reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 2 - CHIP; Coverage; Use of Medicaid Rules › Section 2-2 - Prior authorization; administrative review and appeals

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
(a) The
				procedures and requirements set forth in 405 IAC 5-3 and 405 IAC 5-7 for
				Medicaid prior authorization, administrative review, and appeals shall apply to
				the following:
(1) Services rendered to CHIP
				primary care case management members.
(2) Services rendered to CHIP risk-based
				managed care members if the service is carved out of a CHIP risk-based MCO
				contract.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 2 - CHIP; Coverage; Use of Medicaid Rules › Section 2-3 - Out-of-state services

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
Those services otherwise covered in this article are covered
				  when provided out-of-state, subject to the same requirements applicable to
				  out-of-state services provided under the Medicaid program.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 3-3-3 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 13-2-3 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 3 - Early Intervention Services › Section 3-1 - Immunizations; screening; diagnosis

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Age-appropriate immunizations and periodic screening and
				  diagnosis services shall be covered by CHIP in the same manner and at the same
				  intervals as they are in the Medicaid program.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 3-4-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 13-3-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 3 - Early Intervention Services › Section 3-2 - Treatment

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
Treatment found necessary as a result of a diagnosis pursuant
				  to an initial or periodic screening may be provided subject to any prior
				  authorization requirements and coverage limitations set out in this article. If
				  a service is not covered under the state plan, it is not a reimbursable service
				  by CHIP.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 3-4-2 ) to the
					 Office of the Secretary of Family and Social Services ( 405 IAC 13-3-2 ) by
					 P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 4 - Evaluation and Management Services › Section 4-1 - Limitations

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Reimbursement is available for office visits limited to a
				  maximum of thirty (30) per recipient per rolling twelve (12) month period
				  without prior authorization and subject to the restrictions applicable to the
				  Medicaid program set forth in 405 IAC 5-9.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 3-5-1 ) to
					 the Office of the Secretary of Family and Social Services ( 405 IAC 13-4-1 ) by
					 P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 5 - Medical Supplies and Equipment › Section 5-1 - Coverage and limitations

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
(a) Subject
				to the limitation in subsection (b), durable medical equipment, repairs to
				durable medical equipment, and medical supplies are covered using the same
				coverage criteria and prior authorization procedures applicable to the Medicaid
				program and set forth in 405 IAC 5-19.
(b) Durable medical equipment is subject to a
				maximum benefit of two thousand dollars ($2,000) per calendar year per member
				and five thousand dollars ($5,000) per member per lifetime.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 3-6-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 13-5-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 6 - Mental Health and Substance Abuse Services › Section 6-1 - Reimbursement limitations

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
(a)
				Reimbursement is available for mental health services subject to the
				limitations set out in the Medicaid program as well as additional limitations
				set forth in this rule.
(b)
				Reimbursement is not available for reservation of beds in psychiatric
				hospitals.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 3-7-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 13-6-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 7 - Therapy Services › Section 7-1 - Reimbursement limitations

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Reimbursement is available for physical, speech,
				  occupational, and respiratory therapy subject to the limitations set forth in
				  the Medicaid program as well as the limitations set forth in this rule.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 3-8-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 13-7-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 7 - Therapy Services › Section 7-2 - Maximum visits

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
Physical, speech, occupational, and respiratory therapy is
				  limited to a maximum of fifty (50) visits per member per rolling twelve (12)
				  month period for each type of therapy.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 3-8-2 ) to
					 the Office of the Secretary of Family and Social Services ( 405 IAC 13-7-2 ) by
					 P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 8 - Transportation › Section 8-1 - Reimbursement limitations

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Emergency ambulance transportation is a covered service,
				  subject to the prudent layperson definition of emergency in
				  407 IAC
				  1-1-6
[ 405 IAC 11-1-6
				  ]
.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 3-9-1 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 13-8-1 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 8 - Transportation › Section 8-2 - Nonemergency ambulance transportation

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
Nonemergency ambulance transportation between medical
				  facilities is a covered service when ordered by the treating
				  physician.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 3-9-2 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 13-8-2 ) by P.L. 35-2016, SECTION 53, effective March
					 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 8 - Transportation › Section 8-3 - Copayment

