reglab/statecodes huggingface dataset:
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-4. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.160-2011, SEC.7; P.L.209-2015, SEC.13. Repealed by P.L.30-2016, SEC.8.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-6. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.160-2011, SEC.8. Repealed by P.L.30-2016, SEC.10.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-9. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.160-2011, SEC.9; P.L.278-2013, SEC.14; P.L.213-2015, SEC.132. Repealed by P.L.30-2016, SEC.13.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-10. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.160-2011, SEC.10. Repealed by P.L.30-2016, SEC.14.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-11. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.160-2011, SEC.11. Repealed by P.L.30-2016, SEC.15.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-14. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.42-2011, SEC.30; P.L.213-2015, SEC.133. Repealed by P.L.30-2016, SEC.18.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-19. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.1-2010, SEC.59; P.L.213-2015, SEC.135. Repealed by P.L.30-2016, SEC.21.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-20. Premium Assistance Program

Sec. 20. (a) The office may establish a health insurance coverage premium assistance program for individuals who meet the following:
(1) Have an annual household income of the following:
(A) Through December 31, 2013, not more than two hundred percent (200%) of the federal income poverty level.
(B) Beginning January 1, 2014, not more than one hundred thirty-three percent (133%) of the federal income poverty level, based on the adjusted gross income provisions set forth in Section 2001(a)(1) of the federal Patient Protection and Affordable Care Act.
(2) Are eligible for health insurance coverage through an employer but cannot afford the health insurance coverage premiums.
(b) A program established under this section must:
(1) contain eligibility requirements that are similar to the eligibility requirements of the plan;
(2) include a health care account as a component; and
(3) provide that an individual's payment:
(A) to a health care account; or
(B) for a health insurance coverage premium;
may not exceed five percent (5%) of the individual's annual income.
(c) The office may adopt rules under IC 4-22-2 necessary to implement and administer this section.
As added by P.L.3-2008, SEC.98. Amended by P.L.160-2011, SEC.13; P.L.30-2016, SEC.22.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.2. Healthy Indiana Plan Trust Fund; Premium Assistance Program › 12-15-44.2-21. Repealed

As added by P.L.3-2008, SEC.98. Amended by P.L.160-2011, SEC.14. Repealed by P.L.30-2016, SEC.23.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-1. "Phase Out Period"

Sec. 1. As used in this chapter, "phase out period" refers to the following periods:
(1) The time during which a:
(A) phase out plan;
(B) demonstration expiration plan; or
(C) similar plan approved by the United States Department of Health and Human Services;
is in effect for the plan set forth in this chapter.
(2) The time beginning upon the office's receipt of written notice by the United States Department of Health and Human Services of its decision to:
(A) terminate or suspend the waiver demonstration for the plan; or
(B) withdraw the waiver or expenditure authority for the plan;
and ending on the effective date of the termination, suspension, or withdrawal of the waiver or expenditure authority.
(3) The time beginning upon:
(A) the office's determination to terminate the plan; or
(B) the termination of the plan under section 4(b) of this chapter;
if subdivisions (1) through (2) do not apply, and ending on the effective date of the termination of the plan.
As added by P.L.213-2015, SEC.136.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-2. "Plan"

Sec. 2. As used in this chapter, "plan" refers to the healthy Indiana plan established by section 3 of this chapter.
As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.25.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-2.3. "Preventative Care Services"

Sec. 2.3. As used in this chapter, "preventative care services" means care that is provided to an individual to prevent disease, diagnose disease, or promote good health.
As added by P.L.30-2016, SEC.26.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-3. Plan Established; Eligibility; Oversight of Marketing; Promotion of Plan; Ensure Enrollment Distribution; Consumer Protection; Provider Participation; Exemptions

