reglab/statecodes huggingface dataset:
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-4.5. Insurer's Acceptance of Medicaid Claims

Sec. 4.5. (a) An insurer shall accept a Medicaid claim for a Medicaid recipient for three (3) years from the date the service was provided.
(b) An insurer may not deny a Medicaid claim submitted by the office solely on the basis of:
(1) the date of submission of the claim;
(2) the type or format of the claim form;
(3) the method of submission of the claim; or
(4) a failure to provide proper documentation at the point of sale that is the basis of the claim;
if the claim is submitted by the office within three (3) years from the date the service was provided as required in subsection (a) and the office commences action to enforce the office's rights regarding the claim within six (6) years of the office's submission of the claim.
(c) An insurer may not deny a Medicaid claim submitted by the office solely due to a lack of prior authorization. An insurer shall:
(1) after December 31, 2020, meet the requirements set forth in IC 27-1-37.5;
(2) conduct the prior authorization on a retrospective basis for claims where prior authorization is necessary; and
(3) adjudicate any claim authorized in this manner as if the claim received prior authorization.
As added by P.L.187-2007, SEC.5. Amended by P.L.265-2019, SEC.2.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-5. Medicaid Furnished by Office; Insurer Put on Notice of Claim by Office; Insurer Paying Person or Entity Other Than Office; Office's Claim Not Discharged

Sec. 5. An insurer:
(1) that is put on notice of a claim by the office under section 4 of this chapter; and
(2) proceeds to pay the claim to a person or an entity other than the office;
is not discharged from payment of the office's claim.
[Pre-1992 Revision Citation: 12-1-7-24.2(b).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-6. Payment by Insurer to Office; Discharge of Obligation

Sec. 6. Payment to the office by an insurer under section 4 of this chapter discharges the insurer's obligation with respect to further payment on the claim for the amount paid.
[Pre-1992 Revision Citation: 12-1-7-24.2(c).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-7. Notice to Insurer That Medicaid Has Been Furnished; Requirements; Notification Given Office by Insurer; Payment of Claim

Sec. 7. (a) The notice requirements of section 4 of this chapter are satisfied if:
(1) the insurer receives from the office, electronically or by United States mail, a statement of the claims paid or medical services rendered by the office, together with a claim for reimbursement; or
(2) the insurer receives a claim from a beneficiary stating that the beneficiary has applied for or has received Medicaid from the office in connection with the same claim.
(b) An insurer that receives a claim under subsection (a)(2) shall notify the office of the insurer's obligation on the claim and shall:
(1) pay the obligation to the provider of service; or
(2) if the office has provided Medicaid, pay the office.
[Pre-1992 Revision Citation: 12-1-7-24.2(d).]
As added by P.L.2-1992, SEC.9. Amended by P.L.187-2007, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-8. Unlawful Insurance Clause

Sec. 8. A clause of an insurance contract, plan, or agreement administered by an insurer is void if the clause limits or excludes enrollment or payments to an individual who is eligible for Medicaid.
[Pre-1992 Revision Citation: 12-1-7-24.4.]
As added by P.L.2-1992, SEC.9. Amended by P.L.46-1995, SEC.41.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-9. State's Acquisition of Person's Right to Payment

Sec. 9. (a) IC 27-8-23 applies to this section.
(b) To the extent that payment for covered medical expenses has been made under the state Medicaid program for health care items or services furnished to a person, in a case where a third party has a legal liability to make payments, the state is considered to have acquired the rights of the person to payment by any other party for the health care items or services.
(c) As required under 42 U.S.C. 1396a(a)(25), an insurer shall accept the state's right of recovery and the assignment to the state of any right of the individual or entity to payment for a health care item or service for which payment has been made under the state Medicaid plan.
As added by P.L.46-1995, SEC.42. Amended by P.L.187-2007, SEC.7.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-10. Employer Sponsored Health Insurance to Include Coverage for Child

Sec. 10. (a) IC 27-8-23 and IC 31-16-15 apply to this section.
(b) This section does not apply if an employer has eliminated family health coverage for all of its employees.
(c) Whenever a parent is required by a court or an administrative order to provide health coverage for a child and the parent is eligible for family health coverage through an employer doing business in Indiana, the employer shall provide family health coverage to the child in the manner described under IC 27-8-23-6 and in the notice under IC 31-16-15-4.5(b). In addition, the employer shall:
(1) withhold from the employee's compensation the employee's share, if any, of premiums for health coverage; and
(2) pay that amount to the insurer.
(d) Upon the initiation of withholding under subsection (c), an employee whose applicable child support order did not include a deduction from weekly available income for the cost of the health care premium is entitled to a modification of the child support order, taking into account the payments made as of the date withholding began.
As added by P.L.46-1995, SEC.43. Amended by P.L.80-2010, SEC.20.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30. Contracting › 12-15-30-1. Authorization of Contracts for Administration of Program