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
(a) A ten
				dollar ($10) copayment is required for ambulance transportation.
(b) The copayment shall be paid by the member
				and collected by the provider. Reimbursement shall be adjusted to reflect the
				copayment amount for which the member is liable.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 3-9-3 ) to the
					 Office of the Secretary of Family and Social Services ( 405 IAC 13-8-3 ) by
					 P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 9 - Pharmacy Services › Section 9-1 - Nonlegend drugs

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
(a) A
				nonlegend drug, with the exception of nonlegend insulin, is covered to the
				extent such drug is:
(1) included on the
				Indiana Medicaid nonlegend drug formulary;
(2) included on the Indiana Medicaid
				preferred drug list; and
(3) not
				specifically excluded from coverage.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 9 - Pharmacy Services › Section 9-2 - Generic drugs

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
Brand name drugs, where generic substitution is possible, are
				  covered in accordance with applicable law.
(1) Brand name drugs are covered if the brand
				name drug is:(A)
medically necessary;
				or
(B) less costly than the
				generic.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 9 - Pharmacy Services › Section 9-3 - Copayments

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
(a) A three
				dollar ($3) copayment is required for generic, compound, and sole source
				drugs.
(b) A ten dollar ($10)
				copayment is required for brand name drugs.
(c) The copayment shall be paid by the member
				and collected by the provider. Reimbursement shall be adjusted to reflect the
				copayment amount for which the member is liable.
(d) A provider may deny services if the
				member does not pay the required copayment.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 3-10-3 ) to
					 the Office of the Secretary of Family and Social Services ( 405 IAC 13-9-3 ) by
					 P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 10 - Podiatry Services › Section 10-1 - Covered services

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Reimbursement is available for the following podiatry
				  services when performed within the scope of practice of the podiatry profession
				  as defined by Indiana law, subject to the limitations set forth in the Medicaid
				  program as well as the limitations set forth in this rule:
(1) Surgical procedures involving the
				foot.
(2) Laboratory
				services.
(3) X-ray
				services.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 3-11-1 )
					 to the Office of the Secretary of Family and Social Services ( 405 IAC 13-10-1
					 ) by P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 10 - Podiatry Services › Section 10-2 - Noncovered services

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
Routine foot care as defined in 405 IAC
				  3-26-3
[sic.]
is not covered.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC
					 3-11-2 ) to the Office of the Secretary of Family and
					 Social Services ( 405 IAC 13-10-2 ) by P.L. 35-2016, SECTION 53, effective
					 March 21, 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 11 - Chiropractic Services › Section 11-1 - Reimbursement

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Reimbursement is available for chiropractic services subject
				  to the limitations set forth in the Medicaid program as well as the limitations
				  set forth in this rule.
Transferred from the Office of the Children's Health
					 Insurance Program (
					 407 IAC 3-12-1 ) to
					 the Office of the Secretary of Family and Social Services ( 405 IAC 13-11-1 )
					 by P.L. 35-2016, SECTION 53, effective March 21,
					 2016.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 11 - Chiropractic Services › Section 11-2 - Limitations

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
(a)
				Chiropractic services are limited to:
(1) five
				(5) visits; and
(2) fourteen (14)
				procedures; per rolling twelve (12) month period.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 13 - BENEFITS AND MEDICAL POLICY › Rule 12 - Services Not Covered by CHIP › Section 12-1 - Noncovered services

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
The following services are not covered by CHIP:
(1) Services that are not covered by the
				Medicaid program.
(2) Services
				provided in a nursing facility.
(3)
				Services provided in an intermediate care facility for the mentally retarded
				(ICF/MR).
(4) Private duty
				nursing.
(5) Case management
				services for the following:
(A) Persons with
				HIV/AIDS.
(B) Pregnant
				women.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-1 - Use of Medicaid definitions

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Unless otherwise specifically defined in this title,
				  definitions for terminology used are the same as those used in the Medicaid
				  program and defined in 405 IAC 5-2.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-2 - Applicability

