reglab/statecodes huggingface dataset:
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 19. Disproportionate Share Providers; Enhanced Disproportionate Share Payments › 12-15-19-6. Deposits in Fund; Insufficiency; Suspension or Reduction of Payments to Eligible Institutions

Sec. 6. (a) This section does not apply during the period that the office is assessing a hospital fee authorized by IC 16-21-10. The office is not required to make disproportionate share payments under this chapter from the Medicaid indigent care trust fund established by IC 12-15-20-1 until the fund has received sufficient deposits, including intergovernmental transfers of funds and certifications of expenditures, to permit the office to make the state's share of the required disproportionate share payments.
(b) For state fiscal years beginning after June 30, 2006, if:
(1) sufficient deposits have not been received; or
(2) the statewide Medicaid disproportionate share allocation is insufficient to provide federal financial participation for the entirety of all eligible disproportionate share hospitals' hospital-specific limits;
the office shall reduce disproportionate share payments made under IC 12-15-19-2.1 and Medicaid safety-net payments made in accordance with the Medicaid state plan to eligible institutions using an equitable methodology consistent with subsection (c).
(c) For state fiscal years beginning after June 30, 2006, payments reduced under this section shall, in accordance with the Medicaid state plan, be made:
(1) to best utilize federal matching funds available for hospitals eligible for Medicaid disproportionate share payments under IC 12-15-19-2.1; and
(2) by utilizing a methodology that allocates available funding under this subdivision, and Medicaid supplemental payments as defined in IC 12-15-15-1.5, in a manner that all hospitals eligible for Medicaid disproportionate share payments under IC 12-15-19-2.1 receive payments using a methodology that:
(A) takes into account the situation of the eligible hospitals that have historically qualified for Medicaid disproportionate share payments; and
(B) ensures that payments for eligible hospitals are equitable.
(d) The percentage reduction shall be sufficient to ensure that payments do not exceed the statewide Medicaid disproportionate share allocation or the amounts that can be financed with:
(1) the amount transferred from the hospital care for the indigent trust fund;
(2) other intergovernmental transfers;
(3) certifications of public expenditures; or
(4) any other permissible sources of non-federal match.
[Pre-1992 Revision Citation: 12-1-7-17.8(e).]
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.22; P.L.113-2000, SEC.14; P.L.212-2007, SEC.9; P.L.218-2007, SEC.19; P.L.229-2011, SEC.137; P.L.205-2013, SEC.200.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 19. Disproportionate Share Providers; Enhanced Disproportionate Share Payments › 12-15-19-7. Repealed

[Pre-1992 Revision Citation: 12-1-7-17.9.]
As added by P.L.2-1992, SEC.9. Repealed by P.L.27-1992, SEC.30.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 19. Disproportionate Share Providers; Enhanced Disproportionate Share Payments › 12-15-19-9. Repealed

As added by P.L.126-1998, SEC.13. Amended by P.L.113-2000, SEC.16. Repealed by P.L.2-2005, SEC.131.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 19. Disproportionate Share Providers; Enhanced Disproportionate Share Payments › 12-15-19-10. Priorities of Payments

Sec. 10. This section does not apply during the period that the office is assessing a hospital fee authorized by IC 16-21-10. For state fiscal years beginning after June 30, 2000, the state shall pay providers as follows:
(1) The state shall make municipal disproportionate share provider payments to providers qualifying under IC 12-15-16-1(b) until the state exceeds the state disproportionate share allocation (as defined in 42 U.S.C. 1396r-4(f)(2)).
(2) After the state makes all payments under subdivision (1), if the state fails to exceed the state disproportionate share allocation (as defined in 42 U.S.C. 1396r-4(f)(2)), the state shall make disproportionate share provider payments to providers qualifying under IC 12-15-16-1(a).
(3) After the state makes all payments under subdivision (2), if the state fails to exceed the state disproportionate share allocation (as defined in 42 U.S.C. 1396r-4(f)(2)), or the state limit on disproportionate share expenditures for institutions for mental diseases (as defined in 42 U.S.C. 1396r-4(h)), the state shall make community mental health center disproportionate share provider payments to providers qualifying under IC 12-15-16-1(c).
As added by P.L.126-1998, SEC.14. Amended by P.L.113-2000, SEC.17; P.L.283-2001, SEC.25; P.L.2-2005, SEC.49; P.L.229-2011, SEC.139; P.L.205-2013, SEC.202.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20. Indigent Care Trust Fund › 12-15-20-1. Fund Defined

Sec. 1. As used in this chapter, "fund" refers to the Medicaid indigent care trust fund established by this chapter.
[1992 Revision Citation: New.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20. Indigent Care Trust Fund › 12-15-20-3. Expenses of Administration

