reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 9 - Continuing Education › Section 9-1 - Navigator continuing education course of study

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-12
Affected: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-12
Sec. 1.
To qualify as an approved navigator continuing education
				  course of study for purposes of IC 27-19-4-12 and
				  760 IAC 4-3-6, a navigator
				  continuing education course of study shall meet the following:
(1) Be conducted or developed by a provider
				that is at least one (1) of the following:
(A)
				An individual.
(B) An insurance
				trade association.
(C) An
				accredited college or university.
(D) An educational organization.
(E) An application organization.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 9 - Continuing Education › Section 9-2 - Continuing education credit hour defined

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Affected: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Sec. 2.
(a) A
				continuing education credit hour is based on a one (1) hour block of time.
				Fifty (50) minutes of instruction in a sixty (60) minute period will constitute
				one (1) continuing education credit hour. Time designated by the provider as
				break time may not be considered when computing course credit hours.
(b) Continuing education credit hours may be
				approved in no less than one-half (1/2) hour increments.
(c) One (1) continuing education credit hour
				is the minimum number of hours that may be approved for a navigator continuing
				education course of study.
(d)
				Eight (8) hours of classroom instruction per day is the maximum number of hours
				that may be approved for a navigator continuing education course of study.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 9 - Continuing Education › Section 9-3 - Continuing education course of study application

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-12
Affected: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-12
Sec. 3.
(a) Any:
(1) individual;
(2) insurance trade association;
(3) accredited college or
				university;
(4) educational
				organization; or
(5) application
				organization;
may submit a navigator continuing education course of study
				  for approval by the commissioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 9 - Continuing Education › Section 9-4 - Requirements for self-study continuing education course of study

Current through July 10, 2024
Authority: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-12
Affected: IC 27-19-1-4; IC 27-19-4-1; IC 27-19-4-12
Sec. 4.
(a) In
				addition to the requirements in section 3 of this rule, navigator self-study
				continuing education courses are subject to the following requirements:
(1) A navigator enrolled in a self-study
				continuing education course, including a computer-based course, shall take a
				written or computer-based examination at the conclusion of the self-study
				continuing education course. The written or computerbased examination must
				comply with the following requirements:
(A)
				Examination questions shall be multiple choice.
(B) Questions shall be selected at random
				from a bank of questions.
(C) At
				least three (3) different versions of the examination shall be used on a random
				basis.
(D) The examination for a
				course of study approved for eight (8) hours of credit or less shall consist of
				at least twenty-five (25) questions.
(E) The examination shall be graded by the
				provider.
(F) A computer-based
				examination must be designed to prevent the navigator from skipping the
				education materials before taking the examination and must not include prompts
				designed to aid the navigator in answering examination questions.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 9 - Continuing Education › Section 9-5 - Record keeping requirements

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Affected: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Sec. 5.
(a) A
				provider shall take attendance at each navigator continuing education course of
				study. The provider shall retain the attendance reports for a minimum of four
				(4) years. The attendance report shall contain the following information:
(1) Navigator's name.
(2) Navigator's certificate number.
(3) Navigator's birth date.
(4) Navigator's signature.
(5) Any other information as determined by
				the commissioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 9 - Continuing Education › Section 9-6 - Continuing education course reciprocal agreements

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Affected: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Sec. 6.
The department may enter into reciprocal agreements with
				  other states for the approval or disapproval of navigator continuing education
				  courses of study. When considering an application for continuing education
				  course of study approval, the department shall approve a continuing education
				  course of study approved by a state that has entered into a reciprocal
				  agreement with the department for the same number of credit hours it was
				  approved for in the other state.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 9 - Continuing Education › Section 9-7 - List of providers

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Affected: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Sec. 7.
The department shall maintain a current list of providers
				  who offer an approved navigator continuing education course of study.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 4 - NAVIGATORS AND APPLICATION ORGANIZATIONS › Rule 10 - Waiver of Fees › Section 10-1 - Waiver of fees

Current through July 10, 2024
Authority: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Affected: IC
				  27-19-1-4; IC
				  27-19-4-1; IC
				  27-19-4-12
Sec. 1.
(a) A person
				may request for the commissioner to waive any fee requirement imposed by this
				article upon a showing of good cause as determined by the
				commissioner.
(b) A request for a
				waiver of a fee shall:
(1) be submitted to the
				commissioner in writing in a manner as determined by the commissioner;
				and
(2) state the reasons why the
				waiver of the fee is in the public interest.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-1 - Applicability

