reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-2.5 - Equipment and supplies for newborn screening

Current through July 10, 2024
Authority: IC 16-41-17
Affected: IC 16-41-17
Sec. 2.5.
(a) The
				state-contracted newborn screening laboratory will furnish filter paper kits,
				without additional cost, annually to hospitals, midwives, birthing centers, and
				other collections sources. Manufacturer and lot number for the filter paper
				must be included on the filter paper section of the kit in accordance with the
				Clinical Laboratory Standards Institute (CLSI)-approved national standard.
				Sequential system control numbers for each collection kit must be printed on
				each information section of the collection card and on the filter paper
				section, if that section is detachable.
(b) The state-contracted newborn screening
				laboratory must provide filter paper kits, without additional cost, to local
				health departments, MCH/CSHCS clinics, or other outside
				organizations/individuals as designated by the department for the collection of
				newborn screening specimens.
(c)
				The department's newborn screening program will ensure that all Indiana
				residents who are diagnosed with one (1) of the metabolic conditions included
				in the newborn screening panel have access to the appropriate metabolic formula
				necessary for treatment as follows:
(1) A
				single brand of metabolic formula for each metabolic condition on the newborn
				screen will be designated by the state-contracted metabolic geneticist and made
				available to all Indiana residents as appropriate.
(2) The appropriate metabolic formula will be
				made available to all Indiana residents diagnosed with one (1) of the metabolic
				conditions included on Indiana's newborn screening panel, regardless of the
				individual's ability to pay or socioeconomic status as follows:
(A) Payment for metabolic formula will be
				based on a sliding-fee scale as designated by the department.
(B) All efforts will be made to collect
				payment for metabolic formula from private insurance companies or other
				third-party payers.
(C) The
				department's newborn screening program will serve as a payer of last resort for
				patients without private insurance coverage or for whom reimbursement cannot be
				obtained from another third-party payer.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-3 - Screening for certain disorders; collection procedures

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 3.
(a) Except as
				provided for in section 2(b) of this rule, all newborns and infants born in the
				state of Indiana shall be screened for the following:
(1) The following endocrine disorders:
(A) Congenital adrenal hyperplasia
				(CAH).
(B)
				Hypothyroidism.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-3.5 - Pulse oximetry measurement for critical congenital heart disease

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 3.5.
(a)
				Beginning July 1, 2021, except:
(1) as
				provided for in section 2(b) of this rule;
(2) for infants diagnosed with critical
				congenital heart disease prenatally;
(3) for infants having received
				echocardiogram diagnostic testing prior to the required pulse oximetry
				screening;
(4) for infants on
				supplemental oxygen or respiratory support for noncongenital heart diseases;
				or
(5) for infants on palliative
				care; every newborn shall be given a pulse oximetry screening examination not
				earlier than twenty-four (24) and not later than forty-eight (48) hours after
				birth.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-4 - Designated laboratories; requirements to perform screening tests for disorders

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 4.
An approved laboratory must meet the following requirements
				  in order to perform screening tests for disorders on dried blood samples from
				  newborns or infants:
(1) Complies with
				Public Law
				90-174, the Federal Clinical Laboratory
				Improvement Act of 1988, and is accredited by the College of American
				Pathologists, or is accredited by the Joint Commission on Accreditation of
				Hospitals.
(2) Performs or makes
				reasonable assurances that it will perform each one of the above screening
				tests on all newborns or infants born in the state of Indiana.
(3) Performs repeat newborn screening on
				blood specimens annually as a follow-up to abnormal screens or screens that are
				not legally valid as described above.
(4) Uses laboratory procedures and values for
				normal and abnormal test results that have been submitted to and approved by
				the department.
(5) Initiates the
				approved tests within twenty-four (24) hours of receipt of the specimen and
				completes all approved tests within seventy-two (72) hours of receipt of the
				specimen.
(6) Reports findings in a
				timely manner and maintains records of the results of all screening and
				follow-up testing in accordance with the requirements of the
				department.
(7) Provides reports of
				its screening activities to the department in the format and time frame
				specified by the department.
(8)
				Maintains a written quality assurance program covering all aspects of its
				newborn screening activity, which is approved yearly by the
				department.
(9) Cooperates with
				other relevant agencies concerned with newborn or infant health care.
(10) Participates in a laboratory quality
				assurance program, including proficiency testing, approved by the department.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-5 - Laboratory reports