Sec. 3. The expenses of administering the fund shall be paid from money in the fund.
[Pre-1992 Revision Citation: 12-1-7-61(b).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20. Indigent Care Trust Fund › 12-15-20-4. Investment of Fund Money

Sec. 4. (a) The treasurer of state shall invest the money in the fund not currently needed to meet the obligations of the fund in the same manner as other public funds may be invested.
(b) Interest that accrues from investments shall be deposited in the fund.
[Pre-1992 Revision Citation: 12-1-7-61(c) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20. Indigent Care Trust Fund › 12-15-20-5. Records; Balance in Fund; Investment Earnings

Sec. 5. The office shall maintain records that show the amount of money in the fund and the amount of investment earnings on that amount.
[Pre-1992 Revision Citation: 12-1-7-61(c) part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.24.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20. Indigent Care Trust Fund › 12-15-20-6. Money Not to Revert to General Fund

Sec. 6. Money in the fund at the end of a state fiscal year does not revert to the state general fund.
[Pre-1992 Revision Citation: 12-1-7-61(d).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20. Indigent Care Trust Fund › 12-15-20-7. Use of Fund Money; Availability of Matching Federal Financial Participation

Sec. 7. Money in the fund may only be used for the purposes listed in section 2 of this chapter to the extent that federal financial participation under Medicaid is available to match the state money.
[Pre-1992 Revision Citation: 12-1-7-61(e) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20. Indigent Care Trust Fund › 12-15-20-8. Repealed

[Pre-1992 Revision Citation: 12-1-7-61(e) part.]
As added by P.L.2-1992, SEC.9. Repealed by P.L.27-1992, SEC.30.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20.5. Disproportionate Share Providers › 12-15-20.5-1. Unavailability of Federal Matching Funds; Nonimplementation of State Laws

Sec. 1. The office is not required to implement or continue to implement IC 12-15-16, IC 12-15-17, IC 12-15-18, IC 12-15-19, or IC 12-15-20 if the means of financial matching described is or becomes contrary to federal law.
As added by P.L.27-1992, SEC.25.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20.7. Payment Schedule › 12-15-20.7-1. Definitions

Sec. 1. As used in this chapter:
(1) "Medicaid inpatient payments for safety-net hospitals" means the payments provided for in the Medicaid state plan for inpatient services provided by hospitals that satisfy the definition of a safety-net hospital under the Medicaid state plan; and
(2) "Medicaid outpatient payments for safety-net hospitals" means the payments provided for in the Medicaid state plan for outpatient services provided by hospitals that satisfy the definition of a safety-net hospital under the Medicaid state plan.
As added by P.L.255-2003, SEC.23.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 20.7. Payment Schedule › 12-15-20.7-2. Order of Payments

Sec. 2. (a) This section does not apply during the period that the office is assessing a hospital fee authorized by IC 16-21-10. For each state fiscal year ending before July 1, 2005, and subject to section 3 of this chapter (repealed), the office shall make the payments identified in this section in the following order:
(1) First, payments under IC 12-15-15-9 and IC 12-15-15-9.5.
(2) Second, payments under clauses (A) and (B) of STEP FIVE of IC 12-15-15-1.5(b).
(3) Third, Medicaid inpatient payments for safety-net hospitals and Medicaid outpatient payments for safety-net hospitals.
(4) Fourth, payments under IC 12-15-15-1.1 and IC 12-15-15-1.3.
(5) Fifth, payments under IC 12-15-19-8 for municipal disproportionate share hospitals.
(6) Sixth, payments under IC 12-15-19-2.1 for disproportionate share hospitals.
(7) Seventh, payments under clause (C) of STEP FIVE of IC 12-15-15-1.5(b).
(b) For each state fiscal year ending after June 30, 2007, the office shall make the payments for the programs identified in IC 12-15-20-2(8)(G) in the order of priority that best utilizes available non-federal share, Medicaid supplemental payments, and Medicaid disproportionate share payments, and may change the order or priority at any time as necessary for the proper administration of one (1) or more of the payment programs listed in IC 12-15-20-2(8)(G).
As added by P.L.255-2003, SEC.23. Amended by P.L.212-2007, SEC.11; P.L.218-2007, SEC.21; P.L.229-2011, SEC.141; P.L.6-2012, SEC.92; P.L.205-2013, SEC.204.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 21. Rules › 12-15-21-1. Acceptance by Provider of Medicaid Claim Payment; Agreement to Comply With Statutes and Rules