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5
Sec. 1.
The definitions in this rule apply throughout this
				  article.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-2 - "Audit" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5
Sec. 2.
"Audit" means an audit of a pharmacy:
(1) by or on behalf of a pharmacy benefit
				manager; and
(2) related to
				submitted claims by a contracted pharmacy to the pharmacy benefit
				manager.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-3 - "Auditor" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5
Sec. 3.
"Auditor" means:
(1) a pharmacy benefit manager; or
(2) an independent auditor.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-4 - "Commissioner" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5
Sec. 4.
"Commissioner" means the commissioner of the Indiana
				  department of insurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-5 - "Covered individual" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-1
Sec. 5.
"Covered individual" has the meaning set forth in IC
				  27-1-24.5-1.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-6 - "Department" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5
Sec. 6.
"Department" means the Indiana department of
				  insurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-7 - "Extrapolation audit" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5
Sec. 7.
"Extrapolation audit" means an audit of a sample of claims
				  submitted by a contracted pharmacy to a pharmacy benefit manager, the results
				  of which are used to estimate audit results for a larger group of unaudited
				  claims submitted by the contracted pharmacy to the pharmacy benefit
				  manager.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-8 - "Health plan" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-5
Sec. 8.
"Health plan" has the meaning set forth in IC
				  27-1-24.5-5.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-9 - "Independent auditor" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5
Sec. 9.
"Independent auditor" means a person other than a:
(1) covered individual;
(2) health plan;
(3) pharmacist;
(4) pharmacy;
(5) pharmacy benefit manager; or
(6) pharmacy services administrative
				organization; that conducts an audit on behalf of a pharmacy benefit manager.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-10 - "Maximum allowable cost" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-7
Sec. 10.
"Maximum allowable cost" has the meaning set forth in IC
				  27-1-24.5-7.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-11 - "Pharmacist" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-9
Sec. 11.
"Pharmacist" has the meaning set forth in IC
				  27-1-24.5-9.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-12 - "Pharmacy" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-11
Sec. 12.
"Pharmacy" has the meaning set forth in IC
				  27-1-24.5-11.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-13 - "Pharmacy benefit manager" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-12
Sec. 13.
"Pharmacy benefit manager" has the meaning set forth in IC
				  27-1-24.5-12.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 1 - Definitions › Section 1-14 - "Pharmacy services administrative organization" defined

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-15
Sec. 14.
"Pharmacy services administrative organization" has the
				  meaning set forth in IC 27-1-24.5-15.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 2 - Licensure Requirements › Section 2-1 - Application

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-18; IC 27-1-24.5-22; IC
				  27-1-25-11.1
Sec. 1.
A person must, before establishing or operating as a
				  pharmacy benefit manager, apply to and obtain a license from the commissioner.
				  The pharmacy benefit manager must submit an application on a form prescribed by
				  the commissioner. The application must include the following
				  information:
(1) The name or names
				under which the applicant conducts business.
(2) A copy of the applicant's articles of
				incorporation or other business organization documents.
(3) The following contact information:
(A) The address of the principal place of
				business of the applicant.
(B) The
				mailing address of the applicant.
(C) The address of each office the applicant
				maintains in Indiana.
(D) The
				primary licensing phone number of the applicant.
(E) The primary licensing electronic mail
				address of the applicant.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 2 - Licensure Requirements › Section 2-2 - Financial statement

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-20
Sec. 2.
(a) An
				application for issuance of a license or renewal of a license must be
				accompanied by an applicant's current audited annual financial statements
				prepared by an independent certified public accountant in accordance with
				generally accepted accounting principles reflecting a positive net worth, and
				additional information determined by the commissioner to be necessary for a
				review of the current financial condition of the applicant to determine
				compliance with IC 27-1-24.5 or requirements of this rule. Financial
				information and proprietary information submitted by an applicant to the
				department is confidential under IC 27-1-24.5-20.
(b) An applicant for a license or renewal of
				a license may make written application to the commissioner for approval to file
				audited consolidated or combined financial statements instead of separate
				annual audited financial statements. If an applicant makes written application
				to the commissioner under this subsection, the statement must include a
				columnar consolidating or combining worksheet that includes the amounts shown
				on the consolidated audited financial statement, separately reported on the
				worksheet for each entity included on the statement, and an explanation of
				consolidating and eliminating entries.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 2 - Licensure Requirements › Section 2-3 - License application and renewal application fees

