reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.4 - Presumptive Eligibility Determinations by Other Qualified Providers › Section 3.4-4 - Administrative appeals

Current through July 10, 2024
Authority: IC 12-15-2.3-12; IC 12-15-21
Affected: IC 4-21.5-3
Sec. 4.
(a) A
				qualified provider may appeal the office's revocation of its presumptive
				eligibility status under the provisions of
				405 IAC
				1-1.4.
(b)
				The following actions are not sanctions and are not appealable by qualified
				providers:
(1) The issuance of a warning or
				requirement of a corrective action plan to be created.
(2) The office's decision not to exercise its
				discretion to lift a provider's request for reinstatement under
				405
				IAC 2-3.3-3(e)(1).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 4 - Burial Expenses › Section 4-1 - Payment of burial expenses

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-14; IC 12-15
Sec. 1.
(a) For the
				purpose of implementing the provisions of IC 12-14, a member of Medicaid for
				the aged, blind, and disabled is that person who is receiving Medicaid as of
				the date of his or her death, or who applied for Medicaid prior to the date of
				his or her death and was subsequently determined eligible.
(b) The state department shall pay for the
				cost of the deceased member's burial expenses subject to the following
				limitations:
(1) Payment will be made only to
				the funeral director or cemetery representative upon submission of a completed
				claim form prescribed by the state department.
(2) Payment shall not be made to a funeral
				director who submits a claim for cemetery expenses unless he or she attaches
				proof to the claim that he or she is the cemetery representative or has been
				designated the cemetery representative.
(3) In determining the amount to be paid by
				the state department to the funeral director, contributions paid and payments
				made or available from the estate of the deceased member in excess of the
				exclusion provided by IC 12-14 shall be subtracted from the statutory maximum.
				The balance of the unpaid expenses, up to the statutory maximum, shall be paid
				by the state department.
(4) In
				determining the amount to be paid by the state department to the cemetery
				representative, contributions paid and payments made or available from the
				estate of the deceased member in excess of the statutory exclusion shall be
				subtracted from the statutory maximum. The balance of the unpaid expenses, up
				to the statutory maximum, shall be paid by the state department.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 4 - Burial Expenses › Section 4-2 - Purchase of burial spaces

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 2.
(a) The
				following definitions apply throughout this section:
(1) "Burial expenses" means the following
				additional expenses associated with purchasing an applicable burial space:
(A) The transfer of the deceased.
(B) The use of a hearse during a
				ceremony.
(C) The purchase of death
				certificates.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 4 - Burial Expenses › Section 4-3 - Funeral expenses; exclusion of resources in determining eligibility for Medicaid

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC
				  12-15-1-15;
				  IC
				  12-15-21-2
Affected: IC
				  12-13-7-3;
				  IC 12-15; IC 30-2-13
Sec. 3.
(a) Pursuant
				to IC
				12-15-2-17
				and IC 30-2-13 and subject to subsection (c), if an applicant for or a
				recipient of
Medicaid:
(1)
				establishes one (1) irrevocable trust that has a value of not more than ten
				thousand dollars ($10,000), exclusive of interest, and is established for the
				sole purpose of providing money for the burial of the applicant or
				recipient;
(2) enters into one (1)
				irrevocable prepaid funeral agreement having a value of not more than ten
				thousand dollars ($10,000); or
(3)
				owns one (1) or more life insurance policies with a combined face value of not
				more than ten thousand dollars ($10,000) and with respect to which provision is
				made to pay not more than ten thousand dollars ($10,000) toward the applicant's
				or recipient's funeral expenses;
the value of the trust, prepaid funeral agreement, or life
				  insurance policy may not be considered as a resource in determining the
				  applicant's or recipient's eligibility for Medicaid.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 5 - Determination of Monthly Income › Section 5-1 - Conversion of income

