Sec. 13. (a) The office shall provide coverage for treatment of opioid or alcohol dependence that includes the following:
(1) Counseling services that address the psychological and behavioral aspects of addiction.
(2) When medically indicated, drug treatment involving agents approved by the federal Food and Drug Administration for the:
(A) treatment of opioid or alcohol dependence; or
(B) prevention of relapse to opioids or alcohol after detoxification.
(3) When determined by the treatment plan to be medically necessary, inpatient detoxification in accordance with the most current edition of the American Society of Addiction Medicine Patient Placement Criteria.
(b) The office shall:
(1) develop quality measures to ensure; and
(2) require a managed care organization to report;
compliance with the coverage required under subsection (a).
(c) The office may implement quality capitation withholding of reimbursement to ensure that a managed care organization has provided the coverage required under subsection (a).
(d) The office shall report the clinical use of the medications covered under this section to the mental health Medicaid quality advisory committee established by IC 12-15-35-51. The mental health Medicaid quality advisory committee may make recommendations to the office concerning this section.
As added by P.L.209-2015, SEC.11. Amended by P.L.8-2016, SEC.1; P.L.152-2017, SEC.6; P.L.179-2019, SEC.1.
Structure Indiana Code
12-15-5-1. Services and Supplies Provided; Exceptions
12-15-5-1-b. Services and Supplies Provided; Exceptions
12-15-5-2. Necessity of Federal Financial Participation
12-15-5-5. Office May Provide Drug Coverage; Requirements for Drug Coverage in Managed Care
12-15-5-7. Reimbursement for Doula Services; Rules
12-15-5-8. Maintenance Drugs; Prescriptions; Internet Based Pharmacies
12-15-5-9. Provision of Self-Directed Care Options
12-15-5-9.2. Coverage for Care Related to Cancer Clinical Trials
12-15-5-12. "Child"; Reimbursement for Specialized or Nonstandard Wheelchairs; Prior Authorization
12-15-5-14.5. Eligible Providers for Supervising Treatment Plan
12-15-5-15. Reimbursement for Students; Conditions; Policies
12-15-5-16. Reimbursement for Clinical Addiction Counselors; Clinical Supervision Requirement
12-15-5-18. Emergency Medical Service Provider Agencies; Reimbursement; Federal Approval
12-15-5-18.5. Reimbursement for Emergency Medical Services
12-15-5-20. "Intensive Outpatient Treatment Program"
12-15-5-21. Community Mental Health Centers; Governmental Units