Sec. 3. (a) The healthy Indiana plan is established.
(b) The office shall administer the plan.
(c) The following individuals are eligible for the plan:
(1) The adult group described in 42 CFR 435.119.
(2) Parents and caretaker relatives eligible under 42 CFR 435.110.
(3) Low income individuals who are:
(A) at least nineteen (19) years of age; and
(B) less than twenty-one (21) years of age;
and eligible under 42 CFR 435.222.
(4) Individuals, for purposes of receiving transitional medical assistance.
An individual must meet the Medicaid residency requirements under IC 12-15-4-4 and this article to be eligible for the plan.
(d) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare program (42 U.S.C. 1395 et seq.).
(2) An individual who is otherwise eligible and enrolled for medical assistance.
(e) The department of insurance and the office of the secretary shall provide oversight of the marketing practices of the plan.
(f) The office shall promote the plan and provide information to potential eligible individuals who live in medically underserved rural areas of Indiana.
(g) The office shall, to the extent possible, ensure that enrollment in the plan is distributed throughout Indiana in proportion to the number of individuals throughout Indiana who are eligible for participation in the plan.
(h) The office shall establish standards for consumer protection, including the following:
(1) Quality of care standards.
(2) A uniform process for participant grievances and appeals.
(3) Standardized reporting concerning provider performance, consumer experience, and cost.
(i) A health care provider that provides care to an individual who receives health coverage under the plan shall also participate in the Medicaid program under this article.
(j) The following do not apply to the plan:
(1) IC 12-15-12.
(2) IC 12-15-13.
(3) IC 12-15-14.
(4) IC 12-15-15.
(5) IC 12-15-21.
(6) IC 12-15-26.
(7) IC 12-15-31.1.
(8) IC 12-15-34.
(9) IC 12-15-35.
(10) IC 16-42-22-10.
As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.27; P.L.152-2017, SEC.32; P.L.241-2023, SEC.16.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-4. Scope of the Plan; Termination of Plan; Obligation of State; Report to Budget Committee

Sec. 4. (a) The plan:
(1) is not an entitlement program; and
(2) serves as an alternative to health care coverage under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(b) If either of the following occurs, the office shall terminate the plan in accordance with section 6(b) of this chapter:
(1) The:
(A) percentages of federal medical assistance available to the plan for coverage of plan participants described in Section 1902(a)(10)(A)(i)(VIII) of the federal Social Security Act are less than the percentages provided for in Section 2001(a)(3)(B) of the federal Patient Protection and Affordable Care Act; and
(B) hospital assessment committee (IC 16-21-10), after considering the modification and the reduction in available funding, does not alter the formula established under IC 16-21-10-13.3(b)(1) to cover the amount of the reduction in federal medical assistance.
For purposes of this subdivision, "coverage of plan participants" includes payments, contributions, and amounts referred to in IC 16-21-10-13.3(b)(1)(A), IC 16-21-10-13.3(b)(1)(C), and IC 16-21-10-13.3(b)(1)(D), including payments, contributions, and amounts incurred during a phase out period of the plan.
(2) The:
(A) methodology of calculating the incremental fee set forth in IC 16-21-10-13.3 is modified in any way that results in a reduction in available funding;
(B) hospital assessment fee committee (IC 16-21-10), after considering the modification and reduction in available funding, does not alter the formula established under IC 16-21-10-13.3(b)(1) to cover the amount of the reduction in fees; and
(C) office does not use alternative financial support to cover the amount of the reduction in fees.
(c) If the plan is terminated under subsection (b), the secretary may implement a plan for coverage of the affected population in a manner consistent with the healthy Indiana plan (IC 12-15-44.2 (before its repeal)) in effect on January 1, 2014:
(1) subject to prior approval of the United States Department of Health and Human Services; and
(2) without funding from the incremental fee set forth in IC 16-21-10-13.3.
(d) The office may not operate the plan in a manner that would obligate the state to financial participation beyond the level of state appropriations or funding otherwise authorized for the plan.
(e) The office of the secretary shall submit annually to the budget committee an actuarial analysis of the plan that reflects a determination that sufficient funding is reasonably estimated to be available to operate the plan.
As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.29.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-4.5. Required Health Care Account; Payments

Sec. 4.5. (a) An individual who participates in the plan must have a health care account to which payments may be made for the individual's participation in the plan.
(b) An individual's health care account must be used to pay the individual's deductible for health care services under the plan.
(c) An individual's deductible must be at least two thousand five hundred dollars ($2,500) per year.
(d) An individual may make payments to the individual's health care account as follows:
(1) An employer withholding or causing to be withheld from an employee's wages or salary, after taxes are deducted from the wages or salary, the individual's contribution under this chapter and distributed equally throughout the calendar year.
(2) Submission of the individual's contribution under this chapter to the office to deposit in the individual's health care account in a manner prescribed by the office.
(3) Another method determined by the office.
As added by P.L.30-2016, SEC.30.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-5. Managed Care Organization Responsibilities; Reimbursement; Cultural Competency Standards

Sec. 5. (a) A managed care organization that contracts with the office to provide health coverage, dental coverage, or vision coverage to an individual who participates in the plan:
(1) is responsible for the claim processing for the coverage;
(2) shall reimburse providers at a rate that is not less than the rate established by the secretary; and
(3) may not deny coverage to an eligible individual who has been approved by the office to participate in the plan.
(b) A managed care organization that contracts with the office to provide health coverage under the plan must incorporate cultural competency standards established by the office. The standards must include standards for non-English speaking, minority, and disabled populations.
As added by P.L.213-2015, SEC.136. Amended by P.L.152-2017, SEC.34; P.L.201-2023, SEC.136.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-5.5. Workforce Training and Job Search Program Referral