Sec. 1. A provider who accepts payment of a claim submitted under the Medicaid program is considered to have agreed to comply with the statutes and rules governing the program.
[Pre-1992 Revision Citation: 12-1-7-15.7(a).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 21. Rules › 12-15-21-2. Secretary to Adopt Rules; Consistency With Title Xix of Social Security Act

Sec. 2. The secretary shall, with the advice of the office's medical staff, adopt rules under IC 4-22-2 and consistent with Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.) and regulations promulgated under the federal Social Security Act.
[Pre-1992 Revision Citation: 12-1-7-15.7(b) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 21. Rules › 12-15-21-4. Rules Not to Eliminate Type of Provider Licensed to Provide Services

Sec. 4. The rules adopted by the secretary may not eliminate a type of provider licensed to provide Medicaid services.
[Pre-1992 Revision Citation: 12-1-7-14.7 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 21. Rules › 12-15-21-5. Rules Not to Be More Restrictive Than Federal Medicaid Reimbursement Requirements

Sec. 5. (a) As used in this section, "facility" refers to an intermediate care facility for individuals with intellectual disabilities (ICF/IID) not operated by a state agency.
(b) The rules adopted by the secretary may not establish eligibility criteria for Medicaid reimbursement for placement or services in a facility, including services provided under a Medicaid waiver, that are more restrictive than federal requirements for Medicaid reimbursement in a facility or under a Medicaid waiver.
(c) The office may not implement a policy that may not be adopted as a rule under subsection (b).
As added by P.L.78-1994, SEC.2. Amended by P.L.272-1999, SEC.41; P.L.35-2016, SEC.41.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 21. Rules › 12-15-21-6. Amendment of Prior Authorization Rule

Sec. 6. (a) IC 4-22-2 does not apply to a rulemaking procedure under this section.
(b) The office may amend a rule regarding prior authorization (as defined in 405 IAC 1-6-2) that appears in the Indiana Administrative Code on January 1, 1996, to make the prior authorization rule less restrictive.
(c) If the office amends a prior authorization rule under this section, the office may later amend the prior authorization rule to restore, in whole or in part, the prior authorization rule as it was in effect on January 1, 1996.
(d) An amendment to a prior authorization rule under this section must comply with the notice requirements set forth in IC 12-15-13-6.
As added by P.L.107-1996, SEC.11.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 21. Rules › 12-15-21-6.5. Family Practice Residency Program

Sec. 6.5. A family practice residency program may choose to have the name of the residency program, the primary medical provider, or both, appear on the Medicaid identification card of a recipient who is enrolled in a Medicaid managed care program instead of just the name of the individual primary medical provider in the residency program to whom the recipient has been assigned.
As added by P.L.107-1996, SEC.12 and P.L.257-1996, SEC.11.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 21. Rules › 12-15-21-7. Rules Not to Be More Stringent Than Prior Authorization Rule Effective January 1, 1996

Sec. 7. The office may not amend a prior authorization rule to make it more stringent than the prior authorization rule as it was in effect on January 1, 1996, unless the office changes the rule through the rulemaking process.
As added by P.L.107-1996, SEC.13.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-1. Sanctions for Violations

Sec. 1. If after investigation the office determines that a provider has violated a Medicaid statute or rule adopted under a Medicaid statute, the office may impose at least one (1) of the following sanctions:
(1) Denial of payment to the provider for Medicaid services provided during a specified time.
(2) Rejection of a prospective provider's application for participation in the Medicaid program.
(3) Termination of a provider agreement permitting a provider's participation in the Medicaid program.
(4) Assessment of a civil penalty against the provider in an amount not to exceed three (3) times the amount paid to the provider in excess of the amount that was legally due.
(5) Assessment of an interest charge, at a rate not to exceed the rate established by IC 24-4.6-1-101(2) for judgments on money, on the amount paid to the provider in excess of the amount that was legally due. The interest charge accrues from the date of the overpayment to the provider.
(6) Exclusion from the Medicaid program for a period of time consistent with 42 U.S.C. 1320a-7 et seq.
[Pre-1992 Revision Citation: 12-1-7-15.3(a).]
As added by P.L.2-1992, SEC.9. Amended by P.L.195-2018, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-1.5. Ineligibility After Conviction

Sec. 1.5. In addition to any sanction imposed on a provider under section 1 of this chapter, a provider convicted of an offense under IC 35-43-5 for fraud relating to Medicaid is ineligible to participate in the Medicaid program for ten (10) years after the conviction.
As added by P.L.46-1995, SEC.40. Amended by P.L.174-2021, SEC.10.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-2. Administrative Appeals; Rules