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 5.
Specific reporting/follow-up requirements vary based on
				  whether the analysis indicated whether the specimen met all requirements for a
				  valid screening test and whether the screening results were normal,
				  unsatisfactory, abnormal, presumptive positive, or confirmed positive. The
				  laboratory shall report as follows:
(1) Negative test results shall be reported
				within seven (7) days of the date of receipt of the specimen to the following:
(A) MCH/NBS.
(B) The hospital or birthing center
				submitting the specimens.
(C) The
				responsible physician or midwife.
The report of the test results shall become part of the
				  patient's clinical record.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-6 - Maintenance of screening logs; follow-up of missing results; monthly reports as submitted by hospitals, birthing centers, midwives, and physicians providing home birth services

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 6.
(a) Each
				hospital or birthing center, and midwife or physician submitting screening
				tests on newborns or infants born outside a hospital or birthing center shall
				maintain a newborn screening log that shall contain the following:
(1) Name of newborn or infant.
(2) Attending physician or midwife.
(3) Medical record number.
(4) Form number of sample sent.
(5) Date sample collected.
(6) Date sample sent.
(7) Date results received.
(8) What the results were.
(9) Name of person notified of positive
				results and date and time of notification.
All such information and records shall be confidential but
				  shall be open to examination by the department personnel or its designated
				  agents for any purpose directly connected with the administration of the
				  newborn screening program.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-7 - Follow-up of positive results, recommendations

Current through July 10, 2024
Authority: IC 16-19-3-4; IC 16-41-17-9
Affected: IC 16-41-17
Sec. 7.
(a) When the
				responsible health care provider is notified by telephone by the laboratory of
				an initial presumptive positive test result, the responsible health care
				provider shall obtain the department approved repeat blood specimen from the
				newborn or infant and submit it to the designated laboratory within forty-eight
				(48) hours. If the blood specimen cannot be obtained within forty-eight (48)
				hours, the responsible health care provider shall notify MCH/NBS by telephone.
				The telephone notification shall be noted in the responsible health care
				provider's records, specifying the date of notification, the person notified,
				and the information provided. MCH/NBS will notify the local health officer and
				provide the necessary follow-up to ensure that the repeat blood specimen is
				obtained.
(b) It shall be the
				responsibility of the responsible health care provider or, if none, the local
				health officer to report the following immediately to the newborn or infant's
				parent:
(1) All abnormal results from the
				newborn screening test in order to recommend appropriate diagnostic and
				possible therapeutic procedures.
(2) Any diagnosis of a disorder in order to
				recommend appropriate therapeutic procedures and psychosocial
				support.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-9 - Newborn hearing screening responsibilities

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 9.
(a) The
				department's early hearing and detection intervention (EHDI) program is:
(1) located organizationally within the
				department's newborn screening program; and
(2) the program responsible for ensuring that
				all newborns or infants born in the state of Indiana receive appropriate
				newborn hearing screening and follow-up as necessary.
As the responsibilities, protocols, and reporting
				  requirements for hearing screening differ from those for traditional heel-stick
				  newborn screening, separate sections were created for newborn hearing
				  screening.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-10 - Equipment and supplies for newborn hearing screening

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 10.
(a) All
				materials and supplies required to perform newborn hearing screening are the
				responsibility of the screening facility.
(b) Each screening facility shall calibrate
				the screening equipment annually or according to the manufacturer's guidelines.
				Each screening facility shall provide a copy of the manufacturer's guidelines
				to the department upon request.
(c)
				Educational materials, including a hearing screening certificate, shall be
				provided to the newborn or infant's parent by the screening facility.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-11 - Hearing screening protocols for hospital birthing facilities and midwives