Sec. 1. The office may contract with another state agency or other persons to administer any part of the Medicaid program.
[Pre-1992 Revision Citation: 12-1-7-17.1(a).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30. Contracting › 12-15-30-2. Contract Requirements and Qualifications; Preparation of Bid Specifications

Sec. 2. The office shall do the following:
(1) Prepare requirements, including qualifications, for bidders offering to contract with the state to perform the functions under section 3 of this chapter.
(2) Assist the Indiana department of administration in preparing bid specifications in conformity with requirements.
[Pre-1992 Revision Citation: 12-1-7-17.1(b).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30. Contracting › 12-15-30-3. Medicaid Claims; Finance and Administration; Plan Options

Sec. 3. The office shall select an approach to finance and administer Medicaid claims consisting of one (1) of the following:
(1) A direct provider payment plan administered by the office.
(2) A direct provider payment plan administered by a fiscal agent.
(3) A managed care organization.
(4) Any combination of the plans described in this section.
[Pre-1992 Revision Citation: 12-1-7-17.1(c).]
As added by P.L.2-1992, SEC.9. Amended by P.L.152-2017, SEC.24.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30. Contracting › 12-15-30-4. Term of Contracts; Extensions

Sec. 4. (a) A contract to administer any part of the Medicaid program may be for an original term of not more than four (4) years.
(b) At the option of the office, the term of the contract may be extended for a term of not more than two (2) additional years.
(c) An extension may be granted for a contract that is in effect.
[Pre-1992 Revision Citation: 12-1-7-17.1(d).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30. Contracting › 12-15-30-5. Subcontracts

Sec. 5. (a) A contractor with the state under this chapter may subcontract a part of the contract, subject to the approval of the office and the Indiana department of administration.
(b) A subcontract may not extend beyond the term of the contract.
(c) A contractor shall furnish information concerning the following:
(1) The amount of the subcontract.
(2) The qualifications of the subcontractor for guaranteeing performance.
(3) Other information required by the state.
(d) A contract or subcontract executed under this section is a public record under IC 5-14-3-2.
[Pre-1992 Revision Citation: 12-1-7-17.1(e).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30. Contracting › 12-15-30-6. Statement of Adjusted Actual Medicaid Provider Costs and Insurance Premiums; Certification to Auditor of State; Payment by Auditor of State

Sec. 6. (a) A contractor under section 1 of this chapter shall submit a detailed statement, at the times and in the form prescribed by the office, for the amount of adjusted actual Medicaid provider costs and insurance premiums.
(b) The office shall certify a statement under subsection (a) to the auditor of state, who shall pay the amount of the adjusted actual Medicaid provider costs and insurance premiums from the Medicaid account of the state general fund.
(c) The auditor of state may not pay a Medicaid provider costs in advance of services provided.
[Pre-1992 Revision Citation: 12-1-7-17.1(f).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30. Contracting › 12-15-30-7. Statement Requesting Payment for Fees for Performance of Administrative Responsibilities; Certification to Auditor of State

Sec. 7. (a) A contractor under section 1 of this chapter shall submit a statement, at the times and in the form prescribed by the office, requesting payment for fees for performance of administrative responsibilities under contracts executed under this chapter.
(b) The office shall certify a statement under subsection (a) to the auditor of state, who shall pay the amount of the requested fees.
[Pre-1992 Revision Citation: 12-1-7-17. 1(g).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30.5. Nonemergency Medical Transportation › 12-15-30.5-1. "Broker"

Sec. 1. As used in this chapter, "broker" means a contractor of the office that administers the Medicaid fee-for-service nonemergency medical transportation program.
As added by P.L.116-2019, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30.5. Nonemergency Medical Transportation › 12-15-30.5-2. "Commission"

Sec. 2. As used in this chapter, "commission" refers to the nonemergency medical transportation commission established by section 7 of this chapter.
As added by P.L.116-2019, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30.5. Nonemergency Medical Transportation › 12-15-30.5-3. "Nonemergency Medical Transportation"

