiums for other insurance policies;
(2) for services covered by other insurance policies; or
(3) for services covered by Parts A and B of the Medicare program (42 U.S.C. 1395 et seq.).
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-4. "Health Maintenance Organization" Defined

Sec. 4. As used in this chapter, "health maintenance organization" has the meaning set forth in IC 27-13-1-19.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-5. "Qualified Long Term Care Policy" Defined

Sec. 5. As used in this chapter, "qualified long term care policy" means an insurance policy that:
(1) provides long term care insurance;
(2) meets:
(A) the definition set forth in IC 27-8-12-5; and
(B) the standards established under IC 27-8-12-7.1; and
(3) is issued by an insurer or other person who complies with section 9(a) of this chapter.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-6. Establishment and Administration of Program

Sec. 6. (a) The Indiana long term care program is established to do the following:
(1) Provide incentives for individuals to insure against the costs of providing for their long term care needs.
(2) Provide a mechanism for individuals to qualify for coverage of the costs of their long term care needs under the Medicaid program without first being required to substantially exhaust all their resources.
(3) Assist in developing methods for increasing access to and the affordability of a long term care policy.
(4) Provide counseling services to individuals in planning for their long term care needs.
(5) Alleviate the financial burden on the state's medical assistance program by encouraging the pursuit of private initiatives.
(b) The office of Medicaid policy and planning and the department of insurance shall administer the program. The department of insurance may contract with a local office of aging services, an area agency on aging, or other nonprofit organization to provide counseling services under the program. The department of insurance shall develop and coordinate a plan to provide counseling services under the program.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-7. Information on Long Term Care Insurance; Availability; Assistance

Sec. 7. (a) The department of insurance or the agency with which the department of insurance has contracted under section 6(b) of this chapter shall make available to any individual interested in participating in a long term care program information concerning the following:
(1) The Indiana long term care program established under this chapter.
(2) The Indiana long term care insurance partnership program established under IC 12-15-39.8.
(3) Long term care insurance policies, including:
(A) qualified long term care policies that meet the definition set forth in section 5 of this chapter; and
(B) qualified long term care insurance policies that meet the definition set forth in IC 12-15-39.8-3.
(4) Medicare supplement insurance policies.
(5) Parts A and B of the Medicare program (42 U.S.C. 1395 et seq.).
(6) Health maintenance organizations under IC 27-13 that are contracted with the Medicare program.
(7) The Medicaid program.
(b) If an individual elects to pursue any of the options under subsection (a), the department of insurance shall assist the individual in doing so.
As added by P.L.24-1997, SEC.53. Amended by P.L.196-2021, SEC.5.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-8. Eligibility

Sec. 8. An individual who is either:
(1) the beneficiary of a qualified long term care policy approved by the department of insurance; or
(2) enrolled in a health maintenance organization that both provides long term care services and meets the requirements under sections 4 and 5 of this chapter;
is eligible for assistance under the Medicaid program using the asset disregard under section 10 of this chapter.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-9. Policy Provisions

Sec. 9. (a) An insurer or other person who issues a qualified long term care policy under this chapter must at a minimum offer to each policyholder or prospective policyholder a policy that provides both:
(1) long term care facility coverage; and
(2) home and community care coverage.
(b) An insurer or other person who complies with subsection (a) may also elect to offer a qualified long term care policy that provides only long term care facility coverage.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-10. Asset Disregard Adjustment

Sec. 10. (a) As used in this section, "asset disregard" means one (1) of the following:
(1) A one dollar ($1) increase in the amount of assets an individual who:
(A) purchases a qualified long term care policy; and
(B) meets the requirements under section 8 of this chapter;
may retain under IC 12-15-3 for each one dollar ($1) of benefit paid out under the individual's long term care policy for long term care services.
(2) The total assets an individual owns and may retain under IC 12-15-3 and still qualify for benefits under IC 12-15 at the time the individual applies for benefits if the individual:
(A) is the beneficiary of a qualified long term care policy that provides maximum benefits at time of purchase of at least one hundred forty thousand dollars ($140,000) and includes a provision under which the daily benefit increases by at least five percent (5%) per year, compounded at least annually;
(B) meets the requirements under section 8 of this chapter; and
(C) has exhausted the benefits of the qualified long term care policy.
(b) When the office determines whether an individual is eligible for Medicaid under IC 12-15-3, the office shall:
(1) make an asset disregard adjustment for any individual who purchases a qualified long term care policy; and
(2) if the assets owned by the individual's spouse are included in the individual's eligibility determination, include the assets of the individual's spouse in the asset disregard adjustment.
The asset disregard must be available after benefits of the long term care policy have been applied to the cost of long term care as required under this chapter.
(c) The qualified long term care policy an individual must purchase to be eligible for the asset disregard under subsection (a)(2) must have maximum benefits at time of purchase equal to at least one hundred forty thousand dollars ($140,000) plus five percent (5%) interest compounded annually beginning January 1, 1999.
As added by P.L.24-1997, SEC.53. Amended by P.L.2-1998, SEC.39; P.L.146-2015, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-11. Application of Asset Disregard to Determination of Individual's Assets