Current through July 10, 2024
Authority: IC
				  12-13-5-3; IC
				  12-13-7-3;
				  IC
				  12-14-2-4
Affected: IC 12-14; IC 12-15
Sec. 1.
(a) When
				determining eligibility and the amount of assistance payment for the months
				beginning with the month of application, the following computations shall be
				made to establish income for the payment month:
(1) Income received on a less than monthly
				basis shall be converted to a monthly amount as follows:
(A) Income received weekly shall be
				multiplied by four and three-tenths (4.3) to determine the monthly
				income.
(B) Income received every
				two (2) weeks shall be multiplied by two and fifteen-hundredths (2.15) to
				determine the monthly income.
(C)
				Income received twice per month shall be multiplied by two (2) to determine the
				monthly income.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 6 - Medical Assistance for Individuals 18, 19, and 20 Years of Age › Section 6-1 - Medical assistance for individuals 18, 19, and 20 years of age

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-14-2-4
Affected: IC 12-14; IC 12-15
Sec. 1.
(a) An
				individual eighteen (18), nineteen (19), or twenty (20) years of age who meets
				the criteria established in
				42
				CFR 435.220, as revised and effective on
				October 1, 1991, is eligible for medical assistance.
(b) The income eligibility determination for
				such person shall be based upon those income standards established for the
				assistance to families with dependent children program in accordance with
				470 IAC
				10.1-3-3
[ 470IAC 10.1-3-3 was repealedfiled
				Aug 26, 1987, 11:00 a.m.: 11 IR 90. See 470IAC 10.1-3-3.1 ]
.
(c) The budgeting methodologies established
				for the assistance to families with dependent children program in accordance
				with
				470 IAC
				10.1-3-4 shall apply to this rule.
(d) The income and resources of the applicant
				or recipient and that of his or her parents living in the home with the
				applicant or recipient are considered in determining the individual's
				eligibility.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 6 - Medical Assistance for Individuals 18, 19, and 20 Years of Age › Section 6-2 - Medicaid eligibility for individuals leaving foster care

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC 12-14; IC 12-15
Sec. 2.
(a) An
				individual who:
(1) is:
(A) at least eighteen (18) years of age;
				and
(B) less than twenty-one (21)
				years of age; and
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 6 - Medical Assistance for Individuals 18, 19, and 20 Years of Age › Section 6-3 - Medicaid eligibility for former foster care children under age 26

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC 12-14; IC 12-15
Sec. 3.
(a)
				Beginning January 1, 2014, an individual who:
(1) is:
(A)
				under twenty-six (26) years of age; and
(B) not eligible for and enrolled in other
				mandatory Medicaid coverage;
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 7 - Medical Assistance for Individuals Receiving Supplemental Security Income Benefits › Section 7-1 - Definitions

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-14-2-4
Affected: IC 12-14; IC 12-15
Sec. 1.
(a) As used
				in this rule, "dependent child" means a child under eighteen (18) years of age,
				who meets the conditions of
				45 CFR
				233.90, as revised and effective on October
				1, 1991, (not including tertiary Code of Federal Regulations citations
				resulting therefrom) or
				45 CFR
				233.100, as revised and effective on October
				1, 1991, (not including tertiary Code of Federal Regulations citations
				resulting therefrom).
(b) As used
				in this rule, "caretaker" means a relative as defined in
				45 CFR
				233.90, as revised and effective on October
				1, 1991, (not including tertiary Code of Federal Regulations citations
				resulting therefrom) who has a specified degree of relationship to and assumes
				the primary responsibility for a dependent child.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 7 - Medical Assistance for Individuals Receiving Supplemental Security Income Benefits › Section 7-2 - Medical assistance for supplemental security income recipients

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-14-2-4
Affected: IC 12-14; IC 12-15
Sec. 2.
(a)
				Supplemental security income recipients who meet the criteria established in
				42
				CFR 435.210, as revised and effective on
				October 1, 1991, (not including tertiary Code of Federal Regulations citations
				resulting therefrom) are eligible for medical assistance.
(b) The income and resources of the following
				individuals are considered in the eligibility determination:
(1) The supplemental security income
				recipient.
(2) His or her spouse,
				if the supplemental security income recipient is a caretaker.
(3) His or her parent, if the supplemental
				security income recipient is a dependent child.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 8 - Claims Against Estate of Medicaid Members › Section 8-1 - Claims against estate for benefits paid