Sec. 2. A provider may appeal a sanction under section 1 of this chapter under rules concerning appeal that are adopted by the secretary under IC 4-22-2.
[Pre-1992 Revision Citation: 12-1-7-15.3(b) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-3. Judicial Review

Sec. 3. After exhausting all administrative remedies, a provider may obtain judicial review of a sanction under IC 4-21.5-5.
[Pre-1992 Revision Citation: 12-1-7-15.3(b) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-4. Denial of Payment or Termination of Provider Agreement; Obligation of Provider to Inform Individual Services Recipients

Sec. 4. A final directive made by the office that:
(1) denies payment to a provider for medical services provided during a specified period of time; or
(2) terminates a provider agreement permitting a provider's participation in the Medicaid program;
must direct the provider to inform each eligible individual recipient of services, before services are provided, that the office or the office's contractor under IC 12-15-30 will not pay for those services if provided.
[Pre-1992 Revision Citation: 12-1-7-15.3(c).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-5. Denial of Payment, Rejection of Participation Application or Provider Agreement Termination; Time to Correct Deficiencies

Sec. 5. Subject to section 6 of this chapter, a final directive:
(1) denying payment to a provider;
(2) rejecting a prospective provider's application for participation in the Medicaid program; or
(3) terminating a provider agreement permitting a provider's participation in the Medicaid program;
must be for a sufficient time, in the opinion of the administrator, to allow for the correction of all deficiencies or to prevent further abuses.
[Pre-1992 Revision Citation: 12-1-7-15.3(d) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-6. Eligibility; Repayment of Excess Payments; Payment of Penalties

Sec. 6. A provider may not be declared to be eligible until the office has received the following:
(1) Full repayment of the amount paid to the provider in excess of the proper and legal amount due, including any interest charge assessed by the office.
(2) Full payment of a civil penalty assessed under section 1(4) of this chapter.
[Pre-1992 Revision Citation: 12-1-7-15.3(d) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-7. Provider Subjected to Sanction; Agreement as Provided in Ic 12-15-11

Sec. 7. Except as provided in section 8 of this chapter, a provider who has been subjected to a sanction under section 1 of this chapter may file an agreement as provided in IC 12-15-11.
[Pre-1992 Revision Citation: 12-1-7-15.5(a).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 22. Provider Sanctions › 12-15-22-8. Eligibility to Submit Medicaid Claims; Criminal Convictions; Repeated Imposition of Sanctions

Sec. 8. A provider who:
(1) has been convicted of a crime relating to the provision of services under this chapter; or
(2) has been subjected to a sanction under section 1 of this chapter on three (3) separate occasions by directive of the administrator;
is ineligible to submit claims for Medicaid.
[Pre-1992 Revision Citation: 12-1-7-15.5(b).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-1. Reasonable Grounds to Suspect That Provider Has Received Payments to Which It Is Not Entitled; Certification of Evidence to Medicaid Fraud Control Unit; Exception

Sec. 1. Except as provided in section 2 of this chapter, if the administrator of the office determines that there are reasonable grounds to suspect that a provider has received payments that the provider is not entitled to under Medicaid, the administrator shall certify the evidence of the suspected activity to the state Medicaid fraud control unit established under IC 4-6-10.
[Pre-1992 Revision Citation: 12-1-7-15.8.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-2. Agreement for Overpayment to Be Deducted From Subsequent Payments; Authorization

Sec. 2. (a) If the office of the secretary of family and social services or administrator of the office determines that a provider has received payments the provider is not entitled to, the administrator may enter into an agreement with the provider stating that the amount of the overpayment shall be deducted from subsequent payments to the provider.
(b) If the office of the secretary of family and social services or the administrator of the office and the provider cannot come to an agreement within sixty (60) days after it is determined that a provider has received payments that the provider is not entitled to, the administrator may recoup the amount of overpayment to the provider claimed by the state from subsequent payments to the provider.
[Pre-1992 Revision Citation: 12-1-7-15.9(a) part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.229-2011, SEC.142.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-3. Agreements to Deduct Overpayments From Subsequent Payments; Interest Provisions; Other Provisions

Sec. 3. An agreement under section 2 of this chapter:
(1) must include a provision for the collection of any interest due from the provider on the amount of the overpayment; and
(2) may include any other provisions agreed to by the administrator and the provider.
[Pre-1992 Revision Citation: 12-1-7-15.9(a) part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.8-2005, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-4. Rules

Sec. 4. The secretary may adopt rules under IC 4-22-2 that provide procedures for the calculation of overpayments under this chapter.
[Pre-1992 Revision Citation: 12-1-7-15.9(a) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-5. Discovery of Overpayment; Time for Entering Into Agreement; Certification of Facts to Medicaid Fraud Control Unit