Sec. 3. As used in this chapter, "nonemergency medical transportation" means medically necessary transportation to Medicaid covered services for an eligible Medicaid recipient who:
(1) participates in the Medicaid fee-for-service program; and
(2) does not have available transportation to:
(A) a Medicaid reimbursable service; or
(B) a pharmacy to obtain Medicaid reimbursable pharmacy services.
As added by P.L.116-2019, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30.5. Nonemergency Medical Transportation › 12-15-30.5-5. Broker Requirements; Confidentiality; Remediation Plan

Sec. 5. (a) A broker shall establish, implement, and maintain the following:
(1) One (1) toll free telephone number clearly identified for the handling of complaints concerning the nonemergency medical transportation services.
(2) A link on the home page of the broker's Internet web site titled "File a Complaint Here" that is accessible by the public and that allows for the submission of a complaint concerning the nonemergency medical transportation services.
(3) Instructions on the broker's Internet web site on how to file a complaint concerning nonemergency medical transportation services.
(4) A process to notify a person who files a complaint about:
(A) the steps the broker will take to investigate the complaint; and
(B) the results of the investigation.
(b) Except for disclosure to the office of the secretary, the broker shall keep confidential the identity of any individual who submits a complaint with the broker concerning nonemergency medical transportation services.
(c) If a complaint concerning nonemergency medical transportation services made to the broker is substantiated, the broker shall develop a remediation plan concerning the complaint and submit the remediation plan to the office of the secretary for the office of the secretary to post the remediation plan on the office of the secretary's Internet web site.
As added by P.L.116-2019, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30.5. Nonemergency Medical Transportation › 12-15-30.5-6. Report on Claims

Sec. 6. (a) Before October 1, 2019, the office of the secretary shall prepare a report containing the number of Medicaid fee-for-service nonemergency medical transportation claims paid by:
(1) vehicle type;
(2) Medicaid recipient category; and
(3) whether the recipient for which the claim was paid resided in:
(A) the community;
(B) a health facility;
(C) an intermediate care facility for individuals with intellectual disabilities;
(D) a hospital; or
(E) another location.
(b) Beginning June 1, 2016, through May 31, 2019, the claims data reported in subsection (a) must be organized by month.
(c) The office of the secretary shall submit the report prepared under subsection (a) to the commission.
As added by P.L.116-2019, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30.5. Nonemergency Medical Transportation › 12-15-30.5-8. Commission Member per Diem and Travel

Sec. 8. (a) Each member of the commission who is not a state employee is entitled to the minimum salary per diem provided by IC 4-10-11-2.1(b). Such a member is also entitled to reimbursement for traveling expenses and other expenses actually incurred in connection with the member's duties, as provided in the state travel policies and procedures established by the Indiana department of administration and approved by the budget agency.
(b) Each member of the commission who is a state employee but who is not a member of the general assembly is entitled to reimbursement for traveling expenses and other expenses actually incurred in connection with the member's duties, as provided in the state travel policies and procedures established by the Indiana department of administration and approved by the budget agency.
(c) Each member of the commission who is a member of the general assembly is entitled to receive the same per diem, mileage, and travel allowances paid to legislative members of interim study committees established by the legislative council. Per diem, mileage, and travel allowances paid under this subsection shall be paid from appropriations made to the legislative council or the legislative services agency.
As added by P.L.116-2019, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30.5. Nonemergency Medical Transportation › 12-15-30.5-9. Meetings

Sec. 9. The commission shall meet at least two (2) times per year at a public meeting to do the following:
(1) Review a report submitted under this chapter.
(2) Provide feedback and make recommendations to the office of the secretary concerning the provision of nonemergency medical transportation services.
(3) Approve any monies to be awarded to a broker as part of a withhold provision outlined in the contract between the office of the secretary and the broker.
As added by P.L.116-2019, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 31. Repealed

[Pre-1992 Revision Citations:
12-15-31-1formerly 12-1-7-16.3(a) part12-15-31-2formerly 12-1-7-16.3(a) part12-15-31-3formerly 12-1-7-16.3(a) part12-15-31-4formerly 12-1-7-16.3(b).]
Repealed by P.L.291-2001, SEC.211.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 31.1. Adjustment of Pharmacy Dispensing Fees › 12-15-31.1-1. Dispensing Fee Surveys

Sec. 1. At least once every two (2) years, the office shall conduct a survey of pharmacy providers to assess the appropriate level of dispensing fees to be paid to providers for prescribed drugs.
As added by P.L.15-2002, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 31.1. Adjustment of Pharmacy Dispensing Fees › 12-15-31.1-2. Evaluation of Other Dispensing Fees