Current through July 10, 2024
Authority: IC
				  12-13-5-3; IC
				  12-15-1-10
Affected: IC 12-15-9; IC 12-15-39.6-10
Sec. 1.
(a) Upon the
				death of a Medicaid member fifty-five (55) years of age or older, the office of
				Medicaid policy and planning (office) shall seek recovery from the member's
				estate for Medicaid paid on behalf of the member after the member became
				fifty-five (55) years of age or older. Recovery shall be made for benefits
				provided prior to October 1, 1993, only if the member was sixty-five (65) years
				of age or older at the time the benefits were provided.
(b) As used in this section, "estate", with
				respect to a deceased member, shall include all of the following:
(1) All real and personal property and other
				assets included within the member's estate as defined for purposes of state
				probate law.
(2) Any interest in
				real property owned by the individual at the time of death that was conveyed to
				the individual's survivor through joint tenancy with right of survivorship, if
				the joint tenancy was created after June 30, 2002.
(3) Any real or personal property conveyed
				through a nonprobate transfer. As used in this section, "nonprobate transfer"
				means a valid transfer, effective at death, by a transferor who immediately
				before death had the power, acting alone, to prevent transfer of the property
				by revocation or withdrawal and:
(A) use the
				property for the benefit of the transferor; or
(B) apply the property to discharge claims
				against the transferor's probate estate.
The term does not include a transfer of a survivorship
				  interest in a tenancy by the entireties real estate or payment of the death
				  proceeds of a life insurance policy.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 8 - Claims Against Estate of Medicaid Members › Section 8-1.1 - Claims against estate; exemption

Current through July 10, 2024
Authority: IC
				  12-13-5-3; IC
				  12-15-1-10
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 1.1.
(a) This
				section applies only to real property owned by the individual at the time of
				death that was conveyed to the individual's survivor through joint tenancy with
				right of survivorship.
(b) The
				office may enforce its claim against property described in subsection (a) only
				to the extent that the value of the member's combined total interest in all
				real property described in subsection (a) subject to the claim exceeds
				seventy-five thousand dollars ($75,000).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 8 - Claims Against Estate of Medicaid Members › Section 8-2 - Undue hardship due to Medicaid estate recovery

Current through July 10, 2024
Authority: IC
				  12-13-5-3; IC
				  12-15-1-10;
				  IC
				  12-15-9-6
Affected: IC 12-15-9; IC
				  29-1-14-9
Sec. 2.
(a) The
				office may waive the enforcement of the state's claim, in whole or in part, if
				enforcement of the state's claim will result in substantial and undue hardship
				for the surviving beneficiaries of the decedent's estate. The state's claim is
				suspended as long as the undue hardship condition continues to exist. This rule
				is not applicable to undue hardships encountered by Medicaid applicants due to:
(1) the imposition of transfer of property
				penalties; or
(2) rules related to
				the availability of trusts.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 9 - Medicaid for Employees with Disabilities › Section 9-1 - Purpose and general eligibility requirements

Current through July 10, 2024
Authority: IC 12-15
Affected: IC 12-15-41
Sec. 1.
(a) This
				rule establishes the eligibility requirements for the two (2) optional Medicaid
				categories for employees with disabilities identified in
				42 U.S.C.
				1396a(a)(10)(A)(ii)(XV) and
				42 U.S.C. 1396a(a)(10)(A)(ii)(XVI), and in accordance with the provisions of IC
				12-15-41.
(b) As used in this rule,
				"applicant or member" means an individual whose Medicaid eligibility is being
				determined under one (1) of the Medicaid categories referenced in subsection
				(a) and in accordance with the requirements of this rule.
(c) A person who is:
(1) less than sixteen (16) years of age;
				or
(2) sixty-five (65) years of age
				or older;
is not eligible for Medicaid for employees with
				  disabilities.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 9 - Medicaid for Employees with Disabilities › Section 9-2 - Income of applicant or member