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
The definitions in this rule apply throughout this title
				  unless the context clearly indicates another meaning.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-3 - "Applicant" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
"Applicant" means the person for whom children's health
				  insurance program coverage is requested.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-4 - "Children's health insurance program" or "CHIP" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-2
Sec. 4.
"Children's health insurance program" or "CHIP" means the
				  program established by IC 12-17.6-2.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-5 - "Division" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 5.
"Division" means the division of family and children.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-6 - "Emergency" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 6.
"Emergency" means a medical condition that arises suddenly
				  and unexpectedly and manifests itself by acute symptoms of such severity,
				  including severe pain, that the absence of immediate medical attention could
				  reasonably be expected by a prudent layperson who possesses an average
				  knowledge of health and medicine to:
(1) place an individual's health in serious
				jeopardy;
(2) result in serious
				impairment to the individual's bodily functions; or
(3) result in serious dysfunction of a bodily
				organ or part of the individual.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-7 - "Hoosier Healthwise" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-15; IC 12-17.6
Sec. 7.
"Hoosier Healthwise" means:
(1) the Medicaid program for:
(A) children under nineteen (19) years of
				age;
(B) pregnant women;
				and
(C) certain low income families
				established by IC 12-15; and
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-8 - "Income" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 8.
"Income" means gross monthly income, including earned and
				  unearned income.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-9 - "Institution for mental diseases" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 9.
"Institution for mental diseases" means a hospital, nursing
				  facility, or other institution of more than sixteen (16) beds, that is
				  primarily engaged in providing diagnosis, treatment, or care of persons with
				  mental diseases, including medical attention, nursing care, and related
				  services.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-10 - "Local office" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 10.
"Local office" means the local office of the division of
				  family and children.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-11 - "Managed care organization" or "MCO" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6; IC 27-13-2
Sec. 11.
"Managed care organization" or "MCO" means a health
				  maintenance organization established under IC 27-13-2 or a health insurer
				  licensed by the Indiana department of insurance with whom the office has
				  entered into a contract to provide services to CHIP members.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-12 - "Member" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 12.
"Member" means an individual eligible and enrolled in the
				  children's health insurance program in either the PCCM or RBMC
				  component.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-13 - "Office" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-2-1
Sec. 13.
"Office" means the office of the children's health insurance
				  program established by IC 12-17.6-2-1.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-14 - "Parent" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 14.
"Parent" means the biological or adoptive parent living with
				  an unmarried applicant or member.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-15 - "Primary care case management" or "PCCM" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 15.
"Primary care case management" or "PCCM" means a delivery
				  system for health care in which members are linked to a PMP who contracts
				  directly with the office. The PMP is responsible for coordinating designated
				  covered services, and he or she, as well as all other providers rendering
				  services in this delivery system, is reimbursed on a fee-for-service
				  basis.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-16 - "Primary medical provider" or "PMP" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 16.
"Primary medical provider" or "PMP" means a physician who is
				  responsible for providing primary and preventive care, and for authorizing
				  other CHIP services as needed, and within the scope of his or her contract to
				  authorize, for CHIP members.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-17 - "Risk-based managed care" or "RBMC" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 17.
"Risk-based managed care" or "RBMC" means a fully capitated
				  prepayment plan where a managed care organization, under a contract with the
				  office, is at risk to arrange for and administer the provision of a
				  comprehensive set of covered services to CHIP members. Members are linked to a
				  PMP who contracts directly with the MCO.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-18 - "Secretary" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 18.
"Secretary" means the secretary of the family and social
				  services administration.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-19 - "Spouse" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 19.
"Spouse" means the legal husband or wife of an applicant or
				  member.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 1 - Definitions › Section 1-20 - "Third party" defined

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 20.
"Third party" means an insurer, individual, institution,
				  corporation, or public or private agency who is or may be liable to pay all or
				  part of the medical costs of injury, disease, or disability of a CHIP applicant
				  or member.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-1 - Choice of provider and use of health care card

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
(a) The
				member shall select a physician as PMP who is responsible for coordinating the
				member's health care needs. If a member fails to select a PMP within a
				reasonable time after being furnished a list of managed care providers by the
				office or its contractor, the office or its contractor shall assign a PMP to
				the member. A CHIP member may not receive services from a provider other than
				the designated PMP, except in the following cases:
(1) Medical emergencies.
(2) Where the designated managed care
				provider has authorized referral services in writing.
(3) Where specific covered services can be
				accessed through self-referral by members.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-2 - Filing of claims; filing date; waiver of limit; claim auditing; payment liability; third party payments

