Indiana Code
Chapter 44.5. Healthy Indiana Plan 2.0
12-15-44.5-3.5. Coverage; Vision and Dental; Preventative Care Services

Sec. 3.5. (a) The plan must include the following in a manner and to the extent determined by the office:
(1) Mental health care services.
(2) Inpatient hospital services.
(3) Prescription drug coverage, including coverage of a long acting, nonaddictive medication assistance treatment drug if the drug is being prescribed for the treatment of substance abuse.
(4) Emergency room services.
(5) Physician office services.
(6) Diagnostic services.
(7) Outpatient services, including therapy services.
(8) Comprehensive disease management.
(9) Home health services, including case management.
(10) Urgent care center services.
(11) Preventative care services.
(12) Family planning services:
(A) including contraceptives and sexually transmitted disease testing, as described in federal Medicaid law (42 U.S.C. 1396 et seq.); and
(B) not including abortion or abortifacients.
(13) Hospice services.
(14) Substance abuse services.
(15) Donated breast milk that meets requirements developed by the office of Medicaid policy and planning.
(16) A service determined by the secretary to be required by federal law as a benchmark service under the federal Patient Protection and Affordable Care Act.
(b) The plan may not permit treatment limitations or financial requirements on the coverage of mental health care services or substance abuse services if similar limitations or requirements are not imposed on the coverage of services for other medical or surgical conditions.
(c) The plan may provide vision services and dental services only to individuals who regularly make the required monthly contributions for the plan as set forth in section 4.7(c) of this chapter.
(d) The benefit package offered in the plan:
(1) must be benchmarked to a commercial health plan described in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
(2) may not include a benefit that is not present in at least one (1) of these commercial benchmark options.
(e) The office shall provide to an individual who participates in the plan a list of health care services that qualify as preventative care services for the age, gender, and preexisting conditions of the individual. The office shall consult with the federal Centers for Disease Control and Prevention for a list of recommended preventative care services.
(f) The plan shall, at no cost to the individual, provide payment of preventative care services described in 42 U.S.C. 300gg-13 for an individual who participates in the plan.
(g) The plan shall, at no cost to the individual, provide payments of not more than five hundred dollars ($500) per year for preventative care services not described in subsection (f). Any additional preventative care services covered under the plan and received by the individual during the year are subject to the deductible and payment requirements of the plan.
(h) The office shall apply to the United States Department of Health and Human Services for any amendment to the waiver necessary to implement the providing of the services or supplies described in subsection (a)(15). This subsection expires July 1, 2024.
As added by P.L.30-2016, SEC.28. Amended by P.L.180-2022(ss), SEC.16.

Structure Indiana Code

Indiana Code

Title 12. Human Services

Article 15. Medicaid

Chapter 44.5. Healthy Indiana Plan 2.0

12-15-44.5-1. "Phase Out Period"

12-15-44.5-2. "Plan"

12-15-44.5-2.3. "Preventative Care Services"

12-15-44.5-3. Plan Established; Eligibility; Oversight of Marketing; Promotion of Plan; Ensure Enrollment Distribution; Consumer Protection; Provider Participation; Exemptions

12-15-44.5-3.5. Coverage; Vision and Dental; Preventative Care Services

12-15-44.5-4. Scope of the Plan; Termination of Plan; Obligation of State; Report to Budget Committee

12-15-44.5-4.5. Required Health Care Account; Payments

12-15-44.5-4.7. Application; Pregnant Woman Exemption; Payments; Failure to Make Payments; State Contribution; Change in Health Plan

12-15-44.5-4.9. Eligibility Period; Renewal; Unused Share of Health Care Account Distribution

12-15-44.5-5. Managed Care Organization Responsibilities; Reimbursement; Cultural Competency Standards

12-15-44.5-5.5. Workforce Training and Job Search Program Referral

12-15-44.5-5.7. Nonemergency Services Received in an Emergency Room; Copayment

12-15-44.5-6. Phase Out Funds Deposited From Incremental Hospital Assessment Fees; Notice and Phase Out if Plan Is Terminated

12-15-44.5-7. Phase Out Trust Fund Established; Purpose of the Fund; Uses; Administration; Fund Is Considered a Trust Fund

12-15-44.5-8. Requirements for Use of Money Appropriated to the Fund; Requirements for Use of the Incremental Hospital Assessment Fee; Payment for Health Care Services; Administrative Costs; Profit

12-15-44.5-9. Rules

12-15-44.5-10. Benefits for Adult Group; Negotiation of Plan Limitations