Sec. 5.5. The office shall refer any member of the plan who:
(1) is employed for less than twenty (20) hours per week; and
(2) is not a full-time student;
to a workforce training and job search program.
As added by P.L.30-2016, SEC.33.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-5.7. Nonemergency Services Received in an Emergency Room; Copayment

Sec. 5.7. Subject to appeal to the office, an individual may be held responsible under the plan for receiving nonemergency services in an emergency room setting, including prohibiting the individual from using funds in the individual's health care account to pay for the nonemergency services and paying a copayment for the services of at least eight dollars ($8) for the nonemergency use of a hospital emergency department. However, an individual may not be prohibited from using funds in the individual's health care account to pay for nonemergency services provided in an emergency room setting for a medical condition that arises suddenly and unexpectedly and manifests itself by acute symptoms of such severity, including severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to:
(1) place an individual's health in serious jeopardy;
(2) result in serious impairment to the individual's bodily functions; or
(3) result in serious dysfunction of a bodily organ or part of the individual.
As added by P.L.30-2016, SEC.34. Amended by P.L.114-2018, SEC.7.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-6. Phase Out Funds Deposited From Incremental Hospital Assessment Fees; Notice and Phase Out if Plan Is Terminated

Sec. 6. (a) For a state fiscal year beginning July 1, 2018, or thereafter, the office, after review by the state budget committee, may determine that no incremental fees collected under IC 16-21-10-13.3 are required to be deposited into the phase out trust fund established under section 7 of this chapter.
(b) If the plan is to be terminated for any reason, the office shall:
(1) if required, provide notice of termination of the plan to the United States Department of Health and Human Services and begin the process of phasing out the plan; or
(2) if notice and a phase out plan is not required under federal law, notify the hospital assessment fee committee (IC 16-21-10) of the office's intent to terminate the plan and the plan shall be phased out under a procedure approved by the hospital assessment fee committee.
The office may not submit any phase out plan to the United States Department of Health and Human Services or accept any phase out plan proposed by the Department of Health and Human Services without the prior approval of the hospital assessment fee committee.
(c) Before submitting:
(1) an extension of; or
(2) a material amendment to;
the plan to the United States Department of Health and Human Services, the office shall inform the Indiana Hospital Association of the extension or material amendment to the plan.
As added by P.L.213-2015, SEC.136. Amended by P.L.108-2019, SEC.198.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-7. Phase Out Trust Fund Established; Purpose of the Fund; Uses; Administration; Fund Is Considered a Trust Fund

Sec. 7. (a) The phase out trust fund is established for the purpose of holding the money needed during a phase out period of the plan. Funds deposited under this section shall be used only:
(1) to fund the state share of the expenses described in IC 16-21-10-13.3(b)(1)(A) through IC 16-21-10-13.3(b)(1)(F) incurred during a phase out period of the plan;
(2) after funds from the healthy Indiana trust fund (IC 12-15-44.2-17) are exhausted; and
(3) to refund hospitals in the manner described in subsection (h).
The fund is separate from the state general fund.
(b) The fund shall be administered by the office.
(c) The expenses of administering the fund shall be paid from money in the fund.
(d) The trust fund must consist of:
(1) the funds described in section 6 of this chapter; and
(2) any interest accrued under this section.
(e) 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 money may be invested. Interest that accrues from these investments shall be deposited in the fund.
(f) Money in the fund does not revert to the state general fund at the end of any fiscal year.
(g) The fund is considered a trust fund for purposes of IC 4-9.1-1-7. Money may not be transferred, assigned, or otherwise removed from the fund by the state board of finance, the budget agency, or any other state agency unless specifically authorized under this chapter.
(h) At the end of the phase out period, any remaining funds and accrued interest shall be distributed to the hospitals on a pro rata basis based on the fees authorized by IC 16-21-10 that were paid by each hospital for the state fiscal year that ended immediately before the beginning of the phase out period.
As added by P.L.213-2015, SEC.136.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-8. Requirements for Use of Money Appropriated to the Fund; Requirements for Use of the Incremental Hospital Assessment Fee; Payment for Health Care Services; Administrative Costs; Profit