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
(a) The
				following claims must be originally filed with the fiscal agent contractor
				within twelve (12) months of the date of the provision of service:
(1) All provider claims for payment of
				services rendered to CHIP primary care case management members.
(2) All provider claims for payment of
				services rendered to CHIP risk-based managed care members if the service is
				carved out of a CHIP risk-based MCO contract.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-3 - Denial of claim payment; basis; discretion of director

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
The procedures set out in
				  405
				  IAC 1-1-4 for the denial of claims and the basis for
				  denial for Medicaid providers shall apply to the denial of claims to providers
				  under this title, except that any discretion exercised shall be that of the
				  director of the children's health insurance program, or his or her duly
				  authorized representative.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-4 - Overpayments to providers

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 4.
The procedures set out in
				  405 IAC
				  1-1-5 for recovery of overpayments from Medicaid
				  providers shall apply to the recovery of overpayments made to providers under
				  this title, except that any discretion exercised shall be that of the director
				  of the office of the children's health insurance program, or his or her duly
				  authorized representative.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-5 - Sanctions against providers; determination after investigation

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 5.
The procedures set out in
				  405
				  IAC 1-1-6 for sanctions against Medicaid providers and
				  determinations after investigation shall apply to providers under this title,
				  except that any discretion exercised shall be that of the director of the
				  office of the children's health insurance program, or his or her duly
				  authorized representative.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-6 - Subrogation of claims and third party liability

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 6.
(a) By
				applying for and accepting benefits under the CHIP program, a CHIP applicant or
				member or one legally authorized to act on behalf of an applicant or member
				shall be considered to have assigned to the office the member's rights to
				medical payments from any responsible third party.
(b) The office shall be subrogated to all
				claims by CHIP members against third parties to the extent of CHIP benefits
				paid by the office.
(c) The office,
				acting on behalf of the CHIP member, may initiate an action against a third
				party that is or may be liable for the injury, illness, or disease of a CHIP
				member when:
(1) the member has not done so;
				and
(2) the time remaining under
				the statute of limitations for the action is six (6) months or less.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-7 - Insurance information; release

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 7.
(a) As used
				in this section, "insurer" means any insurance company, health maintenance
				organization, prepaid health care delivery plan, self-funded employee benefit
				plan, pension fund, retirement system, group coverage plan, blanket coverage
				plan, franchise insurance coverage plan, individual coverage plan, family-type
				insurance coverage plan, Blue Cross/Blue Shield plan, group practice plan,
				individual practice plan, labor-management trusteed plan, union welfare plan,
				employer organization plan, employee benefit organization plan, governmental
				program plan, fraternal benefits society, Indiana Comprehensive Health
				Insurance Association plan, any plan or coverage required or provided by any
				statute, or similar entity that is:
(1) doing
				business in this state; and
(2)
				under an obligation to make payments for medical services as a result of an
				injury, illness, or disease suffered by a CHIP member.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 2 - General Provisions › Section 2-8 - Severability; governing provisions; effect of provision inconsistent with or invalid under federal law

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 8.
(a) If any
				provision in this title is or becomes inconsistent with any subsequently
				enacted amendment to the federal Social Security Act or any regulation
				promulgated thereunder, the amendment to the Social Security Act or the
				regulation promulgated thereunder shall govern until such time as this title is
				amended.
(b) If any provision in
				this document is or becomes inconsistent with any subsequently enacted act of
				the Indiana general assembly, the act of the Indiana general assembly shall
				govern until such time as this document is amended.
(c) If any provision in this title, or its
				application to any person, entity, or circumstance is held invalid, the
				invalidity does not affect other provisions or applications of this title that
				can be given effect without the invalid provision or application, and, to this
				end, the provisions in this title are severable.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 3 - Provider Enrollment › Section 3-1 - Provider enrollment

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
The procedures set out in 405 IAC 5-4 for enrollment of
				  providers in the Medicaid program shall apply to providers under this title who
				  render services covered by CHIP.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 3 - Provider Enrollment › Section 3-2 - Provider reciprocity