Sec. 11. A public program administered by the state that:
(1) provides long term care services; and
(2) bases eligibility upon the amount of the individual's assets;
must apply the asset disregard under section 10 of this chapter in determining the amount of the individual's assets.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-12. Discontinuation of Program

Sec. 12. If the Indiana long term care program is discontinued, an individual who purchased a qualified long term care policy prior to the date the program is discontinued is eligible to receive an asset disregard as defined under section 10 of this chapter.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-13. Reciprocal Agreements to Extend Asset Disregard

Sec. 13. The office of Medicaid policy and planning may enter into reciprocal agreements with other states to extend the asset disregard under section 10 of this chapter to Indiana residents who had purchased qualified long term care policies in other states.
As added by P.L.24-1997, SEC.53.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.6. Long Term Care Program › 12-15-39.6-15. Asset Disregard for Long Term Care Policyholders

Sec. 15. An individual who:
(1) owns, as of January 1, 1998, a qualified long term care policy; and
(2) has not exhausted the benefits of the qualified long term care policy described in subdivision (1);
is entitled to receive an asset disregard as provided in section 10 of this chapter.
As added by P.L.16-2009, SEC.19.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.8. Long Term Care Insurance Partnership Program › 12-15-39.8-1. Applicability of Chapter

Sec. 1. This chapter applies to qualified long term care insurance policies that are entered into, issued, or renewed after June 30, 2022.
As added by P.L.196-2021, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.8. Long Term Care Insurance Partnership Program › 12-15-39.8-2. "Program"

Sec. 2. As used in this chapter, "program" means the Indiana long term care insurance partnership program established by section 4(a) of this chapter.
As added by P.L.196-2021, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.8. Long Term Care Insurance Partnership Program › 12-15-39.8-3. "Qualified Long Term Care Insurance Policy"

Sec. 3. As used in this chapter, "qualified long term care insurance policy" means an insurance policy that meets the following requirements:
(1) The policy covers an individual who was a resident of the state when the coverage first became effective under the policy.
(2) The policy was not issued before the effective date of the state plan amendment applied for under IC 12-15-1.3-22.
(3) The policy meets the definition of a qualified long term care insurance contract under 26 U.S.C. 7702B.
(4) The policy meets the model regulations and requirements of the model act of the National Association of Insurance Commissioners provided in 42 U.S.C. 1396p(b)(5).
(5) The policy includes inflation protection as follows:
(A) If the policy is sold to an individual who was less than sixty-one (61) years of age as of the date of purchase, the policy must provide compound inflation protection.
(B) If the policy is sold to an individual who was at least sixty-one (61) years of age but less than seventy-six (76) years of age as of the date of purchase, the policy must provide some level of inflation protection.
(C) If the policy is sold to an individual who is at least seventy-six (76) years of age, the policy may, but is not required to, provide some level of inflation protection.
(6) The department of insurance certifies that the policy meets the requirements of subdivisions (3), (4), and (5).
As added by P.L.196-2021, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.8. Long Term Care Insurance Partnership Program › 12-15-39.8-4. Establishment and Administration of Program

Sec. 4. (a) The Indiana long term care insurance partnership program is established.
(b) The office of Medicaid policy and planning and the department of insurance shall administer the program in accordance with Section 6021 of the federal Deficit Reduction Act of 2005.
As added by P.L.196-2021, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.8. Long Term Care Insurance Partnership Program › 12-15-39.8-5. Applying Asset Disregard

Sec. 5. Under the program, the office of Medicaid policy and planning must exclude and disregard an amount equal to the amount of benefits an individual receives under a qualified long term care insurance policy when determining the following:
(1) The individual's resources for purposes of determining eligibility for Medicaid under IC 12-15-3.
(2) The amount to be recovered from the individual's estate under IC 12-15-9 if the individual is eligible for Medicaid.
As added by P.L.196-2021, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.8. Long Term Care Insurance Partnership Program › 12-15-39.8-6. Training Program for Insurance Producers