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-3-28
Sec. 3.
(a) A
				license application submitted under section 1 of this rule must be accompanied
				by a fee of five hundred dollars ($500).
(b) A renewal application submitted under
				section 6 of this rule must be accompanied by a fee of five hundred dollars
				($500).
(c) License application
				fees and renewal fees shall be deposited in the department of insurance fund
				established by IC 27-1-3-28.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 2 - Licensure Requirements › Section 2-4 - Material changes in application as filed

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-20
Sec. 4.
A pharmacy benefit manager licensee must keep current the
				  information required to be disclosed in its application by timely reporting all
				  material changes to the department. If there is a material change in the
				  information required by the application, the licensee must provide updated
				  information to the department within sixty (60) days of the change.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 2 - Licensure Requirements › Section 2-5 - Denial of initial application

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 4-21.5
Sec. 5.
If an initial application is denied under this section, the
				  applicant may appeal the denial under the terms of the provisions of IC 4-21.5.
				  A hearing of the appeal must be conducted within forty-five (45) days from the
				  date the petition for hearing is filed with the commissioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 2 - Licensure Requirements › Section 2-6 - Renewal of license

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 4-21.5
Sec. 6.
(a) A
				license obtained under this rule is valid for one (1) year.
(b) A pharmacy benefit manager must complete
				a renewal application on a form prescribed by the commissioner. The pharmacy
				benefit manager must identify any change in the information provided with the
				pharmacy benefit manager's initial application for licensure.
(c) A renewal application must be accompanied
				by the renewal fee set forth in section 3(b) of this rule.
(d) A renewal application, with supporting
				documentation, as outlined in section 2 of this rule, must be received by the
				commissioner on or before thirty (30) days prior to the anniversary of the
				effective date of the pharmacy benefit manager's most recent license.
(e) A pharmacy benefit manager license
				remains in effect unless revoked or suspended, as long as the renewal fee set
				forth in subsection (c) is paid, the renewal application is received in
				accordance with subsection (d), and the annual reporting requirements set forth
				in 760 IAC 5-5-1 are met by the due
				date.
(f) If a renewal application
				is denied under this section, the applicant or licensee may appeal the denial
				under the terms of the provisions of IC 4-21.5. A hearing of the appeal must be
				conducted within forty-five (45) days from the date the petition for hearing is
				filed with the commissioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-1 - Applicability

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 1.
This rule does not apply to an audit that involves probable
				  or potential fraud or willful misrepresentation by a pharmacy or pharmacist.
				  This rule does not:
(1) preclude an
				entity from instituting an action for fraud against a pharmacy;
(2) apply to an audit of pharmacy records
				when fraud or other intentional and willful misrepresentation is evidenced by
				physical review, review of claims data or statements, or other investigative
				methods; or
(3) apply to a state
				agency that is conducting audits or a person that has contracted with a state
				agency to conduct audits of pharmacy records.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-2 - Limitations

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 2.
(a) A
				pharmacy benefit manager may cause an audit to occur at a particular pharmacy
				location not more than one (1) time per calendar year. However, if the audit
				results in a finding of material noncompliance at the pharmacy, the pharmacy
				benefit manager or auditor may return within the calendar year to determine
				ongoing compliance.
(b) An
				independent auditor that conducts an audit on behalf of a pharmacy benefit
				manager may conduct an audit at a particular pharmacy location not more than
				one (1) time per calendar year for each pharmacy benefit manager. However, if
				the audit results in a finding of material noncompliance at the pharmacy, the
				auditor may return within the calendar year to determine ongoing
				compliance.
(c) A pharmacy benefit
				manager may not conduct an audit at a particular pharmacy location and engage
				an independent auditor to conduct an audit on behalf of the pharmacy benefit
				manager at the same pharmacy location within the same calendar year. However,
				if an audit results in a finding of material noncompliance at the pharmacy, the
				pharmacy benefit manager or auditor may return within the calendar year to
				determine ongoing compliance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-3 - Conduct of audit