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-15; IC 12-17.6
Sec. 2.
(a) Providers
				that are enrolled in the Medicaid program are enrolled in CHIP as long as they
				comply with the provider enrollment and eligibility requirements for Medicaid
				under IC 12-15 and rules adopted under that article.
(b) A PMP who has filed an addendum to his or
				her Medicaid provider agreement to participate in PCCM is considered a PMP for
				CHIP PCCM.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 3 - Provider Enrollment › Section 3-3 - Risk-based managed care providers

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
(a) Providers
				who have contracts with CHIP risk-based MCOs must also file provider agreements
				with the office.
(b) Providers who
				have contracts with Medicaid risk-based MCOs and who have already filed
				provider agreements with the Medicaid contractor are not required to file an
				additional provider agreement to participate as a CHIP risk-based managed care
				provider.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 4 - Provider Appeals › Section 4-1 - Provider appeal procedures

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

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
The provisions of
				  405 IAC
				  1-5-1 and
				  405 IAC
				  1-5-2 concerning contents, retention, and disclosure
				  of records of Medicaid providers shall apply to providers of covered services
				  under this title.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 6 - Provider Reimbursement › Section 6-1 - Provider reimbursement; fee for service

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 1.
Except for reimbursement to providers who have contracts with
				  a CHIP risk-based MCO, the rates of reimbursement for the services and supplies
				  provided under this title shall be the same as those calculated for Medicaid
				  services and supplies under the Medicaid state plan, state statute, and rules
				  adopted by the secretary at 405 IAC 1. Reimbursement to providers who have
				  contracts with a CHIP risk-based MCO is governed by the contract between the
				  provider and the MCO as described in section 3 of this rule.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 6 - Provider Reimbursement › Section 6-2 - Primary care case management fee

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 2.
Primary medical providers in the CHIP primary care case
				  management program shall receive a per member per month case management fee
				  established by the office.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 1 - CHILDREN'S HEALTH INSURANCE PROGRAM GENERAL PROVISIONS; PROVIDERS › Rule 6 - Provider Reimbursement › Section 6-3 - Provider reimbursement; risk-based managed care

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6
Sec. 3.
Reimbursement to providers who have contracts with a CHIP
				  risk-based MCO is governed by the contract between the provider and the MCO.
				  Such a provider does not retain any independent right or duplicative right for
				  reimbursement from the office in addition to or in lieu of the reimbursement
				  that it would receive from the risk-based MCO.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 1 - General Requirements; Eligibility › Section 1-1 - Application process

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-5
Sec. 1.
(a) An
				application for CHIP shall be filed on the form prescribed by the family and
				social services administration.
(b)
				An application shall be made:
(1) at a local
				office in the county where the applicant resides;
(2) at an enrollment center that has entered
				into an agreement with the division to complete initial intake processing of
				Hoosier Healthwise applications; or
(3) by mail to the division.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 1 - General Requirements; Eligibility › Section 1-2 - Date of application

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-5
Sec. 2.
For purposes of determining the effective date of coverage,
				  the date of application is the date on which the signed application is received
				  by the division or the enrollment center.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 1 - General Requirements; Eligibility › Section 1-3 - Date of coverage

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-5
Sec. 3.
CHIP reimbursement for covered services is available
				  beginning on the first day of the month of application if both of the following
				  requirements are met:
(1) The applicant
				is determined eligible for CHIP.
(2) The applicable premium has been
				paid.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-1 - Age

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2
Sec. 1.
To be eligible to enroll in the program, an applicant must be
				  less than nineteen (19) years of age.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-2 - Income

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-15-2-14; IC 12-17.6-3-2
Sec. 2.
(a) To be
				eligible to enroll in the program, an applicant must be a member of a family
				with an annual income of:
(1) more than one
				hundred fifty percent (150%); and
(2) not more than two hundred fifty percent
				(250%); of the federal income poverty level.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-3 - Agreement to pay cost sharing

