Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-5 - Medication training and support

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 5.
(a) The
				services reimbursable as individual medication training and support involve
				face-to-face contact with the member for the purpose of monitoring medication
				compliance, providing education and training about medications, monitoring
				medication side effects, and providing other nursing or medical assessments.
				This service also includes certain related nonface-to-face activities.
				Requirements for medication training and support services shall be as follows:
(1) Services may be provided for members of
				all ages.
(2) Medication training
				and support services must be provided within the scope of practice as defined
				by federal and state law. Providers must meet any of the following
				qualifications:
(A) A licensed
				physician.
(B) An authorized health
				care professional (AHCP).
(C) A
				licensed registered nurse (RN).
(D)
				A licensed practical nurse (LPN).
(E) A medical assistant (MA) who has
				graduated from a two (2) year clinical program.
(3) Programming standards shall be as
				follows:
(A) Services must be provided
				face-to-face in an individual setting that includes monitoring
				self-administration of prescribed medications and monitoring side
				effects.
(B) When provided in a
				clinic setting, this service may support, but not duplicate, activities
				associated with medication management activities available under the clinic
				option.
(C) When provided in a
				residential treatment setting, this service may include components of
				medication management services.
(D)
				Services may also include the following services that are not required to be
				provided face-to-face with the member:
(i)
				Transcribing physician or AHCP medication orders.
(ii) Setting or filling medication
				boxes.
(iii) Consulting with the
				attending physician or AHCP regarding medication-related issues.
(iv) Ensuring linkage that lab or other
				prescribed clinical orders are sent.
(v) Ensuring that the member follows through
				and receives lab work and services pursuant to other clinical orders.
(vi) Follow-up reporting of lab and clinical
				test results to the member and physician.
(E) The member is the focus of the
				service.
(F) Documentation must
				support how the service benefits the member.
(G) Services must demonstrate movement toward
				or achievement of member treatment goals identified in the individualized
				integrated care plan.
(H) Service
				goals must be rehabilitative in nature.
(4) Exclusions shall be as follows:
(A) If clinic option medication management,
				counseling, or psychotherapy is provided, and medication management is a
				component, then medication training and support may not be billed separately
				for the same visit by the same provider.
(B) Coaching and instruction regarding member
				self-administration of medications is not reimbursable under medication
				training and support.