Sec. 8. The following requirements apply to funds appropriated by the general assembly to the plan and the incremental fee used for purposes of IC 16-21-10-13.3:
(1) At least eighty-seven percent (87%) of the funds must be used to fund payment for health care services.
(2) An amount determined by the office of the secretary to fund:
(A) administrative costs of; and
(B) any profit made by;
a managed care organization under a contract with the office to provide health coverage under the plan. The amount determined under this subdivision may not exceed thirteen percent (13%) of the funds.
As added by P.L.213-2015, SEC.136. Amended by P.L.152-2017, SEC.35.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-9. Rules

Sec. 9. (a) The office may adopt rules under IC 4-22-2 necessary to implement:
(1) this chapter; or
(2) a Section 1115 Medicaid demonstration waiver concerning the plan that is approved by the United States Department of Health and Human Services.
(b) The office may adopt emergency rules under IC 4-22-2-37.1 to implement the plan on an emergency basis.
(c) An emergency rule or an amendment to an emergency rule adopted under this section expires not later than the earlier of:
(1) one (1) year after the rule is accepted for filing under IC 4-22-2-37.1(e); or
(2) July 1, 2016.
As added by P.L.213-2015, SEC.136.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 44.5. Healthy Indiana Plan 2.0 › 12-15-44.5-10. Benefits for Adult Group; Negotiation of Plan Limitations

Sec. 10. (a) The secretary has the authority to provide benefits to individuals eligible under the adult group described in 42 CFR 435.119 only in accordance with this chapter.
(b) The secretary may negotiate and make changes to the plan, except that the secretary may not negotiate or change the plan that would do the following:
(1) Reduce the following:
(A) Contribution amounts below the minimum levels set forth in section 4.7 of this chapter.
(B) Deductible amounts below the minimum amount established in section 4.5(c) of this chapter.
(2) Remove or reduce the penalties for nonpayment set forth in section 4.7 of this chapter.
(3) Revise the use of the health care account requirement set forth in section 4.5 of this chapter.
(4) Include noncommercial benefits or add additional plan benefits in a manner inconsistent with section 3.5 of this chapter.
(5) Allow services to begin:
(A) without the payment established or required by; or
(B) earlier than the time frames otherwise established by;
section 4.7 of this chapter.
(6) Reduce financial penalties for the inappropriate use of the emergency room below the minimum levels set forth in section 5.7 of this chapter.
(7) Permit members to change health plans without cause in a manner inconsistent with section 4.7(g) of this chapter.
(8) Operate the plan in a manner that would obligate the state to financial participation beyond the level of state appropriations or funding otherwise authorized for the plan.
(c) The secretary may make changes to the plan under this chapter if the changes are required by federal law or regulation.
As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.35.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 47. Long Acting Reversible Contraceptives › 12-15-47-1. "Long Acting Reversible Contraceptive"

Sec. 1. As used in this chapter, "long acting reversible contraceptive" includes intrauterine devices and birth control implants.
As added by P.L.177-2023, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 47. Long Acting Reversible Contraceptives › 12-15-47-2. Transfer of Long Acting Reversible Contraceptive; Required Conditions

Sec. 2. A long acting reversible contraceptive that is prescribed to and obtained for a Medicaid recipient may be transferred to another Medicaid recipient if the long acting reversible contraceptive was not delivered to, implanted in, or used on the original Medicaid recipient to whom the long acting reversible contraceptive was prescribed. Before the long acting reversible contraceptive is transferred to another Medicaid recipient, the long acting reversible contraceptive must meet the following conditions:
(1) Be in the original, unopened package.
(2) Have been in the possession of the provider for at least twelve (12) weeks. However, the requirement under this subdivision may be waived by the written consent of the original Medicaid recipient to whom the long acting reversible contraceptive was prescribed.
(3) Not have left the possession of the provider who originally prescribed the long acting reversible contraceptive.
(4) Be medically appropriate and not contraindicated for the
Medicaid recipient to whom the long acting reversible contraceptive is being transferred.
As added by P.L.177-2023, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 47.3. Medicaid Oversight Committee › 12-15-47.3-1. "Oversight Committee"

Sec. 1. As used in this chapter, "oversight committee" refers to the Medicaid oversight committee established by section 2 of this chapter.
As added by P.L.201-2023, SEC.137.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 47.3. Medicaid Oversight Committee › 12-15-47.3-3. Members of Oversight Committee

Sec. 3. The oversight committee consists of the following members:
(1) The chairperson of the house ways and means committee.
(2) The ranking minority member of the house ways and means committee.
(3) One (1) member of the house ways and means committee who is appointed by the speaker of the house of representatives.
(4) The chairperson of the house public health committee.
(5) The chairperson of the senate appropriations committee.
(6) The chairperson of the senate tax and fiscal policy committee.
(7) The ranking minority member of the senate appropriations committee.
(8) The chairperson of the senate health and provider services committee.
(9) The director of the office of management and budget, or the director's designee.
(10) The secretary of the family and social services administration, or the secretary's designee.
As added by P.L.201-2023, SEC.137.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 47.3. Medicaid Oversight Committee › 12-15-47.3-4. Duties of Oversight Committee