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2; IC
				  12-15-41-15
Affected: IC 12-15-2-6.5; IC 12-15-41
Sec. 2.
(a)
				Individuals eligible under
				405
				IAC 2-1,
				405 IAC
				2-2, and
				405
				IAC 2-3, respectively, are subject to income
				definitions and exclusions as provided in
				42
				U.S.C. 1382a and at 20 CFR Part 416, Subpart
				K Income.
(b) Countable income from
				the following individuals shall be excluded:
(1) The spouse of the applicant or
				member.
(2) The parent or parents
				of the applicant or member.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 9 - Medicaid for Employees with Disabilities › Section 9-3 - Income eligibility and posteligibility determinations of applicant or member

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-15-7-2
Sec. 3.
(a) An
				applicant's or member's income eligibility shall be determined by the following
				procedures:
(1) Determine the applicant's or
				member's income in accordance with section 2 of this rule.
(2) Subtract the monthly income standard that
				is equal to three hundred fifty percent (350%) of the federal poverty guideline
				for a family size of one (1), divided by twelve (12) and rounded up to the next
				whole dollar.
(3) If the resulting
				amount in subdivision (2) is zero dollars ($0) or less than zero dollars ($0),
				the applicant or member is eligible for Medicaid for employees with
				disabilities. If the resulting amount is greater than zero dollars ($0), the
				applicant or member is not eligible.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 9 - Medicaid for Employees with Disabilities › Section 9-4 - Resource eligibility of applicant or member

Current through July 10, 2024
Authority: IC 12-15
Affected: IC 12-15-2-6.5; IC 12-15-41-2
Sec. 4.
(a) An
				applicant or member is subject to resource definitions and exclusions as
				provided in
				405 IAC
				2-3-14.
(b) The resources of the applicant's or
				member's parents are excluded.
(c)
				In addition to that property required to be excluded under subsections (a) and
				(b), the following property is exempt from consideration:
(1) Up to twenty thousand dollars ($20,000),
				as approved by the central office of the family and social services
				administration, for an independence and self-sufficiency account defined in IC
				12-15-41-2
				(3). A resource disregard for this purpose will be approved if the applicant or
				member submits a plan in writing to the office that describes specifically the
				goods or services, or both, that he or she intends to purchase that will
				increase, maintain, or retain his or her employability or independence. The
				items must be reasonable in terms of the applicant's or member's ability to
				achieve a stated goal that is focused on the individual's employability by
				removing barriers. Items for personal recreational use will not be approved. A
				request to save money without specifying goods or services to be purchased
				within an achievable period of time will not be approved. An approved account
				will be reviewed by the local office of family and children caseworker at each
				annual redetermination. If the terms of the original approved account have not
				been met, the member will be required to submit an updated request to the
				caseworker within thirty (30) days of receiving written notification from the
				caseworker that such an update is required. If the member fails to submit the
				update, the disregard will be disapproved and resource eligibility will be
				redetermined without it. The caseworker will forward updates to the central
				office for approval. At any time during the period of eligibility under the
				Medicaid for employees with disabilities program, the member may submit an
				update requesting an adjustment in the approved amount. Approval will not be
				given for any services that are available to the member under Medicaid or any
				other publicly funded program.
(2)
				Retirement accounts held by the applicant or member or his or her spouse are
				exempt. This includes Individual Retirement Accounts, Keogh Plans, and 401(k),
				403(b), and 457 plans, and any employer-related retirement account.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 9 - Medicaid for Employees with Disabilities › Section 9-5 - Employment requirements; continuing eligibility when employment ends

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-41-15
Affected: IC 12-15-2-6.5; IC 12-15-41
Sec. 5.
(a) In order
				for an individual to be eligible for Medicaid for employees with disabilities,
				the individual must be engaged in a substantial and reasonable work effort.
				This means that the person must be either employed or self-employed, with the
				intent of such work activity being ongoing. The individual's monthly earned
				income must exceed the sixty-five dollar ($65) earned income disregard
				described in section 2 of this rule. Employment must be verifiable by pay stubs
				or other verification from an employer documenting that the income is subject
				to income tax and FICA withholding. Self-employment must be verified by the
				individual's income tax return or, in the case of a new business for which a
				tax return has not yet been filed, the personal business records of the
				individual.
(b) In order for a
				member of Medicaid for employees with disabilities to remain eligible when the
				definition of medically improved disability in section 7 of this rule is met,
				the member must be employed as defined in subsection (a) and must have monthly
				earnings as calculated under
				405 IAC
				2-5-1 that are equal to or greater than the federal
				minimum wage times forty (40), unless the provisions in subsection (c) are
				met.
(c) A member who is
				involuntarily not working can remain eligible for the Medicaid for employees
				with disabilities program for up to twelve (12) months if he or she meets all
				other program requirements and either:
(1) is
				on temporary medical leave from his or her employment as defined in subsection
				(d); or
(2) maintains a connection
				to the workforce by participating in at least one (1) of the following
				activities:
(A) Enrollment in a vocational
				rehabilitation program.
(B)
				Enrollment or registration with the department of workforce
				development.
(C) Participation in a
				transition from school to work program.
(D) Participation with an approved provider
				of employment services.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 9 - Medicaid for Employees with Disabilities › Section 9-6 - Medical disability determination