Sec. 5. If the administrator and a provider fail to enter into an agreement not more than sixty (60) days after the administrator's discovery of an overpayment, the administrator shall immediately certify the facts of the case to the Medicaid fraud control unit established under IC 4-6-10.
[Pre-1992 Revision Citation: 12-1-7-15.9(a) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-6. Determination by Medicaid Fraud Control Unit; Certification of Facts to Prosecuting Attorney; Reference of Matter to Attorney General

Sec. 6. (a) If the state Medicaid fraud control unit determines that an action based on the state Medicaid fraud control unit's investigations under the unit's authority under IC 4-6-10-1.5 is meritorious, the unit shall certify the facts drawn from the investigation to the prosecuting attorney of the judicial circuit in which the crime may have been committed.
(b) The state Medicaid fraud control unit shall assist the prosecuting attorney in prosecuting an action under this section.
(c) A prosecuting attorney to whom facts are certified under subsection (a) may refer the matter to the attorney general.
(d) If a matter has been referred to the attorney general under subsection (c), the attorney general may:
(1) file an information in a court with jurisdiction over the matter in the county in which the offense is alleged to have been committed; and
(2) prosecute the alleged offense.
[Pre-1992 Revision Citation: 12-1-7-15.9(b).]
As added by P.L.2-1992, SEC.9. Amended by P.L.10-1994, SEC.5; P.L.73-2003, SEC.3; P.L.149-2006, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-7. Action by Attorney General; Reference to Administrator

Sec. 7. The attorney general may do either of the following:
(1) Bring a civil action upon the facts certified to the attorney general by the state Medicaid fraud control unit.
(2) Refer the matter to the administrator for appropriate action under IC 12-15-22.
[Pre-1992 Revision Citation: 12-1-7-15.9(c).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-8. Civil Action; Finding in Favor of Attorney General; Treble Damages; Civil Penalties; Reimbursement of Investigation Costs

Sec. 8. (a) Subject to subsection (b), if the court finds in favor of the attorney general in a civil action brought by the attorney general under section 7 of this chapter, the court may do the following:
(1) Award damages against the provider of not more than three (3) times the amount paid to the provider in excess of the amount that was legally due.
(2) Assess a civil penalty against the provider of not more than five hundred dollars ($500) for each instance of overpayment found by the court.
(3) Order the provider to reimburse the attorney general for the reasonable costs of the attorney general's investigation and enforcement action.
(4) Take any combination of the actions described in subdivisions (1), (2), and (3).
(b) The court may only take action under subsection (a)(2) and (a)(3) if the provider knew or had reason to know that an item or a service was not provided as claimed.
[Pre-1992 Revision Citation: 12-1-7-15.9(d).]
As added by P.L.2-1992, SEC.9. Amended by P.L.73-2003, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-9. Meritorious Action; Money Recoverable Exceeding Cost of Action

Sec. 9. In determining whether an action is meritorious, the attorney general may consider whether the amount of money recoverable under the action would exceed the cost of the action.
[Pre-1992 Revision Citation: 12-1-7-15.9(e) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23. Improper Payments › 12-15-23-10. Action by Attorney General; Compromise

Sec. 10. An action brought under section 7 of this chapter may be compromised in the manner prescribed by IC 4-6-2-11.
[Pre-1992 Revision Citation: 12-1-7-15.9(e) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23.5. Coordination of Benefits Study › 12-15-23.5-2. Examination and Recovery of Medicaid Claims

Sec. 2. (a) Before January 1, 2008, the office shall:
(1) examine all Medicaid claims paid after January 1, 2001, and before July 1, 2007;
(2) determine which claims examined under subdivision (1) were eligible for payment by a third party other than Medicaid; and
(3) recover the claims that were determined under subdivision (2) to be eligible for payment by a third party other than Medicaid.
(b) The office shall require through an eligibility and benefit request, and a covered entity shall provide, any information necessary for the office to complete the examination required by this section. The office, after notice and hearing, may impose a fine not to exceed one thousand dollars ($1,000) for each refusal by a covered entity to provide information concerning an eligibility and benefit request for a Medicaid recipient requested by the office under this section.
As added by P.L.187-2007, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23.5. Coordination of Benefits Study › 12-15-23.5-3. Coordination of Benefits Procedures

Sec. 3. If at least one percent (1%) of the claims were determined under section 2 of this chapter to be eligible for payment by a third party other than Medicaid, the office shall develop and implement a procedure to improve the coordination of benefits between:
(1) the Medicaid program; and
(2) any other third party source of health care coverage provided to a recipient.
As added by P.L.187-2007, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 23.5. Coordination of Benefits Study › 12-15-23.5-4. Procedure Requirements

