Indiana Code
Chapter 1.3. Medicaid Waivers and Plan Amendments
12-15-1.3-6. Waiver Application for Prescription Drug Program for Low Income Senior Citizens; Conditions; Changes to Program Approved by Prescription Drug Advisory Committee; Limitation of State Expenditures; Implementation of Waiver

Sec. 6. (a) The office shall develop a federal Medicaid waiver application under which a prescription drug program may be established or implemented to provide access to prescription drugs for low income senior citizens.
(b) Before the office may submit an application for a federal Medicaid waiver that will affect the Indiana prescription drug program established under IC 12-10-16, the following must occur:
(1) The office shall submit the proposed Medicaid waiver to the prescription drug advisory committee.
(2) The prescription drug advisory committee must review, allow public comment on, and approve the proposed Medicaid waiver.
(c) A prescription drug program established or implemented by the office or a contractor of the office under this section may not limit access to prescription drugs for prescription drug program recipients, except under the following circumstances:
(1) Access may be limited to the extent that restrictions were in place in the Medicaid program on March 26, 2002.
(2) Except as provided by IC 12-15-35.5-3(b) and IC 12-15-35.5-3(c), access may be limited to:
(A) prevent:
(i) fraud;
(ii) abuse;
(iii) waste;
(iv) overutilization of prescription drugs; and
(v) inappropriate utilization of prescription drugs; or
(B) implement a disease management program.
IC 12-15-35.5-7 applies to a limit implemented under this subdivision.
(d) Changes to a prescription drug program that:
(1) is established or implemented by the office or a contractor of the office under this section; and
(2) uses money from the Indiana prescription drug account established under IC 4-12-8-2;
must be approved by the prescription drug advisory committee.
(e) The office shall apply to the United States Department of Health and Human Services for approval of any waiver necessary under the federal Medicaid program to provide access to prescription drugs for low income senior citizens.
(f) A Medicaid waiver developed under this section must limit a prescription drug program's state expenditures to funding appropriated to the Indiana prescription drug account established under IC 4-12-8-2 from the Indiana tobacco master settlement agreement fund.
(g) The office may not implement a waiver under this section until the office files an affidavit with the governor attesting that the federal waiver applied for under this section is in effect. The office shall file the affidavit under this subsection not later than five (5) days after the office is notified that the waiver is approved.
(h) If the office receives a waiver under this section from the United States Department of Health and Human Services and the governor receives the affidavit filed under subsection (g), the office shall implement the waiver not more than sixty (60) days after the governor receives the affidavit.
As added by P.L.220-2011, SEC.264.

Structure Indiana Code

Indiana Code

Title 12. Human Services

Article 15. Medicaid

Chapter 1.3. Medicaid Waivers and Plan Amendments

12-15-1.3-1. Waivers to Implement Intent of p.l.46-1995; Expiration of Section

12-15-1.3-2. Application of Waivers Under p.l.46-1995 to Certain Persons; Expiration of Section

12-15-1.3-3. Application of Waivers Under p.l.46-1995 to Certain Persons; Expiration of Section

12-15-1.3-4. Waivers to Implement p.l.257-1997

12-15-1.3-6. Waiver Application for Prescription Drug Program for Low Income Senior Citizens; Conditions; Changes to Program Approved by Prescription Drug Advisory Committee; Limitation of State Expenditures; Implementation of Waiver

12-15-1.3-13. Application for Waiver to Provide Presumptive Eligibility for Certain Pregnant Women; Implementation of Waiver; Rules

12-15-1.3-15. Waiver Amendment; Emergency Placement Priority

12-15-1.3-17.5. Budget Committee Review of State Plan Amendments, Waiver Requests, or Revisions

12-15-1.3-18. Reimbursement Rates for Federal Home and Community Based Services Program; Direct Care Staff Compensation; Procedures; Documentation

12-15-1.3-19. Application for Amendment to Family and Supports Services Waiver; Priority Status; Rules

12-15-1.3-20. State Plan Amendment for Reimbursement for Eligible Medicaid Rehabilitation Option Services; Required Commencement of a Plan of Treatment

12-15-1.3-21. Medicaid Rehabilitation Option Services; State Plan Amendment for Reimbursement in School Setting

12-15-1.3-22. Application for Amendment to Establish Long Term Care Partnership Program and Discontinue Long Term Care Program

12-15-1.3-22-b. Repealed

12-15-1.3-23. Application for Amendment to State Medicaid Plan

12-15-1.3-24. Application for Waiver to Provide Behavioral Health Services to Committed Offenders