Current through July 10, 2024
Authority: IC 12-15
Affected: IC 12-15-2-6.5; IC 12-15-41
Sec. 6.
In order to qualify for Medicaid for employees with
				  disabilities, an applicant must meet the definition of disability in
				  405 IAC
				  2-2-3. If not for earned income, the applicant or
				  member would medically qualify for Medicaid under the traditional disability
				  category according to statute.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 9 - Medicaid for Employees with Disabilities › Section 9-7 - Medically improved disability

Current through July 10, 2024
Authority: IC 12-15
Affected: IC 12-14-15-1; IC 12-15-2-6.5; IC 12-15-41
Sec. 7.
(a) In order
				to qualify for the Medicaid for employees with disabilities program after
				improvement of a medical condition, a member must meet the requirements in this
				section.
(b) The person must be a
				member of Medicaid under the Medicaid for employees with disabilities group
				described in section 6 of this rule who no longer qualifies for coverage under
				that category due to a medical improvement in his or her condition. The
				improvement of the condition must be verifiable by acceptable clinical
				standards; however, the disease, illness, or process must be of a type that,
				due to the nature and course of the illness, will continue to be a disabling
				impairment. A condition that has been resolved or a person who is completely
				recovered does not medically qualify for this program.
(c) The determination of whether a member
				meets the medical eligibility requirements for this category will be made
				either:
(1) when the Social Security
				Administration determines the member is no longer disabled according to
				20 CFR
				416.905 or 20 CFR 416.906; or
(2) at the time of the member's next medical
				review as determined by the Medicaid medical review team (MMRT). Determination
				of medical eligibility under this section is made by the MMRT.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-1 - Definitions

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 1.
The following definitions apply throughout this rule:
(1) "Disabled" is defined according to the
				criteria established under
				42
				U.S.C. 1382c.
(2) "Interest" means any equitable right,
				title, or interest in real property.
(3) "Lawfully residing in the home" means
				residing in the member's place of residence with the permission of the owners
				or, if under guardianship, the owner's legal guardian.
(4) "Medical institution" means a long term
				care facility, an intermediate care facility for individuals with intellectual
				disabilities (ICF/IID), or other residential medical facility.
(5) "Member's home" means the member's place
				of residence prior to institutionalization.
(6) "Permanently institutionalized" means an
				individual of any age who:
(A) is an inpatient
				in a nursing facility, ICF/IID facility, or other medical
				institution;
(B) is required, as a
				condition of receiving services in such institution under the state plan, to
				spend for costs of medical care all but a minimum amount of his or her income
				required for personal needs; and
(C) after notice and opportunity for a
				hearing, has been determined to have a medical condition of such severity that
				he or she cannot reasonably be expected to be discharged from the medical
				institution and returned to the noninstitutional home environment prior to
				death.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-2 - Recovery

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-8.5
Affected: IC 12-15-3-6; IC 12-15-9
Sec. 2.
The office shall seek reimbursement for Medicaid benefits
				  paid on behalf of a member by either or both of the following methods:
(1) Filing and enforcing a lien in accordance
				with this rule.
(2) Filing and
				enforcing a claim against the estate of a deceased member in accordance with
				405 IAC
				2-8.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-3 - Criteria for instituting a TEFRA lien