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 11.
(a) Prior
				to the hearing screening of a newborn or infant, the hospital or birthing
				center shall provide information explaining the importance of newborn hearing
				screening and follow-up in writing to the newborn or infant's
				parents.
(b) The responsible
				physician, midwife, birthing center, or hospital shall conduct a hearing
				screening of the newborn or infant's ears via the recommended method or methods
				as accepted by the department. Hearing screening shall mean a test to detect
				hearing thresholds of thirty (30) decibels (dB) or greater in the speech
				frequency range of each ear.
(c)
				The newborn or infant's hearing should be screened after six (6) hours of age
				and prior to discharge as follows:
(1) Preterm
				newborns or infants (born prior to thirty-five (35) weeks gestational age) who
				stay in the nursery greater than five (5) days should have hearing screening
				when the newborn or infant is medically stable, but prior to
				discharge.
(2) Newborns or infants
				who reside for greater than five (5) days in the neonatal intensive care unit
				(NICU), especially those who have complicated birth factors, are considered to
				be at significantly greater risk for types of neural hearing loss, such as
				auditory neuropathy/dyssynchrony. These newborns or infants should receive
				hearing screening or diagnostic testing, or both, as recommended by the
				department.
(3) When possible,
				inpatient diagnostic testing shall be made available to long-stay newborns or
				infants who do not pass the initial newborn hearing screening and one (1)
				rescreen (for a total of two (2) hearing screenings).
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-12 - Newborn hearing screening reports

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 12.
(a) Hearing
				screening results shall be provided in writing to the newborn or infant's
				parent prior to discharge.
(b)
				Hearing screening results (from the hearing screening equipment or from the
				heel-stick card) for every newborn, infant, or child that receives a screen
				shall be provided to the department's early hearing detection and intervention
				(EHDI) program in the format, media, and time specified by the department's
				EHDI program.
(c) The birthing
				center or hospital shall report all screening exceptions within five (5)
				business days, including the following:
(1)
				Newborns or infants who are not screened due to equipment or hospital
				error.
(2) Newborns or infants who
				do not pass the initial newborn hearing screening and one (1) additional
				rescreen prior to discharge (for a total of two (2) hearing
				screenings).
(3) Newborns or
				infants at risk for late-onset hearing loss.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-13 - Newborn screening fund; fees; disposition; reporting requirements

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9; IC
				  16-41-17-10
Affected: IC 16-41-17
Sec. 13.
(a) The
				program involving the department and MCH/NBS as described in this rule shall be
				funded by the collection of a newborn screening fee for each initial newborn
				screening performed. The designated laboratory shall assess and collect the
				full amount of the newborn screening fee from hospitals, birthing centers,
				public health nurses, physicians, and midwives submitting newborn screening
				specimens. No surcharge will be assessed, collected, or reported for newborns
				or infants receiving repeat screens. The accumulated collections from the
				newborn screening fees shall be submitted on a monthly basis by the designated
				laboratory to the division of finance at the department. Payments shall be
				postmarked not later than five (5) days after the close of the preceding month.
				The designated laboratory shall also submit a monthly report on the number of
				newborns screened. Revenues submitted by the laboratory shall correspond with
				the number of newborns screened.
(b) The newborn screening fee shall be one
				hundred twenty dollars ($120) based on the projected cost of the program
				described in this rule and the estimated number of newborns per year. The fees
				shall be deposited in the newborn screening fund. Funds for the program
				described in this rule shall be disbursed by the department in accordance with
				normal procedures prescribed by the state budget agency and the state board of
				accounts. The fee shall be reviewed annually by the department.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3 - MATERNAL AND CHILD HEALTH › Rule 3 - Newborn Screening › Section 3-14 - Grounds for filing a complaint

Current through July 10, 2024
Authority: IC
				  16-19-3-4;
				  IC
				  16-41-17-9
Affected: IC 16-41-17
Sec. 14.
The willful or repeated failure of any:
(1) physician;
(2) midwife;
(3) laboratory;
(4) hospital;
(5) birthing center; or
(6) other health care provider;
to comply with the provisions of this rule shall, in addition
				  to any other penalty prescribed by law, constitute grounds for filing a
				  complaint with the individual's or institution's licensing board in addition to
				  other legal remedies.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-1 - Applicability

