Indiana Code
Title 12. Human Services
Article 15. Medicaid

12-15-1-5. Agreement With Commissioner of the United States Social Security Administration; Eligibility Determinations for Aged, Blind, and Disabled; Authorization to Request Transition Change for Determinations - Sec. 5. (a) The office may enter into an agreement...

12-15-1-6. Agreement With Secretary of United States Department of Health and Human Services; Division of Administrative Costs - Sec. 6. The office may pay to the Secretary of...

12-15-1-7. Agreement With Secretary of United States Department of Health and Human Services; Eligibility Determinations After January 1, 1974 - Sec. 7. The agreement under section 5 of this chapter...

12-15-1-8. Receipt of Assistance in Adult Category Before January 1, 1974; Automatic Coverage - Sec. 8. An individual who receives assistance in one (1)...

12-15-1-9. Application to County Offices - Sec. 9. (a) If the state does not enter into...

12-15-1-10. Administrative Actions and Directions; Adoption of Procedures and Rules - Sec. 10. The secretary may: (1) take actions; (2) give...

12-15-1-11. Money Received From Recipient or Collected From Estate; Payment Into Medicaid Account; Apportionment - Sec. 11. (a) Money received from a Medicaid recipient or...

12-15-1-12. Attorney General; Appearance and Representation of State in Proceedings Affecting Property or Resources Upon Which State May Have Claim - Sec. 12. The attorney general may enter the appearance of...

12-15-1-13. Annual Effectiveness Evaluation - Sec. 13. The office shall conduct an annual evaluation of...

12-15-1-14. Effectiveness Evaluation; Annual Report to Legislative Council - Sec. 14. The office shall annually submit a report to...

12-15-1-15. Assignment, Enforcement, and Collection of Rights of Payment; Contracts for Administration of Program; Rules - Sec. 15. (a) The office shall administer the program of...

12-15-1-16. School Corporations; Enrollment in Medicaid Program; Sharing Reimbursable Costs; School Based Covered Services - Sec. 16. (a) Each: (1) school corporation; or (2) school...

12-15-1-17. Reimbursement From Parent for Health Services Provided to Child - Sec. 17. (a) The office shall, under procedures established by...

12-15-1-18. Use of Funds to Encourage Application and Enrollment of Minors - Sec. 18. The office shall use all funds that are...

12-15-1-19. Contracts With Community Entities - Sec. 19. The office may, in administering managed care programs,...

12-15-1-20. Implementation of Policy of Funds Following an Individual Transferring to Community Based Care - Sec. 20. (a) The office shall implement a policy that...

12-15-1-20.2. Computer System for Disproportionate Share Hospital Payment Program; Hci; Upl - Sec. 20.2. The office shall develop, maintain, and use a...

12-15-1-20.4. Suspension of Medicaid for Delinquent Child or Incarcerated Individual - Sec. 20.4. (a) If a Medicaid recipient is: (1) adjudicated...

12-15-1-21. Single Electronic Medicaid Eligibility Verification System - Sec. 21. Beginning January 1, 2012, the office and a...

12-15-1-21.2. Plan to Qualify Services for Exceptional Learners; Recovery of State Share of Cost of Services - Sec. 21.2. (a) The budget agency shall develop a plan...

12-15-1-21.7. Life Insurance Policy Treatment - Sec. 21.7. (a) To the extent allowed by federal law,...

12-15-1-22. Visit to Medicaid Provider Offices, Entities, or Facilities; Rules - Sec. 22. (a) The office shall visit a Medicaid provider's...

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 - Sec. 1. (a) The terms and conditions of any waivers...

12-15-1.3-2. Application of Waivers Under p.l.46-1995 to Certain Persons; Expiration of Section - Sec. 2. (a) Any part of P.L.46-1995 that requires a...

12-15-1.3-3. Application of Waivers Under p.l.46-1995 to Certain Persons; Expiration of Section - Sec. 3. (a) Any part of P.L.46-1995 that requires a...

12-15-1.3-4. Waivers to Implement p.l.257-1997 - Sec. 4. The division of family resources shall seek any...

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...

12-15-1.3-13. Application for Waiver to Provide Presumptive Eligibility for Certain Pregnant Women; Implementation of Waiver; Rules - Sec. 13. (a) The office shall apply to the United...

12-15-1.3-15. Waiver Amendment; Emergency Placement Priority - Sec. 15. (a) As used in this section, "division" refers...

12-15-1.3-17.5. Budget Committee Review of State Plan Amendments, Waiver Requests, or Revisions - Sec. 17.5. The office may not implement any Medicaid state...