Sec. 4. If a procedure is developed and implemented under section 3 of this chapter, the procedure:
(1) must be automated; and
(2) must provide a system for determining whether a Medicaid claim is eligible for payment by another third party before the claim is paid under the Medicaid program.
As added by P.L.187-2007, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 24. Theft; Kickbacks and Bribes › 12-15-24-1. Intent to Deprive State of Money or Benefits; Prima Facie Evidence for Purposes of Ic 35-43-4-2

Sec. 1. Evidence that a person or provider received money or other benefits as a result of a violation of:
(1) a provision of this article; or
(2) a rule established by the secretary under this article;
constitutes prima facie evidence, for purposes of IC 35-43-4-2, that the person or provider intended to deprive the state of a part of the value of the money or benefits.
[Pre-1992 Revision Citation: 12-1-7-27.9.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 24. Theft; Kickbacks and Bribes › 12-15-24-2. Soliciting, Offering, or Receiving Kickbacks, Bribes, or Fee or Charge Rebates; Classification of Violation

Sec. 2. A person who furnishes items or services to an individual for which payment is or may be made under this chapter and who solicits, offers, or receives a:
(1) kickback or bribe in connection with the furnishing of the items or services or the making or receipt of the payment; or
(2) rebate of a fee or charge for referring the individual to another person for the furnishing of items or services;
commits a Class A misdemeanor.
[Pre-1992 Revision Citation: 12-1-7-28.2.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 25. Solicitation of Nonresidents › 12-15-25-1. Solicitation Defined; Prohibition

Sec. 1. (a) As used in this section, "solicitation" means a direct communication initiated by a provider doing business in Indiana to an individual or a provider in another state with the intent of inducing a nonresident of Indiana to relocate the person's residence to Indiana for the purpose of obtaining Medicaid under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(b) A provider that is:
(1) licensed by the state; and
(2) doing business in Indiana;
may not make a solicitation to a person who is eligible for Medicaid under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
[Pre-1992 Revision Citation: 12-1-7-16.2(a), (b).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 25. Solicitation of Nonresidents › 12-15-25-2. Marketing or Advertising Not Precluded

Sec. 2. This chapter does not preclude a provider from marketing or advertising the following:
(1) The provider's services to the general public.
(2) Special therapies or services, such as those offered to ventilator-dependent patients or patients with acquired immunodeficiency syndrome (AIDS) or Alzheimer's disease.
(3) Children's units.
[Pre-1992 Revision Citation: 12-1-7-16.2(c).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 25. Solicitation of Nonresidents › 12-15-25-3. Violations; Sanctions

Sec. 3. A provider that violates this chapter is subject to the sanctions imposed under IC 12-15-22.
[Pre-1992 Revision Citation: 12-1-7-16.2(d).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 26. Prior Authorization › 12-15-26-1. Prior Authorization for Mental Health Services; Providers Licensed Under Ic 25-33-1

Sec. 1. A health service provider in psychology licensed under IC 25-33-1 may submit a request for prior authorization (as defined in 405 IAC 1-6-2) for mental health services provided in the provider's private practice or a community mental health center authorized under IC 12-29 without the supervision or order of a physician.
[Pre-1992 Revision Citation: 12-1-7-17.3.]
As added by P.L.2-1992, SEC.9. Amended by P.L.140-1993, SEC.2.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 26. Prior Authorization › 12-15-26-2. Psychiatrists Practicing in Employment of Community Mental Health Centers

Sec. 2. A psychiatrist practicing in the employment of a community mental health center must not be required to request prior authorization to treat Medicaid eligible patients if the request for prior authorization is not required of psychiatrists in private practice.
[Pre-1992 Revision Citation: 12-1-7-59.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-1. Medicaid Applicants and Recipients; Confidential Records and Documents

Sec. 1. The following concerning a Medicaid applicant or recipient under the Medicaid program are confidential, except as otherwise provided in this chapter:
(1) An application.
(2) An investigation report.
(3) An information.
(4) A record.
[Pre-1992 Revision Citation: 12-1-7-28(b).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-2. Use and Disclosure of Information; Provision of Information to Legislative Services Agency