Sec. 6. (a) The department of insurance shall develop a training program for insurance producers who sell qualified long term care insurance policies that includes a certified prelicensing course and continuing education courses. The courses must cover, at a minimum, the following topics:
(1) State and federal regulations and requirements and the relationship between qualified long term care insurance policies and other public and private coverage of long term care services, including Medicaid.
(2) Available long term care services and providers.
(3) Changes or improvements in long term care services or providers.
(4) Alternatives to the purchase of private long term care insurance.
(5) The effect of inflation on benefits and the importance of inflation protection.
(6) Consumer suitability standards and guidelines.
(b) An insurance producer must:
(1) complete the certified prelicensing course established under subsection (a) before the insurance producer may sell, solicit, or negotiate a qualified long term care insurance policy; and
(2) attend a continuing education course established under subsection (a) at least once every twenty-four (24) months to continue to sell, solicit, or negotiate a qualified long term care insurance policy.
As added by P.L.196-2021, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 39.8. Long Term Care Insurance Partnership Program › 12-15-39.8-7. Reporting Requirements

Sec. 7. An insurer that issues a qualified long term care insurance policy shall provide regular reports to:
(1) the Secretary of the United States Department of Health and Human Services, as required by federal regulations; and
(2) the office of Medicaid policy and planning and the department of insurance, as required by those entities.
As added by P.L.196-2021, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 40. Payment for Hospice Services › 12-15-40-2. "Hospice" Defined

Sec. 2. (a) As used in this chapter, "hospice" means a person or health care provider who owns or operates a hospice program or facility, or both, that uses an interdisciplinary team directed by a licensed physician to provide a program of planned and continuous care for hospice program patients and their families.
(b) The term includes a program that:
(1) provides a continuum of medical or nursing care and other hospice services to hospice program patients that complies with:
(A) the:
(i) conditions of participation for inpatient units under 42 U.S.C. 1395 et seq.; and
(ii) accreditation standards as provided in the Medicare program under 42 U.S.C. 1395x(dd)(2); and
(B) standards adopted under this article; and
(2) provides hospice services to hospice program patients and complies with standards adopted under this article.
As added by P.L.24-1997, SEC.54.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 40. Payment for Hospice Services › 12-15-40-3. "Hospice Program" Defined

Sec. 3. (a) As used in this chapter, "hospice program" means a specialized form of interdisciplinary health care that is designed to alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phase of a terminal illness or disease.
(b) The term does not include services provided by a hospital, a health facility, an ambulatory outpatient surgical center, or a home health agency unless the entity has a distinct hospice program.
As added by P.L.24-1997, SEC.54.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 40. Payment for Hospice Services › 12-15-40-4. "Hospice Program Patient" Defined

Sec. 4. As used in this chapter, "hospice program patient" means a terminally ill patient who:
(1) has been diagnosed by a licensed physician as having a terminal illness;
(2) is expected to die from the terminal illness within six (6) months; and
(3) receives hospice services from a hospice program.
As added by P.L.24-1997, SEC.54.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 40. Payment for Hospice Services › 12-15-40-5. "Hospice Services" Defined

Sec. 5. As used in this chapter, "hospice services" means:
(1) palliative care for the physical, psychological, social, spiritual, and other special needs of a hospice program patient during the final stages of a hospice program patient's terminal illness; and
(2) care for the psychological, social, spiritual, and other needs of the hospice program patient's family before and after the hospice program patient's death.
As added by P.L.24-1997, SEC.54.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 40. Payment for Hospice Services › 12-15-40-6. Payment Rate

Sec. 6. The office shall, under 42 U.S.C. 1396 et seq., establish a payment rate to a hospice program for hospice services provided to hospice program patients who are eligible for medical assistance under this article.
As added by P.L.24-1997, SEC.54.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 40. Payment for Hospice Services › 12-15-40-7. Conditions of Payment

Sec. 7. Payment to a hospice program must meet the following conditions:
(1) Be determined in accordance with a prospective payment rate that is reasonable and adequate to meet the costs that must be incurred by efficiently and economically operated hospice programs to provide services in conformity with applicable state and federal laws, rules, and regulations, including the federal Social Security Act, and quality and safety standards.
(2) Include the increased costs for medical care, including physician and nursing care, intensive case management, social services, and pharmaceutical and allied health costs.
As added by P.L.24-1997, SEC.54.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-1. "Buy-in Program"