Sec. 2. A survey under section 1 of this chapter must include an evaluation of dispensing fees in other states and the policies of the federal Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration).
As added by P.L.15-2002, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 31.1. Adjustment of Pharmacy Dispensing Fees › 12-15-31.1-3. Dispensing Fee Criteria

Sec. 3. A dispensing fee shall be evaluated based upon the following information concerning the costs of pharmacy operation:
(1) Operational data.
(2) Professional services data.
(3) Overhead data.
(4) Profit data.
As added by P.L.15-2002, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 31.1. Adjustment of Pharmacy Dispensing Fees › 12-15-31.1-4. Adjustment of Dispensing Fees

Sec. 4. If an adjustment in dispensing fees is made following a survey conducted under section 1 of this chapter, the secretary shall commence the rulemaking process under IC 4-22-2 to make the adjustment not later than November 1 of the year in which the survey was conducted.
As added by P.L.15-2002, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-1. "Facility"

Sec. 1. As used in this chapter, "facility" means a facility 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.
[Pre-1992 Revision Citation: 12-1-7.3-1 part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.35-2016, SEC.42.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-2. Reimbursement; Voiding of Administrative Rule

Sec. 2. (a) The office shall reimburse community residential facilities for the developmentally disabled for the cost of the Medicaid services that are provided by the facility to individuals who are eligible for Medicaid.
(b) 405 IAC 1-12-27 is void.
[Pre-1992 Revision Citation: 12-1-7.3-2(a).]
As added by P.L.2-1992, SEC.9. Amended by P.L.213-2015, SEC.129; P.L.12-2016, SEC.10.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-3. Repealed

[Pre-1992 Revision Citation: 12-1-7.3-2(b) part.]
As added by P.L.2-1992, SEC.9. Repealed by P.L.78-1994, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-4. Reimbursement Rate Criteria; Necessary Factors

Sec. 4. The criteria for reimbursement under this chapter must include the following:
(1) The method of determining initial rates of reimbursement.
(2) The method of determining the maximum rate of reimbursement.
(3) The frequency of rate reviews.
(4) The method of depreciating the buildings comprising the facilities.
(5) The establishment of a maximum depreciation expense.
(6) The inclusion of first aid supplies as a part of the room charge.
(7) The establishment of maximum costs of equipment purchases or repairs that may be allowed as depreciation expenses.
(8) The establishment of limitations on allowable interest expenses.
(9) The establishment of a limit on the duration of financing.
[Pre-1992 Revision Citation: 12-1-7.3-2(b) part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.78-1994, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-4.5. Reimbursement for Staff Hours of Employees

Sec. 4.5. (a) This section applies to a community residential facility for the developmentally disabled licensed as a child rearing residence that:
(1) is a home exclusively for children;
(2) has a behavior management program staffed by:
(A) a behavior management consultant; or
(B) personnel;
to develop and monitor behavioral training, developmental training, and support in specific areas for all residents who function on a similar level; and
(3) does not have more than six (6) beds.
(b) A community residential facility for the developmentally disabled is entitled to Medicaid reimbursement within available appropriations for staff hours of employees:
(1) hired to work at least two thousand eighty (2,080) paid staff hours per year per employee; and
(2) when the reimbursement requested is for not more than twelve (12) staff hours per resident per day.
As added by P.L.255-1996, SEC.7.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-5. Special Interim Rates

Sec. 5. The office may establish a special interim rate for each community residential facility to ensure that the reasonable special costs involved in the initial year of operation of a facility are reimbursed.
[Pre-1992 Revision Citation: 12-1-7.3-3.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-6. Facility Residents; Personal Allowance; Range of Amounts

Sec. 6. The office shall allow a resident of a facility who is receiving Medicaid to retain a personal allowance of fifty-two dollars ($52) each month.
[Pre-1992 Revision Citation: 12-1-7.3-4(a).]
As added by P.L.2-1992, SEC.9. Amended by P.L.294-2001, SEC.5.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-6.5. Payment Calculation for Federal Ssi Recipient; Exemption From Income Eligibility Consideration

Sec. 6.5. (a) If a resident of a facility:
(1) is a recipient of assistance under the federal Supplemental Security Income (SSI) program; and
(2) receives an income that is less than the amount described in section 6 of this chapter;
the office shall pay to the individual an amount equal to the difference between the amount of the monthly personal allowance described in section 6 of this chapter and the amount of income, including assistance under the federal Supplemental Security Income (SSI) program received by the individual.
(b) Money paid to an individual under subsection (a) is exempt from income eligibility consideration.
As added by P.L.294-2001, SEC.6. Amended by P.L.26-2003, SEC.2.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-7. Rules; Functioning Level of Resident; Personal Allowance