Sec. 4. The oversight committee shall review, consider, and make recommendations concerning all requests for new services and changes in existing services for the Medicaid program.
As added by P.L.201-2023, SEC.137.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 47.3. Medicaid Oversight Committee › 12-15-47.3-5. Appointment of Chairperson

Sec. 5. The chairperson of the legislative council shall appoint the chairperson of the oversight committee from the members of the committee.
As added by P.L.201-2023, SEC.137.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 1. Medical Services for Inmates and Patients › 12-16-1-1. "Affected Agency" Defined

Sec. 1. As used in this chapter, "affected agency" means any of the following:
(1) The department of correction.
(2) The Indiana department of health.
(3) The division of mental health and addiction.
(4) The division of disability and rehabilitative services.
[Pre-1992 Revision Citation: 12-5-7-1 part.]
As added by P.L.2-1992, SEC.10. Amended by P.L.40-1994, SEC.22; P.L.215-2001, SEC.46; P.L.141-2006, SEC.56; P.L.56-2023, SEC.114.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 1. Medical Services for Inmates and Patients › 12-16-1-2. "Covered Medical Services" Defined

Sec. 2. As used in this chapter, "covered medical services" refers to medical services that meet the following qualifications:
(1) Cost more than one hundred fifty dollars ($150).
(2) Are provided to a committed individual or patient of an institution under the jurisdiction of an affected agency.
(3) Are provided outside of an institution under the jurisdiction of an affected agency.
[Pre-1992 Revision Citation: 12-5-7-1 part; 12-5-7-2.]
As added by P.L.2-1992, SEC.10.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 1. Medical Services for Inmates and Patients › 12-16-1-3. Rules; Adoption; Requisites

Sec. 3. (a) The division shall, with the advice of the division's medical staff, representatives of affected agencies, and other individuals selected by the director of the division, adopt rules under IC 4-22-2 to do the following:
(1) Provide for prior review and approval of covered medical services, including special review and approval procedures for emergency covered medical services.
(2) Establish limitations consistent with medical necessity on the duration of services to be provided.
(3) Specify the amount of and method for reimbursement for services.
(4) Specify the conditions under which payments will be denied and improper payments will be recovered.
(b) To the extent possible, rules adopted under this section must be consistent with Title XIX of the federal Social Security Act and with IC 12-15-21-2 and IC 12-15-21-3.
[Pre-1992 Revision Citation: 12-5-7-4.]
As added by P.L.2-1992, SEC.10.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 1. Medical Services for Inmates and Patients › 12-16-1-4. Contract for Services; Same Contractor Requirement

Sec. 4. (a) The division shall contract with the same contractor with which the office contracts under IC 12-15-30 to provide administrative and fiscal services to implement this chapter.
(b) A contract for services is not subject to IC 5-22.
[Pre-1992 Revision Citation: 12-5-7-5.]
As added by P.L.2-1992, SEC.10. Amended by P.L.49-1997, SEC.45.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 1. Medical Services for Inmates and Patients › 12-16-1-5. Payment for Covered Medical Services; Requirements

Sec. 5. Payment for covered medical services approved by the fiscal agent shall be paid:
(1) from money for the Medicaid program if the requirements of IC 12-15 are met; or
(2) if a payment cannot be made under subdivision (1), from a state appropriation either made for an affected agency or for covered medical services for all affected agencies.
[Pre-1992 Revision Citation: 12-5-7-6.]
As added by P.L.2-1992, SEC.10.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 2. Repealed

[Pre-1992 Revision Citations:
12-16-2-1New12-16-2-2formerly 12-5-6-10 part12-16-2-3formerly 12-5-6-1312-16-2-4formerly 12-5-6-2112-16-2-5formerly 12-5-6-2.1(e).]
Repealed by P.L.283-2001, SEC.40.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions › 12-16-2.5-1. Administration of Program

Sec. 1. The division shall administer the hospital care for the indigent program under this article.
As added by P.L.120-2002, SEC.18.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions › 12-16-2.5-2. Repealed

As added by P.L.120-2002, SEC.18. Amended by P.L.255-2003, SEC.24. Repealed by P.L.146-2008, SEC.819.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions › 12-16-2.5-4. Disproportionate Share of Low Income Patients; Calculating Allowable Disproportionate Share Additional Payments