Sec. 1. As used in this chapter, "buy-in program" refers to the Medicaid buy-in program for working individuals with disabilities established by section 3 of this chapter.
As added by P.L.287-2001, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-2. "Countable Resources"

Sec. 2. As used in this chapter, "countable resources" means all cash, other liquid assets, real property, and personal property owned by an applicant for or a recipient of Medicaid under this chapter, or the spouse of an applicant or a recipient, that could be converted to cash to be used for support or maintenance, except the following:
(1) All resources disregarded by the office under this article for the purpose of determining eligibility for Medicaid.
(2) Any resource eligible for exclusion under 42 U.S.C. 1396a(r)(2), including a retirement account established under 26 U.S.C. 220 and held by either the applicant or recipient or the applicant's or recipient's spouse.
(3) Subject to approval by the office, not more than twenty thousand dollars ($20,000) in independence and self-sufficiency accounts held by the applicant or recipient for the sole purpose of purchasing goods or services, including assistive technology and personal assistance, that:
(A) will increase the employability or independence of the applicant or recipient; and
(B) are not services to which the recipient is entitled under Medicaid or any other publicly funded program.
As added by P.L.287-2001, SEC.9. Amended by P.L.197-2011, SEC.42.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-3. Establishment

Sec. 3. The Medicaid buy-in program for working individuals with disabilities is established to provide, beginning July 1, 2002, Medicaid to individuals who are disabled and employed, as authorized under Section 201 of the federal Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106-170, 42 U.S.C. 1396 et seq.).
As added by P.L.287-2001, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-4. Exemptions From Eligibility Requirements

Sec. 4. To participate in the buy-in program beginning July 1, 2002, an individual must meet the eligibility requirements under IC 12-15-2-6, except as follows:
(1) The individual has a severe medically determinable impairment without regard to the individual's employment status.
(2) The individual must be at least sixteen (16) years of age but not more than sixty-four (64) years of age.
(3) The individual must be engaged in a substantial and reasonable work effort as determined by the office and as permitted by federal law.
(4) The individual does not have countable resources that exceed the resource limits for the federal Supplemental Security Income program (42 U.S.C. 1382).
(5) The individual's annual gross income does not exceed three hundred fifty percent (350%) of the federal income poverty level for an individual. In determining an individual's income under this subdivision, the office may not consider the following:
(A) The income of the individual's spouse.
(B) Income disregarded under the state Medicaid plan's financial methodology, including income disregarded under the federal Supplemental Security Income program (42 U.S.C. 1382) as impairment related work expenses (IRWE).
As added by P.L.287-2001, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-5. Continued Eligibility Requirements After Change in Circumstances

Sec. 5. An individual who is enrolled in the buy-in program and who no longer meets the eligibility requirements set forth in section 4 of this chapter due to an improvement in the individual's medical condition continues to be eligible for Medicaid coverage under the buy-in program if the individual meets the following requirements:
(1) The individual continues to have a severe medically determinable impairment, as determined by the office and as allowed by federal law.
(2) The individual is employed and earning a monthly wage that is not less than the federal minimum hourly wage times forty (40).
(3) The individual does not have income or countable resources in excess of the limits established under section 4 of this chapter.
(4) The individual is at least sixteen (16) years of age and less than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing required under this chapter.
(6) The individual meets all other eligibility requirements under this chapter.
As added by P.L.287-2001, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-6. Continued Eligibility if Unable to Maintain Employment

Sec. 6. (a) An individual who is enrolled in the buy-in program and who is unable to maintain employment for involuntary reasons, including temporary leave due to a health problem or involuntary termination, continues to be eligible for Medicaid coverage under the buy-in program if the individual meets the following requirements:
(1) Within sixty (60) days after the date on which the individual becomes unemployed, the individual, or an authorized representative of the individual, submits a written request to the office that the individual's Medicaid coverage be continued.
(2) The individual maintains a connection to the workforce during the individual's continued eligibility period by participating in at least one (1) of the following activities:
(A) Enrollment in a state or federal vocational rehabilitation program.
(B) Enrollment or registration with the office of workforce development.
(C) Participation in a transition from school to work program.
(D) Participation with an approved provider of employment services.
(E) Provision of documentation from the individual's employer that the individual is on temporary involuntary leave.
(3) The individual does not have income or countable resources in excess of the limits established under section 4 of this chapter.
(4) The individual is at least sixteen (16) years of age and less than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing required under this chapter.
(6) The individual meets all other eligibility requirements under this chapter.
(b) The office shall continue Medicaid coverage under the buy-in program for an individual described in subsection (a) for up to twelve (12) months from the date of the individual's involuntary loss of employment.
(c) If an individual is ineligible for continued coverage under the buy-in program because the individual:
(1) fails to meet the requirements of subsection (a); or
(2) has already met twelve (12) months of continuing eligibility under this section;
the individual must meet the eligibility requirements of IC 12-15-2-6 to continue to be eligible for Medicaid.
As added by P.L.287-2001, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-7. Sliding Scale of Premiums