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 1.
The definitions in this rule apply throughout this
				  article.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-1.5 - "Autism" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7;
				  IC
				  16-35-2-10
Affected: IC 16-35-2
Sec. 1.5.
"Autism" means a medical condition classified under
				  Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, Washington,
				  American Psychiatric Association, 1994, pages 70 and 71, code 299.00. Related
				  conditions such as Rett's Disorder, Childhood Disintegrative Disorder,
				  Asperger's Disorder, or other Pervasive Developmental Disorders are not
				  included in this definition.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-2 - "Care coordination" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 2.
"Care coordination" means providing assistance necessary to
				  help ensure the effective and efficient organization of and access to services
				  and resources that are appropriate and necessary to meet the needs of a child
				  with special health care needs and the child's family.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-3 - "Care coordinator" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 3.
"Care coordinator" means a professional staff person
				  assigned to assist a child and family with care coordination services.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-4 - "Child" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 4.
"Child" means an individual who is less than twenty-one (21)
				  years of age.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-5 - "Child and family service plan" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 5.
"Child and family service plan" means a written child and
				  family plan that is developed by a family and a care coordinator. The written
				  plan shall reference the medical needs of the child, shall include appropriate
				  strategies recommended by the care coordinator, and shall set forth family
				  goals and objectives. The plan shall be updated periodically in accordance with
				  Indiana department of health policy.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-6 - "Commissioner" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 6.
"Commissioner" means the commissioner of the Indiana
				  department of health.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-7 - "County department" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 7.
"County department" means the county department of public
				  welfare, family and social services agency, or any subsequent successor
				  agency.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-8 - "Credentials" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 8.
"Credentials" means written documentation, including, but
				  not limited to, the CSHCN program application, financial information, medical
				  information, and social information relating to a child and family.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-9 - "CSHCN program" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 9.
"CSHCN program" means the program for children with special
				  health care needs, Indiana department of health.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-10 - "Dental care" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 10.
"Dental care" means:
(1) routine dental care;
(2) extractions;
(3) fillings;
(4) x-rays;
(5) space maintainers;
(6) cross-bite treatments;
(7) sealants;
(8) orthodontia; and
(9) gingivectomies; necessary to treat a
				child's identified eligible medical condition.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-11 - "Director" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 11.
"Director" means the director of the program for children
				  with special health care needs.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-12 - "Durable equipment and supplies" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 12.
"Durable equipment and supplies" means assistive appliances,
				  including, but not limited to, the following:
(1) Braces.
(2) Prosthetic limbs.
(3) Hearing aids.
(4) Wheelchairs and related adaptive
				devices.
(5) Special supplies that
				are medically necessary to accomplish rehabilitation goals.
Durable equipment and supplies do not include fixed
				  architectural modifications of a dwelling or property related thereto or
				  mechanical lifts needed to provide the child access to a dwelling or
				  automobile.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-13 - "Emergency" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 13.
"Emergency" means an unexpected or sudden event or
				  occurrence that requires immediate attention, intervention, and medical care to
				  prevent serious harm or loss of life.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-14 - "Emergency services" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 14.
"Emergency services" means that the emergency department
				  treatment or ambulance transportation is for a medical emergency that is
				  directly related to or necessary to stabilize a child for care of an identified
				  eligible medical condition. Lack of such treatment would cause harm or be life
				  threatening if emergency care was not received. Emergency treatment for
				  nonemergent medical care or conditions that do not require urgent care are not
				  eligible for payment through the CSHCN program.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-15 - "Enrollment" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 15.
"Enrollment" means that a child's application has been
				  processed, the director has identified and assigned a care coordinator and a
				  health care provider to provide care for the child, and the director may
				  approve eligible services for payment.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-16 - "Family" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 16.
"Family" means a group of two (2) or more persons living
				  together as one (1) economic unit. Two (2) separate households or economic
				  units may reside under one (1) roof; however, each household must be
				  economically independent of one another and must have its own source of income
				  that is adequate to support itself without support from the other family.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-17 - "Health care provider" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-21-2; IC 16-35-2
Sec. 17.
"Health care provider" means a person who is licensed,
				  registered, or certified in Indiana as a health care professional, including,
				  but not limited to, the following:
(1)
				A physician.
(2) A
				dentist.
(3) A registered
				nurse.
(4) An
				optometrist.
(5) A physical
				therapist.
(6) An
				audiologist.
(7) A speech-language
				pathologist.
(8) A
				dietitian.
(9) An occupational
				therapist.
(10) A respiratory
				therapist.
(11) A hospital licensed
				under IC 16-10-1
[IC 16-10 was repealed by P.L. 2-1993, SECTION 209,
				effective July 1, 1993. See IC 16-21-2.]
.
(12) A home health agency licensed under IC
				16-10-2.5
[IC 16-10 was repealed by P.L. 2-1993, SECTION 209, effective
				July 1, 1993. See IC 16-21-2.]
.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-18 - "Household" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 18.
"Household" means all the persons who occupy a housing unit
				  (house or apartment), whether they are related to each other or not, and who
				  are living together as an economic unit.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-19 - "Inpatient services" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-21-2; IC 16-35-2
Sec. 19.
"Inpatient services" means medically necessary treatment
				  related to a child's identified eligible medical condition that is received
				  during an inpatient stay at a public or private facility licensed in accordance
				  with IC 16-10-1
[IC 16-10 was repealed by P.L. 2-1993, SECTION 209,
				  effective July 1, 1993. See IC 16-21-2.]
. Eligible inpatient services
				  include, but are not limited to, the following:
(1) Semiprivate room and specialty care unit
				room charges.
(2) X-rays.
(3) Laboratory tests.
(4) Use of the operating and recovery
				rooms.
(5) Drugs and
				medications.
(6) Oxygen
				therapy.
(7) Blood products.
Eligible inpatient services do not include personal comfort
				  items, services and supplies not directly related to the care of the child such
				  as guest meals and accommodations, telephone charges, and take home supplies.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-20 - "Laboratory services" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 20.
"Laboratory services" means laboratory procedures that are
				  medically necessary to complete a diagnostic evaluation. Laboratory services
				  shall be performed on an outpatient basis unless inpatient services for this
				  purpose are approved by the director.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-21 - "Medical specialist" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2; IC 25-22.5
Sec. 21.
"Medical specialist" means an individual with an unlimited
				  license to practice medicine under IC 25-22.5 and who is certified by a
				  specialty board that is approved by the American Board of Medical
				  Specialties.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-22 - "Nonemergent care" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 22.
"Nonemergent care" means nonlife threatening situations that
				  require care and follow-up but that require no immediate actions. Nonemergent
				  care is consistent with routine primary care and includes the following:
(1) Immunizations.
(2) Routine follow-up of prior injuries or
				illness.
(3) Suture
				removal.
(4) Rashes.
(5) Uncomplicated
				diarrhea.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-23 - "Person" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 23.
"Person" means a corporation, an association, a partnership,
				  or one (1) or more individuals.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-24 - "Poverty income guidelines" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 24.
"Poverty income guidelines" means the poverty income
				  guidelines published annually in the Federal Register, by the Secretary of
				  Health and Human Services, pursuant to
				  42
				  U.S.C. 9902(2) and 42 U.S.C.
				  9847, that provide an update of the poverty income guidelines to account for
				  last year's increase in prices as measured by the Consumer Price Index.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-25 - "Prescription drugs and medications" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 25.
"Prescription drugs and medications" means insulin, insulin
				  syringes, and other generically equivalent drugs and medications requiring a
				  prescription under Indiana or federal law that are medically necessary for
				  treatment or control of a medical condition affecting a child and that are not
				  administered during inpatient care.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-26 - "Primary care physician" defined

