Indiana Code
Chapter 44.5. Healthy Indiana Plan 2.0
12-15-44.5-5. Managed Care Organization Responsibilities; Reimbursement; Cultural Competency Standards

Sec. 5. (a) A managed care organization that contracts with the office to provide health coverage, dental coverage, or vision coverage to an individual who participates in the plan:
(1) is responsible for the claim processing for the coverage;
(2) shall reimburse providers at a rate that is not less than the rate established by the secretary. The rate set by the secretary must be based on a reimbursement formula that is:
(A) comparable to the federal Medicare reimbursement rate for the service provided by the provider; or
(B) one hundred thirty percent (130%) of the Medicaid reimbursement rate for a service that does not have a Medicare reimbursement rate; and
(3) may not deny coverage to an eligible individual who has been approved by the office to participate in the plan.
(b) A managed care organization that contracts with the office to provide health coverage under the plan must incorporate cultural competency standards established by the office. The standards must include standards for non-English speaking, minority, and disabled populations.
As added by P.L.213-2015, SEC.136. Amended by P.L.152-2017, SEC.34.

Structure Indiana Code