12-15-1.3-18. Reimbursement Rates for Federal Home and Community Based Services Program; Direct Care Staff Compensation; Procedures; Documentation - Sec. 18. (a) The definitions set forth in 460 IAC...

12-15-1.3-19. Application for Amendment to Family and Supports Services Waiver; Priority Status; Rules - Sec. 19. (a) Before July 1, 2019, the office of...

12-15-1.3-20. State Plan Amendment for Reimbursement for Eligible Medicaid Rehabilitation Option Services; Required Commencement of a Plan of Treatment - Sec. 20. (a) Before December 1, 2021, the office shall...

12-15-1.3-21. Medicaid Rehabilitation Option Services; State Plan Amendment for Reimbursement in School Setting - Sec. 21. (a) As used in this section, "Medicaid rehabilitation...

12-15-1.3-22. Application for Amendment to Establish Long Term Care Partnership Program and Discontinue Long Term Care Program - Note: This version of IC 12-15-1.3-22 added by P.L.196-2021, SEC.2....

12-15-1.3-22-b. Repealed - Note: This version of IC 12-15-1.3-22, as added by P.L.207-2021,...

12-15-1.3-23. Application for Amendment to State Medicaid Plan - Sec. 23. Before December 1, 2021, the office shall apply...

12-15-1.3-24. Application for Waiver to Provide Behavioral Health Services to Committed Offenders - Sec. 24. (a) Notwithstanding any other law, the secretary, through...

Chapter 1.5. Voter Registration Services and Medicaid Applications

12-15-1.5-1. Purpose of Chapter - Sec. 1. This chapter prescribes the procedures to be followed...

12-15-1.5-1.5. Repealed - As added by P.L.4-1996, SEC.100. Repealed by P.L.81-2005, SEC.35.

12-15-1.5-2. Designated Individual - Sec. 2. A county director may designate an employee of...

12-15-1.5-3. County Director Responsible if No Designated Individual - Sec. 3. If a county director does not designate an...

12-15-1.5-4. Transmittal of Voter Registration Application or Declination Forms - Sec. 4. (a) This section does not apply to a...

12-15-1.5-5. Transmittal of Voter Registration Application or Declination Forms; Accepted During Final Five Days Before End of Registration Period - Sec. 5. (a) This section applies to a voter registration...

12-15-1.5-6. Methods for Transmittal of Applications or Declinations - Sec. 6. A county director or designated employee may use...

12-15-1.5-7. Hand Delivery - Sec. 7. If a county director or designated employee transmits...

12-15-1.5-8. Information to Be Provided to Division - Sec. 8. The election division shall provide the division of...

12-15-1.5-9. Confidentiality of Information - Sec. 9. Voter registration information received or maintained under this...

12-15-1.5-10. Notice Regarding Elections - Sec. 10. The co-directors of the election division shall notify...

12-15-1.5-11. Information to Be Provided to Election Division - Sec. 11. The division shall provide the co-directors of the...

Chapter 2. Eligibility

12-15-2-0.5. Provisions Not Limiting Health Care Assistance - Sec. 0.5. (a) This section applies to a person who...

12-15-2-1. "Federal Income Poverty Level" - Sec. 1. As used in this chapter, "federal income poverty...

12-15-2-2. Determination and Certification of Eligibility and Effective Date of Assistance - Sec. 2. The county office shall determine eligibility and shall...

12-15-2-3. Individuals Eligible; Receipt of Monthly Assistance Payments or Medical Services; Eligibility for Medical Services Under Aid to Dependent Children Assistance Category or Under State Supplemental Assistance Program for Aged, Blind, or Disab... - Sec. 3. An individual who: (1) is receiving monthly assistance...

12-15-2-3.5. Eligibility for Aged or Disabled - Sec. 3.5. An individual: (1) who is: (A) at least...

12-15-2-4. Individuals Eligible; Eligible Under Another Approved State Plan but for Plan Condition or Requirement Prohibited in Medicaid Program Under Social Security Act - Sec. 4. An individual who would be eligible for aid...

12-15-2-5. Individuals Eligible; Recipients of Old Age Assistance, Blind Assistance, or Disabled Assistance Payments as of December 31, 1973 - Sec. 5. An individual who: (1) was receiving assistance payments...

12-15-2-6.5. Medicaid Buy-in Program - Sec. 6.5. Notwithstanding section 6 of this chapter, beginning July...

12-15-2-7. Individuals Eligible; Children in Families Receiving Tanf Assistance - Sec. 7. A child in a family who receives TANF...

12-15-2-8. Individuals Eligible; Patients in Institutions for People With an Intellectual Disability or Medical Institutions - Sec. 8. An individual who: (1) has been found eligible...