Current through July 10, 2024
Authority: IC 16-35-2-7
Affected: IC 16-35-2; IC 25-22.5
Sec. 26.
"Primary care physician" means an individual with an
				  unlimited license to practice medicine under IC 25-22.5, providing health care
				  services included in the basic package as defined at
				  410
				  IAC 3.2-7-2(b).
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-27 - "Primary care visits" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 27.
"Primary care visits" means a child's outpatient visit with
				  an approved health care provider that is conducted in accordance with
				  recommendations of the American Academy of Pediatrics and includes the
				  following:
(1) An initial assessment
				of health problems.
(2) A health
				history.
(3)
				Measurements.
(4) Sensory
				screening.
(5) Developmental and
				behavioral assessment.
(6) Physical
				examination.
(7) Medically
				necessary procedures, including immunizations.
(8) Appropriate discussion.
(9) Referral.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-28 - "Processing an application" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 28.
"Processing an application" means filling out the
				  application form for the CSHCN program, all activity required for determining
				  whether a child is eligible or ineligible for health care services available
				  through the CSHCN program, and notifying the applicant of the decision.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-29 - "Secondary care visits" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 29.
"Secondary care visits" means a child's outpatient visit
				  with an approved provider that includes, but is not limited to, an assessment
				  of health problems and treatment of diagnosed uncomplicated health conditions
				  and eligible medical conditions.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-30 - "State department of health" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 30.
"State department of health" means the Indiana department of
				  health.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-31 - "Surgery" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 31.
"Surgery" means necessary professional services for surgical
				  procedures, anesthesia services, use of the operating and recovery room, and
				  supplies medically necessary to treat or correct a child's identified eligible
				  medical condition.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-32 - "Temporarily" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 32.
"Temporarily" means, for purposes of determining financial
				  eligibility, a child or family is temporarily living within another household
				  or family if the child lives within the family or household for six (6) months
				  or less.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-33 - "Therapy" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 33.
"Therapy" means:
(1) physical therapy;
(2) occupational therapy;
(3) speech and hearing therapy;
(4) nursing; and
(5) other professional health care services;
				provided by an approved provider and necessary to treat a child's eligible
				medical condition. The term includes applied behavioral analysis for the
				treatment of autism.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 1 - Definitions › Section 1-34 - "X-rays" defined

