reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-3 - "Applicant" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
"Applicant" means the person for whom children's health
				  insurance program coverage is requested.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-3 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-3 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-4 - "Children's health insurance program" or "CHIP" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-2
Sec. 4.
"Children's health insurance program" or "CHIP" means the
				  program established by IC 12-17.6-2.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-1-4 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-1-4 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-5 - "Division" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 5.
"Division" means the division of family and
				  children.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-5 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-5 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-6 - "Emergency" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 6.
"Emergency" means 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.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-6 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-6 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-7 - "Hoosier Healthwise" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-15; IC 12-17.6
Sec. 7.
"Hoosier Healthwise" means:
(1) the Medicaid program for:
(A) children under nineteen (19) years of
				age;
(B) pregnant women;
				and
(C) certain low income families
				established by IC 12-15; and
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-8 - "Income" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 8.
"Income" means gross monthly income, including earned and
				  unearned income.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-8 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-8 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-9 - "Institution for mental diseases" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 9.
"Institution for mental diseases" means a hospital, nursing
				  facility, or other institution of more than sixteen (16) beds, that is
				  primarily engaged in providing diagnosis, treatment, or care of persons with
				  mental diseases, including medical attention, nursing care, and related
				  services.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-1-9 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-1-9 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-10 - "Local office" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 10.
"Local office" means the local office of the division of
				  family and children.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-10 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-10 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-11 - "Managed care organization" or "MCO" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6; IC 27-13-2
Sec. 11.
"Managed care organization" or "MCO" means a health
				  maintenance organization established under IC 27-13-2 or a health insurer
				  licensed by the Indiana department of insurance with whom the office has
				  entered into a contract to provide services to CHIP members.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-1-11 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-1-11 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-12 - "Member" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 12.
"Member" means an individual eligible and enrolled in the
				  children's health insurance program in either the PCCM or RBMC
				  component.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-12 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-12 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-13 - "Office" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-2-1
Sec. 13.
"Office" means the office of the children's health insurance
				  program established by IC 12-17.6-2-1.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-13 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-13 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-14 - "Parent" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 14.
"Parent" means the biological or adoptive parent living with
				  an unmarried applicant or member.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-14 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-14 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-15 - "Primary care case management" or "PCCM" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 15.
"Primary care case management" or "PCCM" means a delivery
				  system for health care in which members are linked to a PMP who contracts
				  directly with the office. The PMP is responsible for coordinating designated
				  covered services, and he or she, as well as all other providers rendering
				  services in this delivery system, is reimbursed on a fee-for-service basis.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-1-15 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-1-15 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-16 - "Primary medical provider" or "PMP" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 16.
"Primary medical provider" or "PMP" means a physician who is
				  responsible for providing primary and preventive care, and for authorizing
				  other CHIP services as needed, and within the scope of his or her contract to
				  authorize, for CHIP members.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-1-16 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-1-16 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-17 - "Risk-based managed care" or "RBMC" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 17.
" Risk-based managed care" or "RBMC" means a fully capitated
				  prepayment plan where a managed care organization, under a contract with the
				  office, is at risk to arrange for and administer the provision of a
				  comprehensive set of covered services to CHIP members. Members are linked to a
				  PMP who contracts directly with the MCO.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-1-17 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-1-17 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-18 - "Secretary" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 18.
"Secretary" means the secretary of the family and social
				  services administration.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-18 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-18 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-19 - "Spouse" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 19.
"Spouse" means the legal husband or wife of an applicant or
				  member.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-19 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-19 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-20 - "Third party" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 20.
"Third party" means an insurer, individual, institution,
				  corporation, or public or private agency who is or may be liable to pay all or
				  part of the medical costs of injury, disease, or disability of a CHIP applicant
				  or member.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-1-20 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-1-20 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-1 - Choice of provider and use of health care card

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
(a) The
				member shall select a physician as PMP who is responsible for coordinating the
				member's health care needs. If a member fails to select a PMP within a
				reasonable time after being furnished a list of managed care providers by the
				office or its contractor, the office or its contractor shall assign a PMP to
				the member. A CHIP member may not receive services from a provider other than
				the designated PMP, except in the following cases:
(1) Medical emergencies.
(2) Where the designated managed care
				provider has authorized referral services in writing.
(3) Where specific covered services can be
				accessed through self-referral by members.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-2 - Filing of claims; filing date; waiver of limit; claim auditing; payment liability; third party payments