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 3.
(a) When the
				office in accordance with
				42
				U.S.C. 1396p determines that a Medicaid
				member who resides in a medical institution cannot reasonably be expected to be
				discharged and return home, the office may attach a lien on the Medicaid
				member's real property subject to the provisions of this rule and IC
				12-15-8.5.
(b) The office may not
				obtain a lien on the member's home if any of the following people lawfully
				reside in the home of the institutionalized member:
(1) The member's spouse.
(2) The member's child who is less than
				twenty-one (21) years of age, blind, or disabled as defined in
				42
				U.S.C. 1382c.
(3) The member's sibling who:
(A) was residing in the member's home for a
				period of at least one (1) year immediately before the member's
				institutionalization; and
(B) has
				an ownership interest in the home.
(4) The member's parent.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-4 - Notice and opportunity for hearing

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 4.
(a) The
				office shall notify the member and the member's authorized representative, if
				applicable, of its determination that the member is permanently
				institutionalized and not reasonably expected to return home and its intent to
				file a lien on member's real property. Notice must include an explanation of
				liens and their effect on an individual's ownership of real property.
(b) The office may file a lien not less than
				thirty-one (31) days following notice to member and after any hearing process
				has been completed, if a hearing is requested.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-5 - Appeal

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 5.
(a) A member
				or his or her designee may, within thirty-three (33) days after receipt of
				notice described in this rule, request an administrative hearing under this
				rule.
(b) Administrative hearings
				and appeals by Medicaid members are governed by the procedures and time limits
				set out in 405 IAC 1.1. Only one (1) appeal shall be afforded to a member, for
				each notice received in accordance with section 4 of this rule, notwithstanding
				the number of parcels owned by the member and identified in the notice.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-6 - Lien attachment

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 6.
(a) The
				office or its designee shall file a notice of lien with the recorder of the
				county in which the real property subject to the lien is located. The notice
				shall be filed prior to the member's death and shall include the following:
(1) Name and place of residence of the member
				against whom the lien is asserted.
(2) Legal description of the real property
				subject to the lien.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-7 - Effect of filing; duration

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 7.
(a) From the
				date on which the notice of lien is recorded in the office of the county
				recorder, the notice of lien:
(1) constitutes
				due notice of a lien against the member or member's estate for any amount then
				recoverable and any amounts that become recoverable under this article;
				and
(2) gives a specific lien in
				favor of the office on the Medicaid member's interest in the real
				property.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-7.1 - Notice to office to file an action to foreclose the lien

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 7.1.
(a) This
				section applies after the death of the Medicaid member whose property is
				subject to a lien under this rule or after the sale or other transfer of
				property that is subject to the lien.
(b) A lien under this rule is void if both of
				the following occur:
(1) The owner of property
				subject to a lien under this rule or any person or corporation having an
				interest in the property, including a mortgagee or a lienholder, provides
				written notice to the office to file an action to foreclose the lien.
(2) The office fails to file an action to
				foreclose the lien in the county where the property is located not later than
				thirty (30) days after receiving the notice. However, this section does not
				prevent the claim from being collected as other claims are collected by
				law.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-8 - Enforcement; foreclosure

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 8.
(a) The
				office may not enforce a lien on the member's home under this rule if the
				following individuals are lawfully residing in the member's home and have
				resided there on a continuous basis since the member's date of admission to the
				medical institution:
(1) The member's child of
				any age who:
(A) resided in the member's home
				for at least twenty-four (24) months before the member was institutionalized;
				and
(B) establishes to the
				satisfaction of the office that he or she provided care to the member that
				enabled the member to reside in his or her home delaying
				institutionalization.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-9 - Release; subordination

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC 12-15-9
Sec. 9.
(a) The
				office shall release a lien obtained under this rule within ten (10) business
				days after the county office of family and children receives notice that the
				member is no longer institutionalized and is living in his or her
				home.
(b) A lien obtained under
				this rule is subordinate to the security interest of a financial institution as
				defined in IC 12-15-8.5 that loans money to the member provided that the member
				is able to establish to the satisfaction of the office that the funds were used
				for operating capital for the operation of the member's farm, the member's
				business, or the member's real property that is incomeproducing.
(c) If the real property subject to the lien
				is sold, the office shall release its lien at the closing, and the lien shall
				attach to the net proceeds of the sale.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 10 - Lien Attachment and Enforcement › Section 10-11 - Exemption