Sec. 7. (a) The office shall develop a sliding scale of premiums for individuals participating in the buy-in program.
(b) The sliding scale of premiums required under subsection (a) must:
(1) be based on the annual gross income of the individual and, if married, the individual's spouse; and
(2) provide for a minimum monthly premium of twenty-five dollars ($25) and a maximum monthly premium of two hundred seventy-five dollars ($275).
(c) Subject to the minimum and maximum amounts described in subsection (b), the office may annually adjust the scale of premiums adopted under this section.
As added by P.L.287-2001, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-8. Premiums

Sec. 8. (a) An individual whose gross annual income, including the gross annual income of the individual's spouse, if married, is less than one hundred fifty percent (150%) of the federal income poverty level for the size of the individual's or couple's family may not be required to pay a premium to participate in the buy-in program.
(b) An individual whose gross annual income, including the gross annual income of the individual's spouse, if married, is at least one hundred fifty percent (150%) but not more than three hundred fifty percent (350%) of the federal income poverty level for the size of the individual's or couple's family, must pay a monthly premium in an amount equal to:
(1) the lesser of:
(A) the amount prescribed by the sliding scale developed by the office under section 7 of this chapter; or
(B) seven and one-half percent (7 1/2%) of the individual's or couple's gross annual income divided by twelve (12); minus
(2) the monthly amount of any premium paid by the individual, the individual's spouse, or the individual's parent for health insurance that covers the individual.
As added by P.L.287-2001, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-9. Annual Review of Premiums; Adjustment of Premiums

Sec. 9. (a) The office shall annually review the amount of the premium that an individual is required to pay under section 8 of this chapter.
(b) In addition to the annual review required under subsection (a), the office shall adjust the premium that an individual is required to pay under section 8 of this chapter if:
(1) a change in the individual's income or family size is verified; and
(2) the sliding scale adopted under section 7 of this chapter applied to the individual's changed circumstances prescribes a premium for the individual that is different from the premium the individual is paying.
As added by P.L.287-2001, SEC.9. Amended by P.L.26-2003, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-10. Administrative Procedures Regarding Premiums

Sec. 10. To the greatest extent possible, the office shall use the same administrative procedures regarding premiums for the buy-in program as are used for the children's health insurance program established under IC 12-17.6, including:
(1) the effect of nonpayment of a premium; and
(2) the collection of premiums.
As added by P.L.287-2001, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-11. Annual Redetermination of Disability

Sec. 11. (a) The office shall establish criteria to base the annual redetermination of disability required under 405 IAC 2-2-3(b) for an individual participating in the buy-in program on the individual's medical evidence, including evidence of physical or mental impairment.
(b) In conducting the annual redetermination described in subsection (a), the office may not determine that an individual participating in the buy-in program is no longer an individual with a disability based solely on the individual's:
(1) participation in employment;
(2) earned income; or
(3) income from self-employment.
As added by P.L.287-2001, SEC.9. Amended by P.L.99-2007, SEC.96.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 41. Medicaid Buy-in Program for Working Individuals With Disabilities › 12-15-41-12. Home Health Care Services; Cost Sharing

Sec. 12. Except as otherwise provided in this chapter, an individual participating in the buy-in program:
(1) shall receive the same benefits, including home health care services; and
(2) is subject to the same requirements, including cost sharing;
as an individual receiving Medicaid under IC 12-15-2-6.
As added by P.L.287-2001, SEC.9.
2023 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.
2023 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.
2023 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.
2023 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.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-1. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.213-2015, SEC.130. Repealed by P.L.30-2016, SEC.5.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-3. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.213-2015, SEC.131. Repealed by P.L.30-2016, SEC.7.