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
(a) The
				following claims must be originally filed with the fiscal agent contractor
				within twelve (12) months of the date of the provision of service:
(1) All provider claims for payment of
				services rendered to CHIP primary care case management members.
(2) All provider claims for payment of
				services rendered to CHIP risk-based managed care members if the service is
				carved out of a CHIP risk-based MCO contract.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-3 - Denial of claim payment; basis; discretion of director

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
The procedures set out in
				  405
				  IAC 1-1-4 for the denial of claims and the basis for
				  denial for Medicaid providers shall apply to the denial of claims to providers
				  under this title, except that any discretion exercised shall be that of the
				  director of the children's health insurance program, or his or her duly
				  authorized representative.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-2-3 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-2-3 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-4 - Overpayments to providers

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 4.
The procedures set out in
				  405 IAC
				  1-1-5 for recovery of overpayments from Medicaid
				  providers shall apply to the recovery of overpayments made to providers under
				  this title, except that any discretion exercised shall be that of the director
				  of the office of the children's health insurance program, or his or her duly
				  authorized representative.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-2-4 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-2-4 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-5 - Sanctions against providers; determination after investigation

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 5.
The procedures set out in
				  405
				  IAC 1-1-6 for sanctions against Medicaid providers and
				  determinations after investigation shall apply to providers under this title,
				  except that any discretion exercised shall be that of the director of the
				  office of the children's health insurance program, or his or her duly
				  authorized representative.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-2-5 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-2-5 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-6 - Subrogation of claims and third party liability

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 6.
(a) By
				applying for and accepting benefits under the CHIP program, a CHIP applicant or
				member or one legally authorized to act on behalf of an applicant or member
				shall be considered to have assigned to the office the member's rights to
				medical payments from any responsible third party.
(b) The office shall be subrogated to all
				claims by CHIP members against third parties to the extent of CHIP benefits
				paid by the office.
(c) The office,
				acting on behalf of the CHIP member, may initiate an action against a third
				party that is or may be liable for the injury, illness, or disease of a CHIP
				member when:
(1) the member has not done so;
				and
(2) the time remaining under
				the statute of limitations for the action is six (6) months or less.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-7 - Insurance information; release

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 7.
(a) As used
				in this section, "insurer" means any insurance company, health maintenance
				organization, prepaid health care delivery plan, self-funded employee benefit
				plan, pension fund, retirement system, group coverage plan, blanket coverage
				plan, franchise insurance coverage plan, individual coverage plan, family-type
				insurance coverage plan, Blue Cross/Blue Shield plan, group practice plan,
				individual practice plan, labor-management trusteed plan, union welfare plan,
				employer organization plan, employee benefit organization plan, governmental
				program plan, fraternal benefits society, Indiana Comprehensive Health
				Insurance Association plan, any plan or coverage required or provided by any
				statute, or similar entity that is:
(1) doing
				business in this state; and
(2)
				under an obligation to make payments for medical services as a result of an
				injury, illness, or disease suffered by a CHIP member.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-8 - Severability; governing provisions; effect of provision inconsistent with or invalid under federal law

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 8.
(a) If any
				provision in this title is or becomes inconsistent with any subsequently
				enacted amendment to the federal Social Security Act or any regulation
				promulgated thereunder, the amendment to the Social Security Act or the
				regulation promulgated thereunder shall govern until such time as this title is
				amended.
(b) If any provision in
				this document is or becomes inconsistent with any subsequently enacted act of
				the Indiana general assembly, the act of the Indiana general assembly shall
				govern until such time as this document is amended.
(c) If any provision in this title, or its
				application to any person, entity, or circumstance is held invalid, the
				invalidity does not affect other provisions or applications of this title that
				can be given effect without the invalid provision or application, and, to this
				end, the provisions in this title are severable.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407
					 IAC 1-2-8 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 11-2-8 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 3 - Provider Enrollment › Section 3-1 - Provider enrollment

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
The procedures set out in 405 IAC 5-4 for enrollment of
				  providers in the Medicaid program shall apply to providers under this title who
				  render services covered by CHIP.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 1-3-1
					 ) to the Office of the Secretary of Family and Social Services ( 405 IAC 11-3-1
					 ) by P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 3 - Provider Enrollment › Section 3-2 - Provider reciprocity

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-15; IC 12-17.6
Sec. 2.
(a)
				Providers that are enrolled in the Medicaid program are enrolled in CHIP as
				long as they comply with the provider enrollment and eligibility requirements
				for Medicaid under IC 12-15 and rules adopted under that article.
(b) A PMP who has filed an addendum to his or
				her Medicaid provider agreement to participate in PCCM is considered a PMP for
				CHIP PCCM.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-3-2 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-3-2 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 3 - Provider Enrollment › Section 3-3 - Risk-based managed care providers