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 34.
"X-rays" means x-ray procedures that are medically necessary
				  to complete a diagnostic evaluation. X-rays shall be performed on an outpatient
				  basis unless the director approved inpatient services for a specific purpose.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 2 - Application › Section 2-1 - Eligibility to apply

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 1.
(a) The
				following persons may apply for a child to receive health care services through
				the CSHCN program:
(1) A child's parent
				(regardless of age).
(2) A child's
				legal guardian.
(3) An emancipated
				child who is under twenty-one (21) years of age, who is married or single, and
				who is not dependent on the child's parents for support.
(4) A county department, if a child is a ward
				of the county.
(5) A licensed child
				placing agency, if a child has been placed in their legal
				guardianship.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 2 - Application › Section 2-2 - Intake location

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 2.
(a) A person
				may apply for the CSHCN program at a county department located in the county
				where the child who may receive services through the CSHCN program resides or
				at any other location approved by the director.
(b) The director shall publish in the Indiana
				Register the address of approved locations other than the county departments
				where a child may apply for the CSHCN program.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 2 - Application › Section 2-3 - County to county transfers

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 3.
(a) When a
				child or the child's family moves from one (1) county to another county, the
				child or the child's family shall immediately notify the child's CSHCN program
				care coordinator.
(b) Whenever a
				county department is aware that a child or a child's family has moved to
				another county, the county department shall notify the child's CSHCN program
				care coordinator in writing of the child's new address.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 2 - Application › Section 2-4 - Application process and enrollment in the Medicaid program

Current through July 10, 2024
Authority: IC
				  16-35-2-7
Affected: IC 16-35-2
Sec. 4.
(a) The state
				department of health shall not complete the processing of an application and
				enrollment for the CSHCN program until the applicant shows evidence that the
				child is enrolled in the Medicaid program or that the child has applied for the
				Medicaid program.
(b) All children
				currently enrolled in the CSHCN program shall also meet the conditions
				specified in subsection (a).
(c)
				Refusal to comply with the provisions in subsection (a) shall be sufficient
				cause for the state department of health to deny or cancel enrollment and
				participation in the CSHCN program.
(d) If a child is denied enrollment in the
				Medicaid program, the state department of health shall complete the processing
				of the child's application for the CSHCN program. If the state department of
				health determines that a child is financially and medically eligible for the
				CSHCN program, the effective date for payment of services provided by the CSHCN
				program shall be the date that the applicant submitted a written application
				form, for processing, for health care services through the CSHCN
				program.
(e) Children who are
				enrolled in the Medicaid program may apply for enrollment in the CSHCN program
				for the following purposes only:
(1) Care
				coordination services.
(2) Access
				to the CSHCN program's regional diagnostic and treatment centers.
(3) Access to other approved
				providers.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 2 - Application › Section 2-5 - State department of health responsibilities in the application process