Sec. 7. The secretary may adopt rules under IC 4-22-2 to do the following:
(1) Establish criteria based on the functioning level of the residents.
(2) Determine the personal allowance to which each resident is entitled.
[Pre-1992 Revision Citation: 12-1-7.3-4(b).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-8. Personal Allowance; Income Eligibility Consideration; Exemption

Sec. 8. A personal allowance is exempt from income eligibility consideration by the office.
[Pre-1992 Revision Citation: 12-1-7.3-4(c).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-9. Personal Allowance; Individuals Employed as Part of Habilitation Plan or Working in Sheltered Workshop or Day Activity Center

Sec. 9. The personal allowance for one (1) month for an individual described in section 6 of this chapter whose employment is part of the individual's habilitation plan or who is working in a sheltered workshop or day activity center is the amount that a person would be entitled to retain under section 6 of this chapter plus an amount equal to one-half (1/2) of the remainder of:
(1) gross earned income for that month; minus
(2) the sum of:
(A) sixteen dollars ($16); plus
(B) the amount withheld from the individual's paycheck for that month for payment of state income tax, federal income tax, and the tax prescribed by the Federal Insurance Contribution Act (26 U.S.C. 3101 et seq.); plus
(C) transportation expenses for that month.
[Pre-1992 Revision Citation: 12-1-7.3-4.5.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-10. Placement in Facility; Diagnostic Evaluations

Sec. 10. (a) An applicant for Medicaid who desires to be placed in a community residential facility must first receive a diagnostic evaluation to be provided by the division of disability and rehabilitative services.
(b) Subsequent diagnostic evaluations by the division of disability and rehabilitative services shall be provided at least every twelve (12) months to review the individual's need for services.
(c) The office shall consider the evaluations in determining the appropriateness of placement.
[Pre-1992 Revision Citation: 12-1-7.3-5.]
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.118; P.L.5-1993, SEC.131; P.L.141-2006, SEC.55.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 32. Community Residential Facilities for the Developmentally Disabled › 12-15-32-11. Assessment Upon Total Annual Revenue of Certain Nonstate Facilities; Medicaid Assessment Account; Unavailability of Federal Matching Funds

Sec. 11. (a) The office may assess community residential facilities for the developmentally disabled (as defined in IC 12-7-2-61) and intermediate care facilities for individuals with intellectual disabilities (ICF/IID) (as defined in IC 16-29-4-2) that are not operated by the state in an amount not to exceed ten percent (10%) of the total annual revenue of the facility for the facility's preceding fiscal year.
(b) The assessments shall be paid to the office of Medicaid policy and planning in equal monthly amounts on or before the tenth day of each calendar month. The office may withhold Medicaid payments to a provider described in subsection (a) that fails to pay an assessment within thirty (30) days after the due date. The amount withheld may not exceed the amount of the assessments due.
(c) Revenue from the assessments shall be credited to a special account within the state general fund to be called the Medicaid assessment account. Money in the account may be used only for services for which federal financial participation under Medicaid is available to match state funds. An amount equivalent to the federal financial participation estimated to be received for services financed from assessments under subsection (a) shall be used to finance Medicaid services provided by facilities described in subsection (a).
(d) If federal financial participation to match the assessments in subsection (a) becomes unavailable under federal law, the authority to impose the assessments terminates on the date that the federal statutory, regulatory, or interpretive change takes effect.
As added by P.L.27-1992, SEC.26. Amended by P.L.2-1993, SEC.102; P.L.291-2001, SEC.216; P.L.6-2002, SEC.6; P.L.35-2016, SEC.43.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-2. Committee Created

Sec. 2. The Medicaid advisory committee is created to act in an advisory capacity to the following:
(1) The office in the administration of the Medicaid program.
(2) The children's health policy board established by IC 4-23-27-2 in the board's responsibility to direct policy coordination of children's health programs.
[Pre-1992 Revision Citation: 12-1-13-1(a).]
As added by P.L.2-1992, SEC.9. Amended by P.L.273-1999, SEC.175.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-3. Membership; Appointment