Sec. 4. To the extent permitted under federal statutes or regulations, patient days for patients under the hospital care for the indigent program shall be included in calculating allowable disproportionate share additional payments under 42 U.S.C. 1395 ww(d).
As added by P.L.120-2002, SEC.18.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions › 12-16-2.5-5. Program Not Applicable to Inmates and Patients of Certain Institutions

Sec. 5. The hospital care for the indigent program does not apply to inmates and patients of institutions of the department of correction, the Indiana department of health, the division of mental health and addiction, the division of aging, or the division of disability and rehabilitative services.
As added by P.L.120-2002, SEC.18. Amended by P.L.141-2006, SEC.57; P.L.56-2023, SEC.115.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions › 12-16-2.5-6.3. Definitions

Sec. 6.3. For purposes of this article, the following definitions apply to the hospital care for the indigent program:
(1) "Assistance" means the satisfaction of a person's financial obligation under IC 12-16-7.5-1.2 for hospital items or services, physician services, or transportation services provided to the person.
(2) "Claim" means a statement filed with the division by a hospital, physician, or transportation provider that identifies the health care items or services the hospital, physician, or transportation provider rendered to a person for whom an application under IC 12-16-4.5 has been filed with the division.
(3) "Eligible" or "eligibility", when used in regard to a person for whom an application under IC 12-16-4.5 has been filed with the division, means the extent to which:
(A) the person, for purposes of the application, satisfies the income and resource standards established under IC 12-16-3.5; and
(B) the person's medical condition, for purposes of the application, satisfies one (1) or more of the medical conditions identified in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3).
As added by P.L.145-2005, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 2.5. Hospital Care for the Indigent; Administration and General Provisions › 12-16-2.5-6.5. Repealed

As added by P.L.145-2005, SEC.4. Amended by P.L.1-2006, SEC.188. Repealed by P.L.212-2007, SEC.31; P.L.218-2007, SEC.52.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 3. Repealed

[Pre-1992 Revision Citations:
12-16-3-1formerly 12-5-6-2.1(a)12-16-3-2formerly 12-5-6-2.1(b)12-16-3-3formerly 12-5-6-2.1(c)12-16-3-4formerly 12-5-6-3.]
Repealed by P.L.283-2001, SEC.40.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 3.5. Hospital Care for the Indigent; Eligibility for Assistance › 12-16-3.5-1. Resident Eligibility; Emergency Care; Conditions

Sec. 1. (a) An Indiana resident who meets the income and resource standards established by the division under section 3 of this chapter is eligible for assistance to satisfy the resident's financial obligation for care provided to the resident in a hospital in Indiana that was necessitated after the onset of a medical condition that was manifested by symptoms of sufficient severity that the absence of immediate medical attention would probably result in any of the following:
(1) Placing the individual's life in jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of a bodily organ or part.
(b) A qualified resident is also eligible for assistance to satisfy the resident's financial obligation for the care that is a direct consequence of the medical condition that necessitated the emergency care.
As added by P.L.120-2002, SEC.19. Amended by P.L.145-2005, SEC.5.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 3.5. Hospital Care for the Indigent; Eligibility for Assistance › 12-16-3.5-2. Nonresident Eligibility; Emergency Care; Conditions; Qualifications

Sec. 2. (a) An individual who is not an Indiana resident is eligible for assistance to satisfy the individual's financial obligation for the care provided to the individual in a hospital in Indiana that was necessitated after the onset of a medical condition that was manifested by symptoms of sufficient severity that the absence of immediate medical attention would probably result in any of the following:
(1) Placing the individual's life in jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(b) An individual is eligible for assistance under subsection (a) only if the following qualifications exist:
(1) The individual meets the income and resource standards established by the division under section 3 of this chapter.
(2) The onset of the medical condition that necessitated medical attention occurred in Indiana.
As added by P.L.120-2002, SEC.19. Amended by P.L.145-2005, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 3.5. Hospital Care for the Indigent; Eligibility for Assistance › 12-16-3.5-3. Rules Establishing Income and Resource Eligibility Standards; Adoption; Conditions

Sec. 3. (a) The division shall adopt rules under IC 4-22-2 to establish income and resource eligibility standards for patients whose care is to be paid under the hospital care for the indigent program.
(b) To the extent possible and subject to this article, rules adopted under this section must meet the following conditions:
(1) Be consistent with IC 12-15-21-2 and IC 12-15-21-3.
(2) Be adjusted at least one (1) time every two (2) years.
(c) The income and eligibility standards established under this section do not include any spend down provisions available under IC 12-15-21-2 or IC 12-15-21-3.
(d) In addition to the conditions imposed under subsection (b), rules adopted under this section must exclude a Holocaust victim's settlement payment received by an eligible individual from the income and eligibility standards for patients whose care is to be paid for under the hospital care for the indigent program.
As added by P.L.120-2002, SEC.19. Amended by P.L.145-2005, SEC.7.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 3.5. Hospital Care for the Indigent; Eligibility for Assistance › 12-16-3.5-4. Statement of Eligibility and Benefit Standards; Requirement