Current through July 10, 2024
Authority: IC 16-35-2-7
Affected: IC 4-21.5; IC 16-35-2
Sec. 5.
(a) The
				processing of an application shall only be completed by the state department of
				health.
(b) The state department of
				health shall review the information and recommendations submitted by the county
				department.
(c) The state
				department of health may request additional information or clarification from
				the county department, and the county department shall provide such information
				upon request.
(d) The state
				department of health shall make the determination of financial and medical
				eligibility to participate in the CSHCN program after reviewing information
				submitted by the county department, provide the applicant with written notice
				of the decision taken on the application, and advise the applicant in writing
				of the right to reapply or appeal the decision in accordance with the
				Administrative Orders and Procedures Act (IC 4-21.5 et seq.).
(e) Except as provided in
				410 IAC
				3.2-4-1, the director shall set an effective date for
				payment of health care services as the date that a child or child's family
				submitted a written application form, for processing, for health care services
				through the CSHCN program. The director may set the effective date for payment
				of health care services retroactive up to a maximum of seven (7) working days
				according to the need for health care services.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 2 - Application › Section 2-6 - County department responsibilities in application process

Current through July 10, 2024
Authority: IC 16-35-2-7
Affected: IC 16-35-2
Sec. 6.
(a) The
				county department shall accept and act on all applications, signed by an
				applicant, except as provided in section 4 of this rule and
				410 IAC
				3.2-4-1.
(b) The county department shall be
				responsible for assisting in the completion of the application form and for all
				other activity necessary to determine whether the child is financially eligible
				or ineligible for services under the CSHCN program. The county department shall
				submit to the state department of health its recommendations concerning the
				financial eligibility or ineligibility of the child.
(c) To assist in the completion of the
				application process, the county department shall do the following:
(1) Accept applications for the CSHCN program
				in accordance with section 1 of this rule.
(2) Explain the information that the
				applicant needs to supply the county department.
(3) Assist the child and family in completing
				the CSHCN and Medicaid applications.
(4) Explain the available CSHCN program
				health care and care coordination services.
(5) Inform families that they are required to
				inform the county department or state department of health of significant
				changes in financial circumstances or of a change of address.
(6) Explain the eligibility
				requirements.
(7) Explain the
				appeals process.
(8) Verify the
				child's age by reviewing the child's birth certificate.
(9) Verify the child's residency by reviewing
				at least one (1) of the following:
(A) Rent
				or property payment receipts.
(B)
				Utility records.
(C) City
				directory.
(D) Voter's
				registration.
(E) Driver's
				license.
(F) Federal income tax
				returns.
(10) Explain any
				other information provided or requested by the director.
(11) Document the type of services that the
				applicant is requesting.
(12)
				Document the child's medical problem according to the applicant.
(13) Document the name of the physician or
				other provider, including hospitals or emergency departments, that last
				examined the child and the date and location of the most recent physical
				examination.
(14) Document health
				insurance information in accordance with
				410 IAC
				3.2-5-1.
Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 3.2 - CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Rule 3 - Reevaluation of Eligibility › Section 3-1 - Reevaluation of eligibility and criteria for closure

Current through July 10, 2024
Authority: IC 16-35-2-7
Affected: IC 16-35-2
Sec. 1.
(a) The state
				department of health shall reevaluate the financial eligibility and medical
				eligibility of the children enrolled in the CSHCN program no less frequently
				than every twelve (12) months.
(b)
				Upon completion of an annual reevaluation, the state department of health shall
				stop providing or paying for health care services as of a date certain for one
				(1) or more of the following reasons, including, but not limited to:
(1) Death of the child.
(2) Child has reached twenty-one (21) years
				of age.
(3) Child is no longer an
				Indiana resident.
(4) Location of
				child or family is unknown.
(5)
				Child or the child's family refuses further health care services.
(6) Child is institutionalized in a public or
				private facility that provides health care services.
(7) Child or the child's family fails to
				cooperate in the process of determining or reevaluating financial or medical
				eligibility.
(8) For a child not
				enrolled as of December 31, 1992, the child or the child's family is
				financially ineligible for the CSHCN program.
(9) For a child not enrolled as of December
				31, 1992, the child's physical condition no longer meets the criteria for
				medical eligibility for the CSHCN program.
(10) Child or the child's family voluntarily
				withdraws from the CSHCN program.
(11) Failure of the child or family to
				disclose or utilize health insurance benefits.
(12) Failure of the child or family to
				disclose any of the following:
(A) Monetary
				gifts.
(B) Contributions.
(C) Funds raised by popular subscription to
				assist a child.
(D)
				Prizes.
(E) Winnings.
(F) Awards.
(G) Inheritances.
(13) The recommendations contained in the
				child and family service plan have been met.