Sec. 3. (a) The committee shall be appointed as follows:
(1) One (1) member shall be appointed by the administrator of the office to represent each of the following organizations:
(A) Indiana Council of Community Mental Health Centers.
(B) Indiana State Medical Association.
(C) Indiana State Chapter of the American Academy of Pediatrics.
(D) Indiana Hospital Association.
(E) Indiana Dental Association.
(F) Indiana State Psychiatric Association.
(G) Indiana State Osteopathic Association.
(H) Indiana State Nurses Association.
(I) Indiana State Licensed Practical Nurses Association.
(J) Indiana State Podiatry Association.
(K) Indiana Health Care Association.
(L) Indiana Optometric Association.
(M) Indiana Pharmaceutical Association.
(N) Indiana Psychological Association.
(O) Indiana State Chiropractic Association.
(P) Indiana Ambulance Association.
(Q) Indiana Association for Home Care.
(R) Indiana Academy of Ophthalmology.
(S) Indiana Speech and Hearing Association.
(T) Indiana Academy of Physician Assistants.
(U) Indiana Association of Rehabilitation Facilities.
(V) Indiana Association of Health Plans.
(W) Indiana Primary Health Care Association.
(2) Ten (10) members shall be appointed by the governor as follows:
(A) One (1) member who represents agricultural interests.
(B) One (1) member who represents business and industrial interests.
(C) One (1) member who represents labor interests.
(D) One (1) member who represents insurance interests.
(E) One (1) member who represents a statewide taxpayer association.
(F) Two (2) members who are parent advocates.
(G) Three (3) members who represent Indiana citizens.
(3) Six (6) members shall be appointed by the president pro tempore of the senate acting in the capacity as president pro tempore of the senate to represent the senate. Three (3) of the members appointed under this subdivision shall serve on the standing fiscal subcommittee created under section 8(b) of this chapter.
(4) Six (6) members shall be appointed by the speaker of the house of representatives to represent the house of representatives. Three (3) of the members appointed under this subdivision shall serve on the standing fiscal subcommittee created under section 8(b) of this chapter.
(b) Notwithstanding subsection (a)(3), after consultation with the minority leader of the senate, the president pro tempore of the senate shall appoint three (3) of the members from the minority party of the senate.
(c) Notwithstanding subsection (a)(4), after consultation with the minority leader of the house of representatives, the speaker of the house shall appoint three (3) of the members from the minority party of the house.
[Pre-1992 Revision Citation: 12-1-13-1(b).]
As added by P.L.2-1992, SEC.9. Amended by P.L.157-1995, SEC.1; P.L.158-1995, SEC.1; P.L.42-1995, SEC.24; P.L.109-1996, SEC.2; P.L.273-1999, SEC.176; P.L.35-2016, SEC.44; P.L.114-2018, SEC.2; P.L.140-2019, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-4. Expiration of Term; Designation of Successor

Sec. 4. An appointment to the committee terminates July 1 of the year in which the appointment expires, but a member serves until the member's successor is designated.
[Pre-1992 Revision Citation: 12-1-13-1(d) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-5. Term of Office

Sec. 5. An appointment to the committee is for a four (4) year term, except the representatives of the senate and house of representatives, whose terms coincide with the representative's or senator's respective legislative terms.
[Pre-1992 Revision Citation: 12-1-13-1(d) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-6. Ex Officio Members

Sec. 6. The following shall serve as ex officio members of the committee:
(1) The state health commissioner or the commissioner's designee.
(2) The director of the division of mental health and addiction or the director's designee.
(3) The administrator of the office.
[Pre-1992 Revision Citation: 12-1-13-1(d) part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.215-2001, SEC.45.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-7. Committee Secretary

Sec. 7. The administrator of the office shall serve as secretary of the committee.
[Pre-1992 Revision Citation: 12-1-13-1(d) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-8. Subcommittees

Sec. 8. (a) A subcommittee may be created as the committee considers necessary.
(b) The committee shall create a standing fiscal subcommittee.
(c) The chairman of each subcommittee must be a member of the committee.
(d) Subcommittees may convene as often as needed.
[Pre-1992 Revision Citation: 12-1-13-1(e).]
As added by P.L.2-1992, SEC.9. Amended by P.L.140-2019, SEC.2.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-9. Meetings

Sec. 9. The committee shall do the following:
(1) Meet at least four (4) times each year, one (1) time in each calendar quarter.
(2) Hold special meetings that the committee or the secretary requests.
[Pre-1992 Revision Citation: 12-1-13-1(f).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33. Medicaid Advisory Committee › 12-15-33-10. Travel Allowance