12-15-2-9. Repealed - [Pre-1992 Revision Citation: 12-1-7-14.4(7).] As added by P.L.2-1992, SEC.9. Repealed...

12-15-2-10. Individuals Eligible; Long Term Care Program Participants - Sec. 10. An individual who: (1) is at least sixty-five...

12-15-2-11. Repealed - [Pre-1992 Revision Citation: 12-1-7-14.4(9).] As added by P.L.2-1992, SEC.9. Repealed...

12-15-2-12. Individuals Eligible; Qualified Children - Sec. 12. A qualified child (as defined in 42 U.S.C....

12-15-2-13. Pregnant Woman Eligibility; Eligibility Time Frame - Note: This version of section effective until 8-5-2022. See also...

12-15-2-13-b. Pregnant Woman Eligibility; Eligibility Time Frame - Note: This version of section effective 8-5-2022. See also preceding...

12-15-2-13.5. Eligibility for Women Screened and in Need of Treatment for Breast or Cervical Cancer - Sec. 13.5. (a) A woman: (1) who is not eligible...

12-15-2-14. Minors With Limited Family Income - Sec. 14. (a) An individual: (1) who is less than...

12-15-2-15. Repealed - [Pre-1992 Revision Citations: 12-1-7-14.4(13); 12-1-7-56 part.] As added by P.L.2-1992,...

12-15-2-15.5. Repealed - As added by P.L.46-1995, SEC.35. Amended by P.L.24-1997, SEC.46; P.L.119-1997,...

12-15-2-15.6. Repealed - As added by P.L.58-1998, SEC.6. Repealed by P.L.1-2001, SEC.51.

12-15-2-15.7. Repealed - As added by P.L.58-1998, SEC.7. Amended by P.L.273-1999, SEC.172. Repealed...

12-15-2-15.8. Continuous Eligibility to Three Years of Age - Sec. 15.8. After an individual who is less than three...

12-15-2-16. Eligibility of Individuals Under 18 Years of Age - Sec. 16. An individual: (1) who is less than eighteen...

12-15-2-16.2. Eligibility of Foster Children; Enrollment Assistance - Sec. 16.2. (a) An individual who: (1) is: (A) at...

12-15-2-16.5. Automatic Assignment to Medical Support and Third Party Medical Payments; Application - Sec. 16.5. (a) An individual who is applying for Medicaid...

12-15-2-17. Exclusion of Resources in Determining Eligibility for Medicaid; Conditions - Sec. 17. (a) This section applies beginning the later of...

12-15-2-17.5. Income Exclusion in Determining Eligibility - Sec. 17.5. (a) This section applies beginning on the date...

12-15-2-17.7. Census Work Income Exclusion in Determining Eligibility - Sec. 17.7. (a) This section applies beginning on the date...

12-15-2-18. Financial Resources; State or Federal Higher Education Awards - Sec. 18. Except as provided by federal law, if an...

12-15-2-19. Acquisition of Property, Income, or Resources; Notification of County Office; Alteration or Cancellation of Assistance; Recovery of Excess Assistance - Sec. 19. (a) If, while receiving Medicaid, a recipient becomes...

12-15-2-20. Conviction of Certain Offenses and Ineligibility for Medicaid Assistance Time Frame; Removal for Medicaid Fraud; Appeal; Rules - Sec. 20. (a) A person convicted of an offense under...

12-15-2-21. Ineligibility Due to Noncompliance - Sec. 21. Notwithstanding any other provision of this article, a...

12-15-2-22. Determination of Eligibility; Certain Equity Value in Motor Vehicle May Not Be Considered - Sec. 22. When the office applies a resource standard to...

12-15-2-23. Look Back; Exemption for Certain Contributions - Sec. 23. (a) This section is effective beginning October 1,...

12-15-2-23.5. Implementation of Federal Deficit Reduction Act of 2005 - Sec. 23.5. (a) This section is effective beginning October 1,...

12-15-2-24. Eligibility; Community Spouse Resource Requirements - Sec. 24. (a) This section applies to determining eligibility for...

12-15-2-25. Eligibility; Retention of Income to Support Community Spouse - Sec. 25. (a) This section applies to an individual who:...

12-15-2-26. Eligibility for Medicare Beneficiaries - Sec. 26. (a) This section applies beginning the later of...

Chapter 2.2. Repealed - Repealed by P.L.1-2001, SEC.51.

Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer

12-15-2.3-1. Applicability of Chapter - Sec. 1. This chapter applies to a woman who is...