Sec. 2. (a) The use and the disclosure of the information described in this chapter to persons authorized by law in connection with the official duties relating to:
(1) financial audits;
(2) legislative investigations; or
(3) other purposes directly connected with the administration of the plan;
is permitted.
(b) The secretary shall provide to the legislative services agency, in the form and on the schedule specified by the executive director of the legislative services agency, all information or data described in section 1(1) through 1(4) of this chapter (including, but not limited to, applications, enrollments, claims, and encounters) and any additional information or data concerning a program described in this article or concerning the children's health insurance program established under IC 12-17.6 that is requested by the executive director of the legislative services agency. The legislative services agency:
(1) shall maintain the confidentiality of confidential information or data received under this subsection; and
(2) may use information or data received under this subsection only to estimate the fiscal impact of proposed legislation, prepare program evaluation reports, and forecast enrollment and program costs of the Medicaid program, the healthy Indiana plan, and the children's health insurance program.
(c) Unless:
(1) redaction of an identifier is required under subsection (d); or
(2) the executive director of the legislative services agency requests redaction of an identifier;
from the information or data requested under subsection (b), the information or data received under subsection (a) or (b) must include all identifiers specified in 45 CFR 164.514(b).
(d) Before information or data with names, addresses, or individualized identification numbers of applicants or individuals receiving services under the Medicaid program, the healthy Indiana plan, or the children's health insurance program is provided to the legislative services agency under subsection (a) or (b), the secretary or office shall as soon as practicable after a request provide the information or data to the legislative services agency after:
(1) redacting names, street addresses (other than county and ZIP code information), and individualized identification numbers used in the operation of the Medicaid program, the healthy Indiana plan, or the children's health insurance program; and
(2) generating and substituting for each applicant or individual a unique number that is not used in the Medicaid program, the healthy Indiana plan, or the children's health insurance program but is maintained over time and is useful for longitudinal analysis described in subsection (b).
The system of numbering under subdivision (2) must be approved by the executive director of the legislative services agency.
[Pre-1992 Revision Citation: 12-1-7-28(c).]
As added by P.L.2-1992, SEC.9. Amended by P.L.78-2016, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-3. Release and Use of General Information

Sec. 3. (a) The release and use of information of a general nature shall be provided as needed for adequate interpretation or development of the Medicaid program.
(b) The information under subsection (a) includes the following:
(1) Total Medicaid expenditures.
(2) The number of recipients.
(3) Statistical and social data used in connection with studies.
(4) Reports or surveys on health and welfare problems.
[Pre-1992 Revision Citation: 12-1-7-28(d).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-4. Repealed

[Pre-1992 Revision Citation: 12-1-7-28(e).]
As added by P.L.2-1992, SEC.9. Repealed by P.L.210-2015, SEC.49.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-5. Eligibility for Federal Financial Participation; Limitations on Chapter; Rules

Sec. 5. (a) If it is established that this chapter causes the state Medicaid plan to be ineligible for federal financial participation, the provision is limited or restricted to the extent that is essential to make the plan eligible for federal financial participation.
(b) The secretary shall establish rules under IC 4-22-2 that are necessary to carry out this section.
[Pre-1992 Revision Citation: 12-1-7-28(f).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-6. Eligibility Information; Immediate Access Systems

Sec. 6. The office shall make available the following for providing health care providers with immediate access to information indicating whether an individual is eligible for Medicaid:
(1) A twenty-four (24) hour telephone system.
(2) A computerized data retrieval system.
[Pre-1992 Revision Citation: 12-1-7-28.5(a).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-7. Limitations on Eligibility Information Available Through Immediate Access Systems

Sec. 7. Information released under section 6 of this chapter is limited to the following:
(1) Disclosure of whether an individual has been determined to be eligible for Medicaid or whether the individual has an application pending.
(2) The date the individual became eligible for Medicaid and the individual's Medicaid number.
(3) Restrictions, if any, on the scope of services to be reimbursed under the Medicaid program for the individual.
(4) Information concerning third party liability.
[Pre-1992 Revision Citation: 12-1-7-28.5(b).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-8. Eligibility Information Obtained by Health Care Providers; Confidentiality

Sec. 8. Information obtained by a health care provider under this chapter concerning an individual's eligibility for Medicaid is confidential and may not be disclosed to any person.
[Pre-1992 Revision Citation: 12-1-7-28.5(c).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-8.5. Use and Disclosure of Voter Registration Records

Sec. 8.5. A person may not examine, disclose, or use any record described in this chapter concerning voter registration except in the manner permitted under IC 12-15-1.5.
As added by P.L.12-1995, SEC.122.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 27. Confidentiality and Release of Information › 12-15-27-9. Eligibility Information Access and Confidentiality; Rules

Sec. 9. The secretary shall adopt rules under IC 4-22-2 necessary to carry out sections 6, 7, and 8 of this chapter.
[Pre-1992 Revision Citation: 12-1-7-28.5(d).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 28. Appeals and Hearings › 12-15-28-1. Decisions Appealable to Office