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 25-26; IC 27-1-24.5-22
Sec. 3.
An auditor conducting an audit must comply with all of the
				  following:
(1) The contract under
				which the audit is performed must provide a description of audit procedures
				that will be followed.
(2) For an
				onsite audit conducted at a pharmacy's location, the auditor that conducts the
				audit must provide written notice to the pharmacy or pharmacist at least
				fourteen (14) calendar days before conducting the initial onsite audit for each
				audit cycle.
(3) The auditor must
				not interfere with the delivery of pharmacist services to a patient, and must
				use every effort to minimize inconvenience and disruption to pharmacy
				operations during the audit. This subdivision does not prohibit audits during
				normal business hours of the pharmacy.
(4) If the audit requires use of clinical or
				professional judgment, the audit must be conducted by or in consultation with
				an individual licensed as a pharmacist under IC 25-26.
(5) The auditor must allow the use of written
				or otherwise transmitted hospital, physician, or other health practitioner
				records to validate a pharmacy record.
(6) The auditor must perform the audit
				according to the same standards and parameters that the auditor uses to audit
				all other similarly situated pharmacies.
(7) The period covered by the audit must not
				exceed twenty-four (24) months after the date on which a claim that is the
				subject of the audit was submitted to or adjudicated by the pharmacy benefit
				manager, unless a longer period is required under federal or state law. The
				pharmacy must be permitted to resubmit electronically any claims disputed by
				the audit. Audit procedures must provide for a period of at least thirty (30)
				calendar days during which the pharmacy may resubmit a disputed
				claim.
(8) The auditor must not
				schedule an audit to begin during the first seven (7) calendar days of a month
				without the voluntary consent of the pharmacy. The consent may not be mandated
				by a contract or other means.
(9)
				Payment to the auditor for conducting the audit must not be based on a
				percentage of the amount recovered as a result of the audit.
(10) Within twenty-four (24) hours of
				receiving the notice of an audit, a pharmacy may reschedule the audit to a date
				not more than fourteen (14) calendar days after the date proposed by the
				auditor. However, if the auditor is unable to reschedule within the fourteen
				(14) calendar day period, the auditor must select and reschedule the audit for
				a date after the fourteen (14) calendar day period.
(11) The auditor must allow a pharmacy or
				pharmacist to produce documentation to address a discrepancy found during the
				audit.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-4 - Written audit reports

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 4.
Following an audit, an auditor must provide to the pharmacy
				  written audit reports as follows:
(1)
				Deliver the preliminary audit report to the pharmacy or pharmacist not later
				than ninety (90) calendar days after the audit is concluded, with reasonable
				extensions allowed.
(2) Provide
				with the preliminary audit report a written appeal procedure for the pharmacy
				to follow if the pharmacy desires to appeal a finding contained in the
				preliminary audit report. The written appeal procedure must provide for a
				period of at least thirty (30) calendar days after the pharmacy receives the
				preliminary audit report, during which the pharmacy may file an appeal of
				findings contained in the preliminary audit report.
(3) Deliver a final audit report to the
				pharmacy or pharmacist not later than one hundred twenty (120) calendar days
				after:
(A) the preliminary audit report is
				received by the pharmacy; or
(B) if
				an appeal is filed, a final appeal determination is made; whichever is
				later.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-5 - Clerical errors; fraud; recoupment of payment

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 5.
(a) A
				clerical or record keeping error, such as a typographical error, scrivener's
				error, or computer error related to or contained in a document that is
				necessary to the conduct of an audit, does not constitute fraud without proof
				of intent to commit fraud.
(b) If a
				clerical error is identified during the course of an audit, the pharmacy must
				be allowed to obtain a prescription that corrects the clerical error from the
				prescriber.
(c) A clerical or
				record keeping error may not result in the recoupment of payment if the patient
				has received the drug for which the claim was submitted.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-6 - Overpayment and underpayment audit findings

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 6.
An audit finding of an overpayment or underpayment of a
				  claim:
(1) must be based on an actual
				overpayment or underpayment of an audited claim discovered to include a
				recoverable error;
(2) must not be
				based on a projection that is based on the number of:
(A) patients who:
(i) have similar diagnoses; and
(ii) are served by the pharmacy; or
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-7 - Audit report; distribution; interest accrual

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 7.
(a) Before
				recoupment of funds may be made based on an audit finding of overpayment or
				underpayment:
(1) a final audit report must be
				distributed; and
(2) except when an
				audit finds that fraud, willful misrepresentation, or alleged serious abuse has
				occurred, at least thirty (30) calendar days must elapse after the date on
				which the final audit report is distributed before the recoupment of funds
				exceeding ten thousand dollars ($10,000).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-8 - Prohibition on use of extrapolation for calculating recoupments or penalties

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 8.
The results of an extrapolation audit or any similar
				  methodology may not be used by an auditor as a basis for calculating
				  overpayment or underpayment recoupments or penalties, unless required by state
				  or federal law.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-9 - Internal appeal process