12-15-2.3-2. "Qualified Entity" - Sec. 2. As used in this chapter, "qualified entity" means...

12-15-2.3-3. Qualified Entities to Establish Eligibility - Sec. 3. A qualified entity may establish the presumptive eligibility...

12-15-2.3-4. Identity of Qualified Entities - Sec. 4. The office shall consider the following to be...

12-15-2.3-5. Qualified Entities Provided With Application Forms and Information - Sec. 5. The office shall provide each qualified entity with...

12-15-2.3-6. Period During Which Services Provided - Sec. 6. The office shall provide Medicaid services to a...

12-15-2.3-7. Woman's Eligibility Determined by Qualified Entity - Sec. 7. A woman described in section 1 of this...

12-15-2.3-8. Actions Taken After Establishment of Eligibility - Sec. 8. A qualified entity that determines that a woman...

12-15-2.3-9. Completion of Application - Sec. 9. If a woman described in section 1 of...

12-15-2.3-11. Reimbursement for Care During Presumptive Eligibility - Sec. 11. If a woman described in section 1 of...

12-15-2.3-12. Rules - Sec. 12. The office shall adopt rules under IC 4-22-2...

12-15-2.3-13. Annual Appropriation to Provide Services - Sec. 13. There is annually appropriated to the office of...

Chapter 2.5. Eligibility of Refugees, Lawful Permanent Residents, and Illegal Aliens for Medicaid Assistance

12-15-2.5-1. Refugees - Sec. 1. A person who is classified as a refugee...

12-15-2.5-2. Lawful Permanent Residents; Exceptions - Sec. 2. (a) Except as provided in subsection (b), a...

12-15-2.5-3. Illegal Aliens - Sec. 3. A person who is in the United States...

12-15-2.5-4. Child Born in United States - Sec. 4. A child who: (1) is born in the...

12-15-2.5-5. Violation of Federal Law - Sec. 5. Any provision of this chapter that violates a...

Chapter 3. Ineligibility; Financial Limitations

12-15-3-0.5. Applicability of Chapter - Sec. 0.5. This chapter does not apply to an individual...

12-15-3-1.5. Eligibility of Aged, Blind, Disabled; Spouse Assets - Sec. 1.5. (a) This section applies beginning the later of...

12-15-3-4. Repealed - [Pre-1992 Revision Citation: 12-1-7-18.5(d).] As added by P.L.2-1992, SEC.9. Repealed...

12-15-3-5. Limitation on Total Cash Value of Money, Stocks, Bonds, and Life Insurance Owned by Applicants or Recipients Not Described in Ic 12-15-3-1 - Sec. 5. Except as provided in section 7 of this...

12-15-3-6. Purchase of Qualified Long Term Care Insurance Policy; Computation Under This Chapter - Sec. 6. A computation under this chapter concerning an individual...

12-15-3-7. Effect of Certain Applicants' Assignment of Life Insurance Benefits to State on Applicants' Medicaid Eligibility - Sec. 7. (a) As used in this section, "value" includes...

12-15-3-8. 529 Education Savings Plan - Sec. 8. Except as otherwise provided under federal law, the...

Chapter 4. Application for Assistance

12-15-4-1. Applying for Medicaid; Enrollment Centers; Duties of Authorized Workers; Final Determination; Submitting Application - Sec. 1. (a) An application or a request for Medicaid...

12-15-4-2. Tanf Assistance Recipients; Necessity of Making Medicaid Application - Sec. 2. An individual who is receiving monthly assistance payments...

12-15-4-2.5. Department of Correction and Sheriff as Medicaid Authorized Representative - Sec. 2.5. (a) The department of correction is, for an...

12-15-4-3. Records of Applicants' Circumstances and Other Information - Sec. 3. Whenever the county office receives an application or...

12-15-4-4. Grant of Assistance; Eligibility Requirements - Sec. 4. Medicaid shall be granted to an applicant who...

12-15-4-5. Outreach Strategies - Sec. 5. The office shall implement outreach strategies that build...

Chapter 5. Services Provided

12-15-5-1. Services and Supplies Provided; Exceptions - Note: This version of section effective until 8-5-2022. See also...

12-15-5-1-b. Services and Supplies Provided; Exceptions - Note: This version of section effective 8-5-2022. See also preceding...

12-15-5-2. Necessity of Federal Financial Participation - Sec. 2. Medicaid does not include a service or supply...

12-15-5-3. Repealed - As added by P.L.46-1995, SEC.39. Repealed by P.L.161-2007, SEC.40.

12-15-5-5. Office May Provide Drug Coverage; Requirements for Drug Coverage in Managed Care - Sec. 5. (a) The office may provide a prescription drug...