Sec. 10. (a) Appointed members of the committee other than members of the general assembly are entitled to receive travel allowance to and from regular or special meetings in accordance with the amounts set by and the provisions of the budget committee for state employees.
(b) Each member of the committee who is a member of the general assembly is entitled to receive the same per diem, mileage, and travel allowances paid to legislative members of interim study committees established by the legislative council. Per diem, mileage, and travel allowances paid under this subsection shall be paid from appropriations made to the legislative council or the legislative services agency.
[Pre-1992 Revision Citation: 12-1-13-1(g).]
As added by P.L.2-1992, SEC.9. Amended by P.L.140-2019, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33.5. Medicaid Clinical Advisory Committee › 12-15-33.5-2. Establishment

Sec. 2. The office shall establish a clinical advisory committee to provide clinical insights and applications of clinical policy issues related to programs administered by the office, including issues related to:
(1) current standards of care;
(2) quality of care;
(3) accessibility of care;
(4) appropriateness of care; and
(5) cost-effectiveness of care.
As added by P.L.42-1995, SEC.25.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 33.5. Medicaid Clinical Advisory Committee › 12-15-33.5-3. Membership; Meetings; Consultations; Ad Hoc Clinical Advisory Committee

Sec. 3. (a) The committee consists of at least seven (7) members and not more than thirteen (13) members.
(b) The office's medical consultant shall serve as the chairperson of the committee.
(c) The committee shall include at least seven (7) physicians who are:
(1) licensed under IC 25-22.5; and
(2) actively engaged in the practice of medicine.
(d) The office shall select the remaining committee members from the medical provider community to represent the services most critical to the Medicaid recipient population.
(e) The committee shall meet:
(1) one (1) time every two (2) months; or
(2) as determined necessary by the chairperson.
(f) The committee may consult as needed with other persons who have expertise in any clinical policy issue being considered by the committee.
(g) If the committee established under subsection (a) considers a change in clinical policy related to care and services provided under:
(1) IC 25-10 (chiropractic services);
(2) IC 25-14 (dental services);
(3) IC 25-24 and IC 25-26 (eye care services); or
(4) IC 25-29 (foot care services);
the office shall establish an ad hoc clinical advisory committee comprised of three (3) licensed non-physician practitioners directly affected by the proposed clinical policy change.
(h) The chairperson of a committee under subsection (g) shall be the office's medical consultant.
(i) When an ad hoc clinical advisory committee is established under subsection (g)(3), one (1) member of the committee shall be a physician licensed under IC 25-22.5 who provides services similar to those provided by an optometrist licensed under IC 25-24 or IC 25-26.
(j) A committee established under subsection (g) shall provide clinical insights and applications of clinical policy issues relating to:
(1) current standards of care;
(2) quality of care;
(3) accessibility of care;
(4) appropriateness of care; and
(5) cost-effectiveness of care.
As added by P.L.42-1995, SEC.25.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-1. "Home Health Agency"

Sec. 1. As used in this chapter, "home health agency" means a public or private organization, whether owned or operated by one (1) or more persons, that furnishes or offers to furnish home health services.
[Pre-1992 Revision Citation: 12-1-7.5-1(a) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-2. "Home Health Services"

Sec. 2. (a) As used in this chapter, "home health services" means any of the following items or services furnished to an individual by a home health agency or by others under arrangements with a home health agency on a visiting basis, and except as provided in subsection (b), in a place of temporary or permanent residence used as the individual's home:
(1) Part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse.
(2) Physical, occupational, or speech therapy or other therapeutic services.
(3) Medical social services.
(4) Home health aid services.
(5) Medical supplies other than drugs and biologicals.
(6) The use of medical appliances.
(7) Homemaking services provided by the home health agency to help the individual stay in the individual's own home.
(b) The term includes items and services of a kind described in subsection (a)(1) through (a)(6) that:
(1) are provided on an outpatient basis under arrangements made by a home health agency at:
(A) a hospital;
(B) a health facility;
(C) a rehabilitation center; or
(D) other appropriate locations outside of the home, as determined by the office; and
(2) either:
(A) involve the use of equipment of a nature that cannot readily be made available to the individual in the individual's home; or
(B) that are furnished at the hospital, health facility, or rehabilitation center while the individual is there to receive items or services.
(c) The term does not include transportation of the individual in connection with receiving items or services described in subsection (b)(1) and (b)(2).
[Pre-1992 Revision Citation: 12-1-7.5-1(b) part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.2-1995, SEC.49; P.L.114-2018, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-3. Items and Services Furnished Either by Home Health Agency or by Others Under Arrangements With Home Health Agency; Exception

Sec. 3. Home health services includes items and services furnished to an individual by either of the following:
(1) A home health agency.
(2) Others under arrangements with a home health agency on a visiting basis and, except for section 4(5) of this chapter, in a place of temporary or permanent residence used as the individual's home.
[Pre-1992 Revision Citation: 12-1-7.5-1(b) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-4. Items and Services Included Under Ic 12-15-34-2 Definition of Home Health Services