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 9.
(a) An
				auditor must establish an internal appeal process under which a pharmacy or
				pharmacist may appeal a disputed claim in a preliminary audit report.
(b) Under the internal appeals process, an
				auditor must allow a pharmacy or pharmacist to request an internal appeal
				within thirty (30) calendar days after receipt of a preliminary audit report,
				with reasonable extensions allowed.
(c) An auditor must include in its
				preliminary audit report a written explanation of the internal appeals process,
				including the name, address, and telephone number of the person or entity to
				whom an internal appeal should be addressed.
(d) The decision of the auditor on an appeal
				of a disputed claim in a preliminary audit report by a pharmacy or pharmacist
				must be reflected in the final audit report.
(e) An auditor must deliver a final audit
				report to a pharmacy or pharmacist not later than one hundred twenty (120)
				calendar days after a final appeal determination is made. The final report must
				include a final accounting of all monies to be recovered or returned by the
				pharmacy benefit manager.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 3 - Pharmacy Claims Audits › Section 3-10 - Use of third party auditors

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 10.
The acts of an independent auditor are considered to be the
				  acts of the pharmacy benefit manager on whose behalf the independent auditor is
				  acting.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 4 - Maximum Allowable Cost Pricing › Section 4-1 - Maximum allowable cost pricing

Current through July 10, 2024
Authority: IC 27-1-24.5-20; IC 27-1-24.5-23
Affected: IC 27-1-24.5
Sec. 1.
(a) In a
				contract between a pharmacy benefit manager and a pharmacy, or a pharmacy
				benefit manager and a pharmacy services administrative organization, the
				pharmacy or the pharmacy services administrative organization must be given the
				right to obtain from the pharmacy benefit manager, within ten (10) calendar
				days after a request, a current list of the sources used to determine maximum
				allowable cost pricing. The pharmacy benefit manager must update the maximum
				allowable cost list at least every seven (7) calendar days and provide a means
				by which contracted pharmacies and pharmacy services administrative
				organizations may promptly review maximum allowable cost list updates in a
				format that is readily available and accessible.
(b) A pharmacy benefit manager must maintain
				a procedure to eliminate products from the list of drugs subject to maximum
				allowable cost pricing in a timely manner in order to remain consistent with
				pricing changes in the marketplace.
(c) In order to place a prescription drug on
				a maximum allowable cost list, a pharmacy benefit manager must ensure that:
(1) the drug is listed as "A" or "B" rated in
				the most recent version of the United States Food and Drug Administration's
				Approved Drug Products with Therapeutic Equivalence Evaluations, also known as
				the Orange Book, or has an "NR" or "NA" rating or similar rating by a
				nationally recognized reference; and
(2) the drug:
(A) is generally available for purchase by
				pharmacies in Indiana from a national or regional wholesaler licensed and
				operating in Indiana; and
(B) is
				not obsolete, temporarily unavailable, included on a drug shortage list, or
				unable to be lawfully substituted.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 4 - Maximum Allowable Cost Pricing › Section 4-2 - Disputes

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-22
Sec. 2.
A pharmacy benefit manager shall establish a process for
				  contracted pharmacies, pharmacy services administrative organizations, and
				  group purchasing organizations to appeal, investigate, and resolve disputes
				  regarding maximum allowable cost pricing that includes the following:
(1) The right to appeal a claim in accordance
				with IC 27-1-24.5-22(b)(1).
(2) A
				requirement that the appeal be investigated and resolved within thirty (30)
				calendar days after the appeal is received.
(3) A requirement that if an appeal is
				denied, the pharmacy benefit manager must do the following:
(A) Provide a reason for the appeal
				denial.
(B) Provide the appealing
				contracted pharmacy, pharmacy services administrative organization, or group
				purchasing organization with the national drug code of a prescription drug that
				is generally available for purchase by pharmacies in Indiana:
(i) from a national or regional wholesaler
				licensed and operating in Indiana; and
(ii) for a price at or below the maximum
				allowable cost price as determined by the pharmacy benefit manager.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 5 - Annual Reporting › Section 5-1 - Annual reporting

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5-21
Sec. 1.
A pharmacy benefit manager must file annually by June 1 a
				  report containing data from the immediately preceding calendar year on a form
				  provided by the commissioner. The report must contain the information set forth
				  in IC 27-1-24.5-21(a).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 6 - Violations › Section 6-1 - Violations

Current through July 10, 2024
Authority: IC 27-1-24.5-28
Affected: IC 27-4-1-4
Sec. 1.
Violations of this article constitute an unfair or deceptive
				  act under IC 27-4-1-4. The penalties, actions, or orders, including, but not
				  limited to, monetary fines, suspensions, or license revocations, as authorized
				  under IC 27-4-1, shall apply to violations of this article.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 7 - Conflict with Federal Law › Section 7-1 - Conflict with federal law