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
(a)
				Providers who have contracts with CHIP risk-based MCOs must also file provider
				agreements with the office.
(b)
				Providers who have contracts with Medicaid risk-based MCOs and who have already
				filed provider agreements with the Medicaid contractor are not required to file
				an additional provider agreement to participate as a CHIP risk-based managed
				care provider.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-3-3 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-3-3 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 4 - Provider Appeals › Section 4-1 - Provider appeal procedures

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
(a) All
				provider appeals from office action taken under this article shall be governed
				by the procedures and time limits for Medicaid providers set out in 405 IAC
				1-1.5.
(b) Providers who have
				contracts with CHIP risk-based MCOs right to appeal actions taken by the MCO is
				limited to that provided for in their contracts with the MCO. There is no state
				appeal right.
(c) The reimbursement
				dispute resolution procedure set out in 405 IAC 1-1.6 shall apply to providers
				who do not have a contract with a CHIP risk-based MCO for services provided
				under CHIP.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-4-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-4-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 5 - Provider Records › Section 5-1 - Provider records

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
The provisions of
				  405 IAC
				  1-5-1 and
				  405 IAC
				  1-5-2 concerning contents, retention, and disclosure
				  of records of Medicaid providers shall apply to providers of covered services
				  under this title.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 1-5-1 )
					 to the Office of the Secretary of Family and Social Services ( 405 IAC 11-5-1 )
					 by P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 6 - Provider Reimbursement › Section 6-1 - Provider reimbursement; fee for service

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Except for reimbursement to providers who have contracts with
				  a CHIP risk-based MCO, the rates of reimbursement for the services and supplies
				  provided under this title shall be the same as those calculated for Medicaid
				  services and supplies under the Medicaid state plan, state statute, and rules
				  adopted by the secretary at 405 IAC 1. Reimbursement to providers who have
				  contracts with a CHIP risk-based MCO is governed by the contract between the
				  provider and the MCO as described in section 3 of this rule.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-6-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-6-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 6 - Provider Reimbursement › Section 6-2 - Primary care case management fee

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
Primary medical providers in the CHIP primary care case
				  management program shall receive a per member per month case management fee
				  established by the office.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-6-2 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-6-2 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 11 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 6 - Provider Reimbursement › Section 6-3 - Provider reimbursement; risk-based managed care

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
Reimbursement to providers who have contracts with a CHIP
				  risk-based MCO is governed by the contract between the provider and the MCO.
				  Such a provider does not retain any independent right or duplicative right for
				  reimbursement from the office in addition to or in lieu of the reimbursement
				  that it would receive from the risk-based MCO.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 1-6-3 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 11-6-3 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 1 - General Requirements; Eligibility › Section 1-1 - Application process

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-5
Sec. 1.
(a) An
				application for CHIP shall be filed on the form prescribed by the family and
				social services administration.
(b)
				An application shall be made:
(1) at a local
				office in the county where the applicant resides;
(2) at an enrollment center that has entered
				into an agreement with the division to complete initial intake processing of
				Hoosier Healthwise applications; or
(3) by mail to the division.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 1 - General Requirements; Eligibility › Section 1-2 - Date of application

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-5
Sec. 2.
For purposes of determining the effective date of coverage,
				  the date of application is the date on which the signed application is received
				  by the division or the enrollment center.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 2-1-2
					 ) to the Office of the Secretary of Family and Social Services ( 405 IAC 12-1-2
					 ) by P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 1 - General Requirements; Eligibility › Section 1-3 - Date of coverage

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-5
Sec. 3.
CHIP reimbursement for covered services is available
				  beginning on the first day of the month of application if both of the following
				  requirements are met:
(1) The
				applicant is determined eligible for CHIP.
(2) The applicable premium has been
				paid.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 2-1-3 )
					 to the Office of the Secretary of Family and Social Services ( 405 IAC 12-1-3 )
					 by P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-1 - Age

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2
Sec. 1.
To be eligible to enroll in the program, an applicant must be
				  less than nineteen (19) years of age.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 2-2-1 ) to the Office
					 of the Secretary of Family and Social Services ( 405 IAC 12-2-1 ) by P.L.
					 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-2 - Income

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-15-2-14; IC 12-17.6-3-2
Sec. 2.
(a) To be
				eligible to enroll in the program, an applicant must be a member of a family
				with an annual income of:
(1) more than one
				hundred fifty percent (150%); and
(2) not more than two hundred fifty percent
				(250%); of the federal income poverty level.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-3 - Agreement to pay cost sharing