Sec. 4. A provider may provide a patient, and if the patient is not able to understand the statement, the patient's representative, with a statement of the eligibility and benefit standards adopted by the division if at least one (1) of the following occurs:
(1) The provider has reason to believe that the patient may be indigent.
(2) The patient requests a statement of the standards.
As added by P.L.120-2002, SEC.19. Amended by P.L.212-2007, SEC.12; P.L.218-2007, SEC.23.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4. Repealed

[Pre-1992 Revision Citations:
12-16-4-1formerly 12-5-6-4(a) part12-16-4-2formerly 12-5-6-4(a) part12-16-4-3formerly 12-5-6-4(b) part12-16-4-4formerly 12-5-6-4(b) part12-16-4-5formerly 12-5-6-4(c)12-16-4-6formerly 12-5-6-4(d)12-16-4-7formerly 12-5-6-4(e)12-16-4-8formerly 12-5-6-4(f).]
Repealed by P.L.283-2001, SEC.40.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4.5. Hospital Care for the Indigent; Application for Assistance › 12-16-4.5-1. Repealed

As added by P.L.120-2002, SEC.20. Amended by P.L.255-2003, SEC.25; P.L.145-2005, SEC.8; P.L.212-2007, SEC.13; P.L.218-2007, SEC.24. Repealed by P.L.146-2008, SEC.819.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4.5. Hospital Care for the Indigent; Application for Assistance › 12-16-4.5-2. Time Period for Provider Filing Application

Sec. 2. A provider must file the application with the division not more than forty-five (45) days after the person has been released or discharged from the hospital, unless the person is medically unable and the next of kin or legal representative is unavailable.
As added by P.L.120-2002, SEC.20. Amended by P.L.255-2003, SEC.26; P.L.145-2005, SEC.9; P.L.212-2007, SEC.14; P.L.218-2007, SEC.25.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4.5. Hospital Care for the Indigent; Application for Assistance › 12-16-4.5-3. Rules

Sec. 3. Subject to this article, the division shall adopt rules under IC 4-22-2 prescribing the following:
(1) The form of an application.
(2) The establishment of procedures for applications.
(3) The time for submitting and processing claims.
As added by P.L.120-2002, SEC.20. Amended by P.L.145-2005, SEC.10.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4.5. Hospital Care for the Indigent; Application for Assistance › 12-16-4.5-5. Assistance in Preparing Application

Sec. 5. A hospital or an attending physician may assist the patient in the preparation of an application for assistance under the hospital care for the indigent program.
As added by P.L.120-2002, SEC.20.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4.5. Hospital Care for the Indigent; Application for Assistance › 12-16-4.5-6. Civil or Criminal Liability Arising From Assistance in Preparation of Application; Immunity

Sec. 6. A person who in good faith provides assistance in the completion of an application under this chapter is immune from civil or criminal liability arising from the assistance.
As added by P.L.120-2002, SEC.20.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4.5. Hospital Care for the Indigent; Application for Assistance › 12-16-4.5-7. Signing of Application; Requirements

Sec. 7. (a) A patient must sign an application if the patient is medically able to sign.
(b) If a patient is medically unable to sign an application, the patient's next of kin or a legal representative, if available, may sign the application.
(c) If no person under subsections (a) and (b) is able to sign the application to file a timely application, a provider's representative may sign the application instead of the patient.
As added by P.L.120-2002, SEC.20. Amended by P.L.212-2007, SEC.15; P.L.218-2007, SEC.26.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4.5. Hospital Care for the Indigent; Application for Assistance › 12-16-4.5-8. Filing Application by Patient or Patient's Representative

Sec. 8. (a) A person or a person's representative may file an application directly with the division if the application is filed not more than forty-five (45) days after the person has been released or discharged from the hospital.
(b) Reimbursement for the costs incurred in providing care to an eligible person may only be made to the providers of the care.
As added by P.L.120-2002, SEC.20. Amended by P.L.255-2003, SEC.27; P.L.145-2005, SEC.11.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 4.5. Hospital Care for the Indigent; Application for Assistance › 12-16-4.5-8.5. Provider Claim Filing Deadline