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-4-1-4
Sec. 1.
Nothing in this article is intended or shall be construed to
				  be in conflict with existing relevant federal law.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 5 - PHARMACY BENEFIT MANAGER STANDARDS › Rule 8 - Severability › Section 8-1 - Severability

Current through July 10, 2024
Authority: IC 27-1-24.5-20
Affected: IC 27-1-24.5
Sec. 1.
If the provisions of this article, or the application
				  thereof, to a person or circumstance is for a reason held to be invalid, the
				  remainder of the article and the application of the provisions to other persons
				  or circumstances shall not be affected.
Indiana Administrative Code › Title 762 - INDIANA POLITICAL SUBDIVISION RISK MANAGEMENT COMMISSION › Article 2 - MEMBERSHIP IN POLITICAL SUBDIVISION RISK MANAGEMENT FUND AND CATASTROPHIC LIABILITY FUND › Rule 1 - Responsibilities › Section 1-1 - Definitions

Current through July 10, 2024
Authority: IC  27-1-29-16; IC  27-1-29.1-20
Affected: IC  27-1-29; IC  27-1-29.1-9; IC  27-1-29.1-22; IC  34-6-2-110
Sec. 1.
The following definitions apply throughout this rule:
(1) "Additional assessments" means any assessments made in excess of those paid by the member or former member in order to meet the eligibility requirements of IC  27-1-29-11, IC  27-1-29-12, IC  27-1-29.1-9, and IC  27-1-29.1-22.
(2) "Assessment" means the assessment set forth in IC  27-1-29-12 or IC  27-1-29.1-22.
(3) "Capitalization" means the annual surcharge set forth in IC  27-1-29-7(b)(10).
(4) "Catastrophic liability fund" means the political subdivision catastrophic liability fund established by IC  27-1-29.1.
(5) "Commission" means the Indiana political subdivision risk management commission established by IC  27-1-29-5.
(6) "Commissioner" means the commissioner of the Indiana department of insurance.
(7) "Member" means a political subdivision that is a member of the risk management fund or the catastrophic liability fund.
(8) "Political subdivision" has the meaning set forth in IC  34-6-2-110.
(9) "Risk management fund" means the political subdivision risk management fund established by IC  27-1-29.
Indiana Administrative Code › Title 762 - INDIANA POLITICAL SUBDIVISION RISK MANAGEMENT COMMISSION › Article 2 - MEMBERSHIP IN POLITICAL SUBDIVISION RISK MANAGEMENT FUND AND CATASTROPHIC LIABILITY FUND › Rule 1 - Responsibilities › Section 1-2 - Membership

Current through July 10, 2024
Authority: IC  27-1-29-16; IC  27-1-29.1-20
Affected: IC  27-1-29-4; IC  27-1-29.1
Sec. 2.
(a) A political subdivision that applies to become a member of the risk management fund or the catastrophic liability fund may become a member after the following occurs:
(1) An application is filed with the manager or vendor of the risk management fund and the catastrophic liability fund.
(2) The manager or vendor provides the commission with twelve (12) copies of the application.
(3) The commission votes, by a majority, to accept the political subdivision as a member of the risk management fund or the catastrophic liability fund.
(4) The political subdivision pays the assessment and capitalization.
Indiana Administrative Code › Title 762 - INDIANA POLITICAL SUBDIVISION RISK MANAGEMENT COMMISSION › Article 2 - MEMBERSHIP IN POLITICAL SUBDIVISION RISK MANAGEMENT FUND AND CATASTROPHIC LIABILITY FUND › Rule 1 - Responsibilities › Section 1-3 - Assessments

Current through July 10, 2024
Authority: IC  27-1-29-16; IC  27-1-29.1-20
Affected: IC  27-1-29-4; IC  27-1-29.1
Sec. 3.
(a) In any twelve (12) month period, no additional assessment shall exceed one hundred percent (100%) of the assessment paid by the member for the last twelve (12) month period in which it was a member.
(b) Notwithstanding subsection (a), a member may voluntarily pay the full amount of any additional assessment at any time.
(c) Members' assessments and capitalization are due no later than the first day of renewal for each year.
Indiana Administrative Code › Title 762 - INDIANA POLITICAL SUBDIVISION RISK MANAGEMENT COMMISSION › Article 2 - MEMBERSHIP IN POLITICAL SUBDIVISION RISK MANAGEMENT FUND AND CATASTROPHIC LIABILITY FUND › Rule 1 - Responsibilities › Section 1-4 - Failure to pay assessment