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2
Sec. 3.
(a) As a
				condition of eligibility for CHIP, at least one (1) of the following
				individuals must agree to pay the cost-sharing required by the office under
				this title:
(1) The parent, guardian, or
				caretaker of an applicant.
(2) The
				applicant, if the applicant is either:
(A)
				eighteen (18) years of age and not living with a parent, guardian, or
				caretaker; or
(B) married and
				living with his or her spouse.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-4 - Waiting periods for certain members

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-4-4
Sec. 4.
(a) Except
				as provided in subsection (b), an individual who was covered under a group
				health plan or under health insurance coverage as such terms are defined in
				42
				U.S.C. §
										300gg-91 is ineligible for CHIP
				for three (3) months from the effective date of termination of that
				coverage.
(b) This section does not
				apply if the individual's coverage under a group health plan or other health
				insurance coverage was terminated involuntarily, including, but not limited to,
				loss of coverage for the following reasons:
(1) The employer of the individual, parent,
				guardian, or other family member terminated the health plan coverage.
(2) The individual, parent, guardian, or
				other family member is no longer eligible for the plan due to termination of
				employment or a reduction in working hours.
(3) The individual is no longer covered under
				the plan due to the death or divorce of the parent, guardian, or other family
				member.
(4) The individual has
				reached the lifetime limit of benefits under the plan.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-5 - Eligibility

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-3
Sec. 5.
(a) Subject
				to subsection (b), an individual who is eligible for CHIP shall remain covered
				under the program until the earlier of the following:
(1) The child becomes financially
				ineligible.
(2) The end of the
				month in which child becomes nineteen (19) years of age.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-6 - Ineligibility

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2
Sec. 6.
(a)
				Notwithstanding any other provision of this article, an individual is not
				eligible for CHIP if any of the following apply:
(1) The individual is eligible for Medicaid,
				except for an individual who is subject to a spenddown under
				405 IAC
				2-3-10. An individual who is eligible for Medicaid
				with a spenddown may be eligible for CHIP if all other CHIP eligibility
				requirements are met.
(2) The
				individual is covered under a group health plan or under health insurance
				coverage as such terms are defined in
				42
				U.S.C. §
											300gg-91.
(3) The individual is eligible for health
				benefits coverage under a state health benefits plan on the basis of a family
				member's employment with a public agency in the state.
(4) The individual is an inmate of a public
				institution as defined in
				42 CFR
				435.1009.
(5) The individual is not a resident of
				Indiana.
(6) The individual is an
				undocumented alien.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 3 - Premiums › Section 3-1 - Responsibility for premium payment

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2; IC 12-17.6-4-3
Sec. 1.
(a) In order
				for an individual to receive benefits under CHIP, the individual's family must
				pay the monthly premium established by the office in accordance with
				42 U.S.C.
				1397cc. The rates, approved by the Centers
				for Medicare & Medicaid Services, are set forth in Section 8 of the CHIP
				State Plan.
(b) Premiums must be
				paid monthly. Partial month payments will not be accepted.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 2-3-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 12-3-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 3 - Premiums › Section 3-2 - Nonpayment of premium

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2; IC 12-17.6-4-3
Sec. 2.
(a) When an
				applicant is determined eligible for CHIP, the applicant will be conditionally
				approved for CHIP pending payment of the premium. Coverage begins when the
				first premium is received by the office or its designated contractor. After the
				premium is received, coverage will be retroactive to the first day of the month
				of application.
(b) The parent or
				guardian must pay the first premium in order for the applicant to receive
				coverage under CHIP. If payment is not received by the due date specified in
				the second premium notice, the CHIP application will be denied.
(c) If any premium after the first premium is
				not paid by the due date, a maximum of sixty (60) days coverage without premium
				payment will be permitted before coverage is discontinued. When a member has
				been discontinued from the program due to non-payment of premiums, the family
				may reapply, but must pay all past due premiums and the premium for the current
				month in order to begin coverage. The member is not required to pay premiums
				for the time period between the date of discontinuance and the date that
				coverage resumes. Any services received by the member during the time period
				between the date of discontinuance and the date that coverage resumes are not
				covered by CHIP.
(d) A payment of
				less than the full amount due will not be accepted and will be considered
				nonpayment.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 2-3-2 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 12-3-2 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 3 - Premiums › Section 3-3 - Maximum total annual aggregate cost-sharing