Current through July 10, 2024
Authority: IC
				  12-15-1-10;
				  IC 12-15-8.5
Affected: IC
				  12-15-3-6;
				  IC
				  12-15-39.6-10
Sec. 11.
Real property that is disregarded for eligibility purposes
				  in connection with the purchase and use of a qualified long term care insurance
				  policy pursuant to IC
				  12-15-39.6-10
				  is exempt from lien placement and enforcement.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 4 - PURCHASE OF PRODUCTS AND SERVICES OF PERSONS WITH DISABILITIES › Rule 1 - Qualified Nonprofit Agencies › Section 1-1 - Criteria for qualified nonprofit agencies

Current through July 10, 2024
Authority: IC
				  5-22-13-1
Affected: IC 5-22-13; IC 16-32-2
Sec. 1.
In order to be a qualified nonprofit agency for purposes of
				  IC
				  5-22-13-1,
				  the nonprofit agency shall be accredited by CARF.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 1 - General Provisions › Section 1-1 - Intent and purpose

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2; IC
				  12-15-21-3
Affected: IC
				  12-7-1-1; IC
				  12-13-7-3; IC
				  12-15-5-1; IC
				  12-15-5-2
Sec. 1.
(a) Under IC
				12-7-1-1, Title XIX of the federal
				Social Security Act, and federal regulations adopted thereunder (as adopted by
				IC 12-13-7-3), the office with the
				advice of its medical staff, hereby adopts and promulgates this article to:
(1) interpret and implement the provisions of
				IC 12-15-5-1 and IC
				12-15-21-3;
(2) ensure the efficient, economical, and
				medically reasonable operation of a medical assistance program (hereinafter
				referred to as Medicaid) in Indiana; and
(3) safeguard against overutilization, fraud,
				abuse, and utilization and provision of services and supplies that are not
				medically necessary.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 1 - General Provisions › Section 1-2 - Nondiscrimination

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2; IC
				  12-15-21-3
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 2.
(a) All
				providers of care and suppliers of services under Medicaid must comply with the
				requirements of Title VI of the Civil Rights Act of 1964 and Section 504 of the
				Rehabilitation Act of 1973.
(b) No
				provider may discriminate in the provision of Medicaid services with regard to
				age, race, creed, color, national origin, sex, or handicap.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 1 - General Provisions › Section 1-3 - Freedom of choice of provider

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC
				  12-15-21-3
Affected: IC 12-13-7-3; IC 12-15-11-2
Sec. 3.
Except as provided in
				  405 IAC
				  1-1-2(b), all members shall have
				  freedom of choice in the selection of a provider of service among qualified
				  providers who meet the requirements of this article and who have executed a
				  provider agreement under IC
				  12-15-11-2.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 1 - General Provisions › Section 1-4 - Solicitation of services

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC
				  12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
Sec. 4.
(a)
				Solicitation, or a fraudulent, misleading, or coercive offer by a provider to
				provide a service to a member, is prohibited. Examples of solicitation include,
				but are not limited to, the following:
(1)
				Door-to-door solicitation.
(2)
				Screenings of large or entire inpatient populations of long term care
				facilities, hospitals, institutions for mental diseases, ICFs/IID, or CRFs/DD,
				except where such screenings are specifically mandated by law.
(3) The use of any advertisement prohibited
				by federal or state statute or regulation.
(4) Any other type of inducement or
				solicitation to cause a member to receive a service that the member either does
				not want or does not need.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 1 - General Provisions › Section 1-5 - Global fee billing; codes