Sec. 1. An applicant for or a recipient of Medicaid may appeal to the office if one (1) of the following occurs:
(1) An application or a request is not acted upon by the county office within a reasonable time after the application or request is filed.
(2) The application is denied.
(3) The applicant or recipient is dissatisfied with the action of the county office.
(4) The recipient is dissatisfied with a determination made by the office under IC 12-15-8.5.
[Pre-1992 Revision Citation: 12-1-7-22.]
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.115; P.L.5-1993, SEC.128; P.L.178-2002, SEC.86.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 28. Appeals and Hearings › 12-15-28-2. Secretary to Conduct Hearings Under Ic 4-21.5

Sec. 2. The secretary shall conduct hearings and appeals concerning Medicaid under IC 4-21.5.
[Pre-1992 Revision Citation: 12-6-6-10(b) part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 28. Appeals and Hearings › 12-15-28-3. Notice of Appeal; Setting Matter for Hearing; Opportunity for Hearing; Location

Sec. 3. The office shall, upon receipt of notice of appeal under section 1 of this chapter, set the matter for hearing and give the applicant or recipient an opportunity for a fair hearing in the county in which the recipient resides.
[Pre-1992 Revision Citation: 12-1-7-23 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 28. Appeals and Hearings › 12-15-28-4. Hearing; Introduction of Evidence

Sec. 4. At the hearing, the applicant and county office may introduce additional evidence.
[Pre-1992 Revision Citation: 12-1-7-23 part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.116; P.L.5-1993, SEC.129.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 28. Appeals and Hearings › 12-15-28-5. Conduct of Hearing; Rules

Sec. 5. The hearing shall be conducted under rules adopted by the secretary that are not inconsistent with IC 4-21.5 and the Medicaid program.
[Pre-1992 Revision Citation: 12-1-7-23 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 28. Appeals and Hearings › 12-15-28-6. Additional Investigations by Office; Decision by Office to Grant Medicaid

Sec. 6. The office:
(1) may make necessary additional investigations; and
(2) shall make decisions relative to the granting of Medicaid and the amount of Medicaid to be granted to the applicant that the office believes are justified and in conformity with the Medicaid program.
[Pre-1992 Revision Citation: 12-1-7-23 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 28. Appeals and Hearings › 12-15-28-7. Decision by Office to Grant Medicaid Assistance; Effect

Sec. 7. A decision of the office made in conformity with the Medicaid program, including the establishment of dates of eligibility:
(1) is binding upon the county office involved;
(2) shall be complied with by the county office; and
(3) has the same effect as decisions of the county office from which the appeal is taken.
[Pre-1992 Revision Citation: 12-1-7-23 part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.117; P.L.5-1993, SEC.130.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-1. Insurers; Authorization to Release Information

Sec. 1. An applicant for or a recipient of Medicaid is considered to have authorized an insurer to release to the office information needed by the office to secure or enforce the office's rights under Medicaid.
[Pre-1992 Revision Citation: 12-1-7-24.1(a).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-2. Requests for Information From Insurers; Limitation

Sec. 2. (a) Subject to subsection (b), an insurer shall furnish records or information pertaining to the coverage of an individual for the individual's medical costs under an individual or a group policy or other obligation, or the medical benefits paid or claims made under a policy or an obligation, if the office or its agent does the following:
(1) Requests the information electronically or by United States mail.
(2) Certifies that the individual is:
(A) a Medicaid applicant or recipient; or
(B) a person who is legally responsible for the applicant or recipient.
(b) The office may request only the records or information necessary to determine whether insurance benefits have been or should have been claimed and paid with respect to items of medical care and services that were received by a particular individual and for which Medicaid coverage would otherwise be available.
[Pre-1992 Revision Citation: 12-1-7-24.1(b).]
As added by P.L.2-1992, SEC.9. Amended by P.L.187-2007, SEC.4; P.L.234-2007, SEC.209; P.L.3-2008, SEC.94.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-3. Guidelines for Information Requests

Sec. 3. The administrator and the insurance commissioner shall establish guidelines for information requests under this chapter.
[Pre-1992 Revision Citation: 12-1-7-24.1(c).]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 29. Insurance › 12-15-29-4. Direct Payments by Insurers to Office; Amount of Payments

Sec. 4. (a) If:
(1) an insurer has not discharged the insurer's obligation to make payments to an individual for medical services;
(2) the individual has received Medicaid from the office; and
(3) the insurer has received notice that Medicaid has been furnished to the individual;
the insurer shall make payments directly to the office.
(b) The payments under subsection (a) may not exceed the amount of Medicaid paid by the office.
[Pre-1992 Revision Citation: 12-1-7-24.2(a).]
As added by P.L.2-1992, SEC.9.