Current through July 10, 2024
Authority: IC  27-1-29-16; IC  27-1-29.1-20
Affected: IC  27-1-29-4; IC  27-1-29.1
Sec. 4.
(a) If a member fails to pay an assessment or capitalization, the commission may do either of the following:
(1) Send a notice of coverage cancellation to the delinquent member providing a minimum of ten (10) days notice before the cancellation is effective.
(2) Assess the interest specified by statute on any outstanding balance.
Indiana Administrative Code › Title 804 - BOARD OF REGISTRATION FOR ARCHITECTS AND LANDSCAPE ARCHITECTS › Article 1.1 - REGISTRATION; CODE OF CONDUCT FOR ARCHITECTS › Rule 1 - General Provisions › Section 1-2 - Organization; meetings; officers

Current through July 10, 2024
Authority: IC
				  25-4-1-3
Affected: IC 5-14-1.5
Sec. 2.
(a)
				Procedure: Roberts Rules of Order are adopted as the rules for conducting the
				business of the board to the extent not in conflict with applicable
				law.
(b) Meetings: A minimum of two
				(2) regular meetings will be held in each calendar year and special meetings as
				the board in its discretion may deem necessary or advisable.
(1) The first meeting of the board, the
				annual meeting, shall be as soon as practicable after the start of the calendar
				year.
(2) The other regular meeting
				as near as practicable to the middle of the calendar year.
(3) Special meetings shall be at the request
				of the chairman or any three (3) members by presenting a request to the
				secretary of the board.
(4) Time
				and place of meetings shall be determined by the chairman.
(5) Notice of all meetings by the secretary
				setting out the time and place of the meeting and including a proposed agenda
				of the items for action at the meeting are to be mailed to all board members
				not less than 10 days prior to the date of such meeting, unless such notice has
				been waived by the chairman with any such waiver subject to the public notice
				which must be given as required by IC 5-14-1-5
[Repealed by P.L.
				19-1983, SECTION 12. See IC 5-14-1.5.]
.
(6) Five (5) members of the board shall
				constitute a quorum for the transaction of any and all business which may come
				before the board. Approval by a majority of all members of the board present
				shall be required for action to be taken.
Indiana Administrative Code › Title 804 - BOARD OF REGISTRATION FOR ARCHITECTS AND LANDSCAPE ARCHITECTS › Article 1.1 - REGISTRATION; CODE OF CONDUCT FOR ARCHITECTS › Rule 2 - Certificate of Registration; Application, Examination, Reciprocity › Section 2-1 - Applications

Current through July 10, 2024
Authority: IC
				  25-4-1-3; IC 25-4-2
Affected: IC 25-4-1; IC
				  25-4-2-4; IC
				  25-4-2-6
Sec. 1.
(a) In
				keeping with the purpose of IC 25-4-1 and IC 25-4-2, an application for
				original registration will be accepted by the board from any person desiring to
				engage in the practice of architecture or landscape architecture or use the
				title of "architect" or "landscape architect" in Indiana.
(b) Reciprocity registration shall be as
				follows:
(1) For an architect, a person who is
				currently a licensed architect in good standing in another state or territory
				of the United States, foreign country, or province and who wishes to be
				considered for registration in Indiana may apply through NCARB. It shall be the
				responsibility of the applicant to ensure that NCARB furnishes the record to
				the board.
(2) For a landscape
				architect, a person who is currently a licensed or certified landscape
				architect in good standing in another state or jurisdiction and who wishes to
				be considered for registration in Indiana may apply through CLARB. It shall be
				the responsibility of the applicant to ensure that CLARB furnishes the record
				to the board and to request an application from the Indiana board.
Indiana Administrative Code › Title 804 - BOARD OF REGISTRATION FOR ARCHITECTS AND LANDSCAPE ARCHITECTS › Article 1.1 - REGISTRATION; CODE OF CONDUCT FOR ARCHITECTS › Rule 2 - Certificate of Registration; Application, Examination, Reciprocity › Section 2-2 - Landscape architects; experience requirements