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-4-3
Sec. 3.
(a) The
				total annual aggregate cost-sharing for a family may not exceed five percent
				(5%) of the family's income for the twelve (12) month period beginning on the
				date that the child's eligibility is determined. As used in this section,
				"total aggregate cost-sharing" means premiums and copayments paid by the member
				or the member's parent or guardian. For purposes of this section, the family's
				income includes the income considered in
				407 IAC 2-2-2
[
				405 IAC 12-2-2 ]
.
(b) The
				member's family is responsible for informing the local office when the total
				aggregate cost-sharing for the family has reached five percent (5%) of the
				family's income and for maintaining documentation to substantiate the amount of
				cost-sharing paid by the family. When the member provides the local office with
				documentary verification that the total aggregate cost-sharing for a family has
				reached five percent (5%) of the family's income for the twelve (12) month
				period:
(1) the member's parent or guardian
				will not be required to pay any premiums for the remainder of the twelve (12)
				month period; and
(2) the office
				will refund any copayments paid during the remainder of the twelve (12) month
				period.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 4 - Appeals and Hearings › Section 4-1 - Appeals by applicants and members of CHIP

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-8
Sec. 1.
(a) In the
				event that the rights, duties, obligations, privileges, or other legal
				relations of any person or entity are required or authorized by law to be
				determined by the office of CHIP or any local office of family and children,
				then such person or entity may request an administrative hearing under this
				rule.
(b) Appeals by CHIP members
				and applicants are governed by the procedures and time limits for Medicaid
				applicants and recipients set out in 405 IAC 1.1.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 2-4-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 12-4-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 4 - Appeals and Hearings › Section 4-2 - Members of managed care organizations

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-8; IC 27-13-10
Sec. 2.
A member complaining of an action of an MCO must exhaust the
				  MCO's internal grievance procedure prior to requesting a hearing by the office.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 2-4-2 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 12-4-2 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 12 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 4 - Appeals and Hearings › Section 4-3 - Maintaining services

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-8
Sec. 3.
(a) Except
				as provided in subsection (c), if a member requests a hearing prior to the
				effective date of a notice of discontinuance of coverage, the member may elect
				to continue CHIP coverage until the administrative law judge issues a decision
				after the hearing pursuant to
				405 IAC 1.1-1-6.
				The member's parent or guardian must continue to pay premiums in order to
				continue coverage.
(b) If the
				office's action is sustained by the administrative law judge, the member or the
				member's parent or guardian is responsible for repaying the cost of any
				services furnished by reason of this section, minus any premiums paid for
				coverage during the pendency of the appeal.
(c) If the member is notified that coverage
				is to be discontinued due to nonpayment of the premium, CHIP coverage will not
				be maintained after the effective date of the discontinuance.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 2-4-3 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 12-4-3 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 1 - General Provisions › Section 1-1 - Intent and purpose

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-4
Sec. 1.
(a) Under IC
				12-17.6, Title XXI of the federal Social Security Act, the office of the
				children's health insurance program hereby adopts and promulgates this article
				to:
(1) interpret and implement the provisions
				of IC 12-17.6-4;
(2) ensure the
				efficient, economical, and medically reasonable operations of a children's
				health insurance program (referred to as CHIP) in Indiana; and
(3) safeguard against overutilization, fraud,
				abuse, and utilization and provision of services and supplies that are not
				medically reasonable or medically necessary and are not covered by the CHIP
				benefits package.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 2 - CHIP; Coverage; Use of Medicaid Rules › Section 2-1 - Covered services

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
(a) The
				following services will be covered by CHIP using the same coverage criteria,
				limitations, and procedures, including prior authorization, as Medicaid under
				rules adopted by the secretary at 405 IAC 5 unless a service is listed as
				noncovered in 407 IAC 3-13
[ 405 IAC 13-12 ]
:
(1) Physician services, except that office
				visits shall be reimbursed in accordance with
				407 IAC 3-5-1
[ 405 IAC 13-4-1 ]
.
(2) Inpatient hospital, except that inpatient
				rehabilitation services are limited to fifty (50) days per calendar
				year.
(3) Outpatient
				hospital.
(4) Laboratory and
				radiology.
(5) Certified nurse
				practitioner.
(6) Family planning
				services and supplies.
(7)
				Certified nurse-midwife.
(8)
				Vision.
(9) Home health and clinic
				services.
(10) Dental.
(11) Hospice.
(12) Diabetes self-management
				training.
(13) Food supplements,
				nutritional supplements, and infant formulas.
(14) Restricted utilization.
(15) Consultations and second
				opinions.
(16)
				Anesthesia.