Sec. 4. The items and services under section 2 of this chapter include the following:
(1) Part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse.
(2) Physical, occupational, or speech therapy or other therapeutic services.
(3) Medical social services and home health aid services.
(4) Medical supplies other than drugs and biologicals and the use of medical appliances.
(5) Any of the items and services under subdivisions (1), (2), (3), and (4) that:
(A) are provided on an outpatient basis under arrangements made by a home health agency at a hospital, health care facility, or rehabilitation center; and
(B) involves the use of equipment of a nature that the items and services cannot readily be made available to the individual in the individual's home or that are furnished at the facility while the individual is there to receive any item or service, but not including transportation of the individual in connection with the item or service.
(6) Homemaking services provided by the agency to help the individual's stay in the individual's own home.
[Pre-1992 Revision Citation: 12-1-7.5-1(b) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-5. Office and Secretary; Actions, Directions, and Rules; Providing of Services and Ensuring Uniform Equitable Treatment of Applicants and Recipients

Sec. 5. The office and the secretary shall:
(1) take action;
(2) give directions; and
(3) adopt rules under IC 4-22-2;
necessary to carry out this chapter and the federal Social Security Act concerning the providing of services and to ensure uniform equitable treatment of all applicants for and recipients of Medicaid supportive services in the recipients' own homes.
[Pre-1992 Revision Citation: 12-1-7.5-2.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-6. Contracts for Services; Authorization

Sec. 6. The office may contract with any of the following to purchase the necessary services to implement this chapter:
(1) A state, public, or private agency.
(2) A business firm.
(3) A corporation.
[Pre-1992 Revision Citation: 12-1-7.5-3 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-7. Contracts; Maximum Term

Sec. 7. A contract made with the following may be for a term not to exceed three (3) years:
(1) A public or private agency.
(2) A business firm.
(3) A foundation.
(4) A corporation.
[Pre-1992 Revision Citation: 12-1-7.5-3 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-8. Preparation of Qualifications and Specifications for Bidders

Sec. 8. The office shall assist the Indiana department of administration in the preparation of qualifications and specifications for bidders contracting with the state to administer the fiscal provisions of or to provide services under this chapter.
[Pre-1992 Revision Citation: 12-1-7.5-3 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-9. Subcontracts; Authorization; Term

Sec. 9. A contractor with the state under this chapter may subcontract a part of the contractor's prime contract. However, a subcontract may not extend beyond the term of the prime contract.
[Pre-1992 Revision Citation: 12-1-7.5-3 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-10. Subcontracts; Approval

Sec. 10. A subcontract let by a prime contractor must be approved by the office and the Indiana department of administration.
[Pre-1992 Revision Citation: 12-1-7.5-3 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-11. Subcontracts; Information Furnished to Office

Sec. 11. The contractor or the subcontractor shall furnish the following information to the office:
(1) The amount of the subcontract.
(2) The qualifications of the subcontractor for guaranteeing performance.
(3) Other data required by the state.
[Pre-1992 Revision Citation: 12-1-7.5-3 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-12. Contract or Subcontract; Availability to Legislative Council

Sec. 12. Upon request, a contract or subcontract shall be made available to the legislative council or the council's representative for inspection and examination.
[Pre-1992 Revision Citation: 12-1-7.5-3 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-13. Plan for Purchase of Services Under Ic 4-23-17-9.3

Sec. 13. The office shall include in the division's state plan for the purchase of services under IC 4-23-17-9.3 (repealed) a comprehensive program for the provision of home health services to an individual who is eligible for Medicaid.
[Pre-1992 Revision Citation: 12-1-7.5-4.]
As added by P.L.2-1992, SEC.9. Amended by P.L.1-2009, SEC.103.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-14. Utilization Review Procedures

Sec. 14. The office shall develop adequate utilization review procedures for home health agencies to conform to federal guidelines.
[Pre-1992 Revision Citation: 12-1-7.5-5.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 34. Home Health Care Services; Office of Medicaid Policy and Planning › 12-15-34-14.5. Reduce Reimbursement for Home Health Services Prohibited

Sec. 14.5. (a) This section is effective beginning July 1, 2017.
(b) The office of the secretary may not reduce reimbursement for home health services.
(c) 405 IAC 1-4.2-4(l) and any successor rule concerning reducing home health services reimbursement are void and may not be renewed or otherwise implemented.
As added by P.L.217-2017, SEC.79.