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 5.
(a) Providers
				must submit one (1) billing for a related group of procedures and services
				provided to a member.
(b) The
				Centers for Medicare and Medicaid Service's Common Procedure Coding System
				(HCPCS) and International Classification of Diseases 10th Revision Clinical
				Modification (ICD-10-CM) codes shall be used by providers when submitting
				medical claims to the contractor for adjudication. American Dental Association
				codes from the Current Dental Terminology Users Manual shall be used by
				providers when submitting dental claims to the contractor for adjudication.
				Providers must use the most up-to-date versions of these coding
				classifications.
(c) Medicaid
				claims filed by pharmacy providers on the drug claim form/format must utilize
				an appropriately configured National Drug Code (NDC), Universal Package Code
				(UPC), Health Related Item Code (HRI), or state-assigned code. When services
				are billed that have been prior authorized, the procedure code from the prior
				authorization form shall be utilized. On UB-04 forms, use the appropriate UB-04
				Revenue Codes, as well as the narrative descriptions of services, and the
				appropriate diagnostic and procedure code contained in ICD-10-CM.
(d) Documentation in the medical records
				maintained by the provider must substantiate that the procedure or service is
				medically necessary and the code selected or description given by the provider.
				This is subject to postpayment audit and review.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 1 - General Provisions › Section 1-6 - New or experimental product, service, or technology

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 6.
(a) A
				provider may request consideration for coverage of any new or experimental
				product, service, or technology not specifically covered in this article. Such
				a request must be submitted by the provider to the office along with a detailed
				written statement, along with all available supporting documentation,
				justifying how such product, service, or technology is medically
				necessary.
(b) This section does
				not apply to legend drugs.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-1 - Applicability

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-13-7-2; IC 12-15
Sec. 1.
The definitions in this rule apply throughout this
				  article.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-3 - "Attending provider" defined

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 3.
"Attending provider" means the provider who is providing
				  specialized or general medical care to the Medicaid member.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-6 - "Covered service" defined

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC
				  12-15-5
Sec. 6.
"Covered service" means a service or supply provided by a
				  provider for a member for which payment is available under Medicaid subject to
				  the limitations of this article.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-7 - "CPT" defined

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC
				  12-15-5
Sec. 7.
"CPT" means current procedural terminology.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-7.1 - "Curative care services" defined

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC 12-15
Sec. 7.1.
"Curative care services" means services, utilized to achieve
				  a disease free state, that are related to the treatment of the medical
				  condition for which diagnosis of terminal illness has been made.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-9 - "Emergency service" defined

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 9.
"Emergency service" means a service provided to a member
				  after the sudden onset of a medical condition manifesting itself by acute
				  symptoms of sufficient severity that the absence of immediate medical attention
				  could reasonably be expected to result in:
(1) placing the patient's health in serious
				jeopardy;
(2) serious impairment to
				bodily functions; or
(3) serious
				dysfunction of any bodily organ or part.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-10 - "EPSDT" defined

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-7-2-128; IC
				  12-13-7-3; IC 12-15
Sec. 10.
"EPSDT" means early and periodic screening, diagnostic, and
				  treatment.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-10.1 - "Hospice" defined

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2; IC
				  12-15-40
Affected: IC 12-15
Sec. 10.1.
"Hospice" means a person or health care provider who owns or
				  operates a hospice program or facility, or both, that uses an interdisciplinary
				  team directed by a licensed physician to provide a program of planned and
				  continuous care for hospice program patients and their families.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-10.2 - "Hospice program" defined

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-21-2; IC
				  12-15-40
Affected: IC 12-15
Sec. 10.2.
"Hospice program" means a specialized form of
				  interdisciplinary health care that is designed to alleviate the physical,
				  emotional, social, and spiritual discomforts of an individual who is
				  experiencing the last phase of a terminal illness or disease.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-10.5 - "HCPCS" defined

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 10.5.
"HCPCS" means Healthcare Common Procedure Coding System as
				  set forth in 45 CFR
				  162.1002.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-11.5 - "ICF/IID" defined

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-15
Sec. 11.5.
"ICF/IID" or "ICFs/IID" has the meaning set forth in
				  405 IAC
				  1-1-1(5).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 2 - Definitions › Section 2-12 - "Inpatient services" defined

Current through July 10, 2024
Authority: IC
				  12-15-1-10; IC
				  12-15-1-15; IC
				  12-15-21-2
Affected: IC
				  12-13-7-3; IC 12-15
Sec. 12.
"Inpatient services" means only those services provided to a
				  member while the member is registered as an inpatient in an acute care or
				  psychiatric hospital.