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2
Sec. 3.
(a) As a
				condition of eligibility for CHIP, at least one (1) of the following
				individuals must agree to pay the cost-sharing required by the office under
				this title:
(1) The parent, guardian, or
				caretaker of an applicant.
(2) The
				applicant, if the applicant is either:
(A)
				eighteen (18) years of age and not living with a parent, guardian, or
				caretaker; or
(B) married and
				living with his or her spouse.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-4 - Waiting periods for certain members

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-4-4
Sec. 4.
(a) Except as
				provided in subsection (b), an individual who was covered under a group health
				plan or under health insurance coverage as such terms are defined in 42 U.S.C.
				§300gg-91 is ineligible for CHIP for three (3) months from the effective
				date of termination of that coverage.
(b) This section does not apply if the
				individual's coverage under a group health plan or other health insurance
				coverage was terminated involuntarily, including, but not limited to, loss of
				coverage for the following reasons:
(1) The
				employer of the individual, parent, guardian, or other family member terminated
				the health plan coverage.
(2) The
				individual, parent, guardian, or other family member is no longer eligible for
				the plan due to termination of employment or a reduction in working
				hours.
(3) The individual is no
				longer covered under the plan due to the death or divorce of the parent,
				guardian, or other family member.
(4) The individual has reached the lifetime
				limit of benefits under the plan.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-5 - Eligibility

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-3
Sec. 5.
(a) Subject
				to subsection (b), an individual who is eligible for CHIP shall remain covered
				under the program until the earlier of the following:
(1) The child becomes financially
				ineligible.
(2) The end of the
				month in which child becomes nineteen (19) years of age.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 2 - Eligibility Requirements › Section 2-6 - Ineligibility

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2
Sec. 6.
(a)
				Notwithstanding any other provision of this article, an individual is not
				eligible for CHIP if any of the following apply:
(1) The individual is eligible for Medicaid,
				except for an individual who is subject to a spenddown under
				405 IAC
				2-3-10. An individual who is eligible for Medicaid
				with a spenddown may be eligible for CHIP if all other CHIP eligibility
				requirements are met.
(2) The
				individual is covered under a group health plan or under health insurance
				coverage as such terms are defined in 42 U.S.C. §300gg-91.
(3) The individual is eligible for health
				benefits coverage under a state health benefits plan on the basis of a family
				member's employment with a public agency in the state.
(4) The individual is an inmate of a public
				institution as defined in
				42 CFR
				435.1009.
(5) The individual is not a resident of
				Indiana.
(6) The individual is an
				undocumented alien.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 3 - Premiums › Section 3-1 - Responsibility for premium payment

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2; IC 12-17.6-4-3
Sec. 1.
(a) In order
				for an individual to receive benefits under CHIP, the individual's family must
				pay the monthly premium established by the office in accordance with
				42 U.S.C.
				1397 cc. The rates, approved by the Centers
				for Medicare & Medicaid Services, are set forth in Section 8 of the CHIP
				State Plan.
(b) Premiums must be
				paid monthly. Partial month payments will not be accepted.
Indiana Administrative Code › Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM › Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES › Rule 3 - Premiums › Section 3-2 - Nonpayment of premium

Current through July 10, 2024
Authority: IC 12-17.6-2-11
Affected: IC 12-17.6-3-2; IC 12-17.6-4-3
Sec. 2.
(a) When an
				applicant is determined eligible for CHIP, the applicant will be conditionally
				approved for CHIP pending payment of the premium. Coverage begins when the
				first premium is received by the office or its designated contractor. After the
				premium is received, coverage will be retroactive to the first day of the month
				of application.
(b) The parent or
				guardian must pay the first premium in order for the applicant to receive
				coverage under CHIP. If payment is not received by the due date specified in
				the second premium notice, the CHIP application will be denied.
(c) If any premium after the first premium is
				not paid by the due date, a maximum of sixty (60) days coverage without premium
				payment will be permitted before coverage is discontinued. When a member has
				been discontinued from the program due to non-payment of premiums, the family
				may reapply, but must pay all past due premiums and the premium for the current
				month in order to begin coverage. The member is not required to pay premiums
				for the time period between the date of discontinuance and the date that
				coverage resumes. Any services received by the member during the time period
				between the date of discontinuance and the date that coverage resumes are not
				covered by CHIP.
(d) A payment of
				less than the full amount due will not be accepted and will be considered
				nonpayment.