Sec. 8.5. A claim for services must be filed with the division not more than one hundred eighty (180) days after the person who received the care has been released or discharged from the hospital. For good cause as determined by the division, this one hundred eighty (180) day limit may be extended or waived for a claim.
As added by P.L.145-2005, SEC.12. Amended by P.L.212-2007, SEC.16; P.L.218-2007, SEC.27.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 5. Repealed

[Pre-1992 Revision Citations:
12-16-5-1formerly 12-5-6-5(a) part12-16-5-2formerly 12-5-6-5(a) part12-16-5-3formerly 12-5-6-5(b)12-10-5-4formerly 12-5-6-5(c).]
Repealed by P.L.283-2001, SEC.40.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations › 12-16-5.5-1. Repealed

As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003, SEC.28; P.L.145-2005, SEC.13; P.L.212-2007, SEC.17; P.L.218-2007, SEC.28. Repealed by P.L.146-2008, SEC.819.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations › 12-16-5.5-1.2. Prompt Review of Claim; Calculation of Claim

Sec. 1.2. (a) The division shall, upon receipt of a claim pertaining to a person:
(1) who was provided care by an eligible provider; and
(2) whose medical condition satisfies one (1) or more of the medical conditions identified in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3);
promptly review the claim to determine if the health care items or services identified in the claim were necessitated by the person's medical condition or, if applicable, if the items or services were a direct consequence of the person's medical condition.
(b) In conducting the review of a claim referenced in subsection (a), the division shall calculate the amount of the claim. For purposes of this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, and IC 12-16-7.5, the amount of a claim shall be calculated in a manner described in IC 12-16-7.5-2.5(c).
As added by P.L.145-2005, SEC.14. Amended by P.L.212-2007, SEC.18; P.L.218-2007, SEC.29.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations › 12-16-5.5-2. Disclosure of Information by Provider; Immunity

Sec. 2. (a) The provider of medical care to a patient shall provide information the provider has that would assist in the verification of indigency of a patient.
(b) A provider that provides information under subsection (a) is immune from civil and criminal liability for divulging the information.
As added by P.L.120-2002, SEC.21. Amended by P.L.212-2007, SEC.19; P.L.218-2007, SEC.30.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations › 12-16-5.5-3. Denial of Eligibility Claim; Notice; Eligibility Information

Sec. 3. (a) Subject to subsection (b) and IC 12-16-6.5-1.5, if the division is unable after prompt and diligent efforts to verify information contained in the application that is reasonably necessary to determine eligibility, the division may deny assistance under the hospital care for the indigent program. The pending expiration of the period specified in IC 12-16-6.5-1.5 is not a valid reason for denying a person's eligibility for the hospital care for the indigent program.
(b) Before denying assistance under the hospital care for the indigent program, the division must provide the person and the provider who submitted a claim under IC 12-16-4.5-8.5 written notice of:
(1) the specific information or verification needed to determine eligibility;
(2) the specific efforts undertaken to obtain the information or verification; and
(3) the statute or rule requiring the information or verification identified under subdivision (1).
(c) The division must provide the provider who submitted a claim under IC 12-16-4.5-8.5 a period of time, not less than ten (10) days beyond the deadline established under IC 12-16-6.5-1.5, to submit to the division information concerning the person's eligibility. If the division does not make a determination of the person's eligibility within ten (10) days after receiving the information under this subsection, the person is eligible without the division's determination of the person's eligibility for the hospital care for the indigent care program under this article.
As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003, SEC.29; P.L.145-2005, SEC.15; P.L.212-2007, SEC.20; P.L.218-2007, SEC.31.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations › 12-16-5.5-4. Notification to Person and Provider; Requirements

Sec. 4. The division shall notify in writing the person and the provider of the following:
(1) A decision concerning eligibility.
(2) The reasons for a denial of eligibility.
(3) That either party has the right to appeal the decision.
As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003, SEC.30; P.L.212-2007, SEC.21; P.L.218-2007, SEC.32.
2023 Indiana Code › Title 12. Human Services › Article 16. Payment for Health Services Other Than Medicaid › Chapter 6. Repealed

[Pre-1992 Revision Citations:
12-16-6-1formerly 12-5-6-8(a) part12-16-6-2formerly 12-5-6-8(a) part12-16-6-3formerly 12-5-6-8(a) part12-16-6-4formerly 12-5-6-8(a) part12-16-6-5formerly 12-5-6-8(a) part12-16-6-6formerly 12-S-6-8(a) part12-16-6-7formerly 12-5-6-8(b).]
Repealed by P.L.283-2001, SEC.40.