Current through July 10, 2024
Authority: IC
				  25-4-1-3
Affected: IC
				  25-4-2-1; IC
				  25-4-2-3
Sec. 2.
(a) This
				section establishes the actual practical experience requirements under IC
				25-4-2-3(a)(2)(B)
				 and IC
				25-4-2-3(a)(6) 
				for applicants for registration as a landscape architect. Subsection (b)
				establishes the requirements for IC
				25-4-2-3(a)(2)(B)
				 as an alternative to graduation from an
				accredited curriculum of landscape architecture presented by a college or
				school approved by the board. Subsections (c) through (g) establish the
				requirements for IC
				25-4-2-3(a)(6).
(b) Experience of a grade and character
				satisfactory to the board, which would be used in lieu of an accredited degree
				in landscape architecture includes the following:
(1) Work under the direct supervision of a
				registered landscape architect, which falls within the scope of the services
				described in the definition of landscape architecture found in IC
				25-4-2-1(b).
(2) Has attained before January 1, 2003, at
				least eight (8) years of satisfactory experience as described in subdivision
				(1).
Indiana Administrative Code › Title 804 - BOARD OF REGISTRATION FOR ARCHITECTS AND LANDSCAPE ARCHITECTS › Article 1.1 - REGISTRATION; CODE OF CONDUCT FOR ARCHITECTS › Rule 2 - Certificate of Registration; Application, Examination, Reciprocity › Section 2-5 - Issuance of certificate of registration

Current through July 10, 2024
Authority: IC
				  25-4-1-3;
				  IC 25-4-2
Affected: IC
				  25-4-1-10;
				  IC
				  25-4-2-2
Sec. 5.
(a) Upon
				successful completion of the requirements for registration and the board's
				approval of the application, the board shall:
(1) order a certificate of registration to be
				issued to the applicant; and
(2)
				designate the date of the certificate.
Upon receipt of the registration fee, the board will assign a
				  certificate number to the registrant. Thereafter, the board will issue a
				  registration card and provide a certificate of registration.
Indiana Administrative Code › Title 804 - BOARD OF REGISTRATION FOR ARCHITECTS AND LANDSCAPE ARCHITECTS › Article 1.1 - REGISTRATION; CODE OF CONDUCT FOR ARCHITECTS › Rule 2 - Certificate of Registration; Application, Examination, Reciprocity › Section 2-6 - Renewal of registration

Current through July 10, 2024
Authority: IC
				  25-4-1-3;
				  IC 25-4-2
Affected: IC
				  25-1-2-6;
				  IC
				  25-4-1-14;
				  IC
				  25-4-1-22
Sec. 6.
(a)
				Certificates of registration shall be renewable every two years with the
				renewal fee payable in advance.
(b)
				A renewal notice will be sent to each registrant at least sixty (60) days prior
				to December 1st of each odd numbered year and it will designate the amount of
				renewal fee and the date payment is due.
A renewal notice shall be sent to each holder of an expired
				  registration delinquent no more than two (2) renewal periods. The notice will
				  designate the total amount of the renewal and the delinquent fees and the date
				  payments are due in order to restore the certificate of registration to good
				  standing for the succeeding biennial period.
All renewal notices and other communications will be sent to
				  the last address given by the registrant to the board and failure to receive a
				  notice, so addressed, shall not relieve the registrant from his obligation to
				  pay the renewal fee at the proper time subject to IC
				  25-1-2-6.
(c) When the renewal fee is not
				paid on time, the certificate of registration expires and the holder of the
				expired certificate of registration cannot lawfully practice or offer to
				practice as an architect or practice under the title "landscape architect" and
				his name will be deleted from future rosters until the renewal fee and required
				restoration fee shall have been paid.
(d) A failure to renew in the time allowed in
				IC
				25-4-1-14
				(five (5) years) shall cause termination of the registration so that it cannot
				be renewed thereafter.
Indiana Administrative Code › Title 804 - BOARD OF REGISTRATION FOR ARCHITECTS AND LANDSCAPE ARCHITECTS › Article 1.1 - REGISTRATION; CODE OF CONDUCT FOR ARCHITECTS › Rule 2 - Certificate of Registration; Application, Examination, Reciprocity › Section 2-8 - Firm, partnership, or corporate practice

Current through July 10, 2024
Authority: IC
				  25-4-1-3;
				  IC 25-4-2
Affected: IC
				  25-4-1-22
Sec. 8.
A firm, partnership or corporation offering architectural
				  service shall have a registrant who is a principal of the firm or partnership
				  or officer of the corporation and all work shall be performed under the
				  responsible direction and supervision of said registrant.
The name of such principal or officer who is registered shall
				  appear whenever the name of the firm, partnership or corporation is used in
				  professional practice to indicate to clients or prospective clients that
				  registrant is in responsible charge and is validly registered as determined by
				  the board.