12-15-5-6. Repealed - As added by P.L.107-2002, SEC.10. Repealed by P.L.229-2011, SEC.272.

12-15-5-7. Reimbursement for Doula Services; Rules - Sec. 7. (a) Pregnancy services provided under this article may...

12-15-5-8. Maintenance Drugs; Prescriptions; Internet Based Pharmacies - Sec. 8. (a) As used in this section, "maintenance drug"...

12-15-5-9. Provision of Self-Directed Care Options - Sec. 9. The office shall have self-directed care options and...

12-15-5-9.2. Coverage for Care Related to Cancer Clinical Trials - Sec. 9.2. (a) As used in this section, "care method"...

12-15-5-10. Care Available for Individuals Receiving Medicaid Waiver Services; Eligibility Not Affected by Receipt of Services - Sec. 10. (a) An individual who receives Medicaid services through...

12-15-5-11. "Telehealth Services"; Reimbursement; Prohibition on Distance Restrictions and Location Requirements; Waiver of Confidentiality; Community Mental Health Centers; Rules - Sec. 11. (a) As used in this section, "telehealth services"...

12-15-5-12. "Child"; Reimbursement for Specialized or Nonstandard Wheelchairs; Prior Authorization - Sec. 12. (a) As used in this section, "child" includes...

12-15-5-13. Coverage for Treatment of Opioid or Alcohol Dependence; Office Requirements; Report Use of Medications to Committee - Sec. 13. (a) The office shall provide coverage for treatment...

12-15-5-14. Reimbursement for Services Provided by Advanced Practice Registered Nurse; Eligible Provider - Sec. 14. (a) As used in this section, "advanced practice...

12-15-5-14.5. Eligible Providers for Supervising Treatment Plan - Sec. 14.5. (a) The office shall include a: (1) licensed...

12-15-5-15. Reimbursement for Students; Conditions; Policies - Sec. 15. (a) This section is effective upon approval by...

12-15-5-16. Reimbursement for Clinical Addiction Counselors; Clinical Supervision Requirement - Sec. 16. (a) This section is effective upon approval by...

12-15-5-17.5. Report on Implementation of Risk Based Managed Care Program; Request for Proposal; Budget Committee Review - Sec. 17.5. (a) The office shall report on its progress...

12-15-5-18. Emergency Medical Service Provider Agencies; Reimbursement; Federal Approval - Sec. 18. (a) This section applies to an emergency medical...

12-15-5-18.2. Mobile Integrated Healthcare Program; Authority to Apply for a Waiver and for Federal Funding - Sec. 18.2. The office of the secretary may apply to...

12-15-5-18.5. Reimbursement for Emergency Medical Services - Sec. 18.5. (a) This section applies to an emergency medical...

12-15-5-18.7. Reimbursement for Emergency Medical Services Provider Organizations; Waiver or State Plan Amendment - Sec. 18.7. (a) This section applies to an emergency medical...

12-15-5-19. Medicaid Rehabilitation Option Service; Review; Determination on Services; Report; Notification; Contract With Community Mental Health Center - Sec. 19. (a) Not later than one (1) year from...

12-15-5-20. "Intensive Outpatient Treatment Program" - Sec. 20. (a) As used in this section, "intensive outpatient...

12-15-5-21. Community Mental Health Centers; Governmental Units - Sec. 21. For purposes of required nonfederal share medical assistance...

Chapter 6. Individual Contributions

12-15-6-1. Enrollment Fees, Premiums, or Other Charges as Condition of Eligibility - Sec. 1. Except as provided in section 2 of this...

12-15-6-2. Copayment; Application for Certain Services - Sec. 2. The office shall apply a copayment for certain...

12-15-6-3. Copayment; Time for Making - Sec. 3. (a) A copayment shall be made by the...

12-15-6-4. Services to Which Copayment Applies; Exceptions - Sec. 4. A copayment applies to all services except the...

12-15-6-5. Provider to Charge Maximum Copayment Allowable - Sec. 5. A provider shall charge the maximum copayment allowable...

12-15-6-6. Repealed - [Pre-1992 Revision Citation: 12-1-7-16(c) part.] As added by P.L.2-1992, SEC.9....

12-15-6-7. Repealed - [Pre-1992 Revision Citation: 12-1-7-16(d).] As added by P.L.2-1992, SEC.9. Repealed...

Chapter 7. Personal Allowance

12-15-7-1. Persons Entitled to Allowance; Receipt of Care in Hospital or Nursing Home; Amount of Allowance - Sec. 1. Subject to section 2 of this chapter, an...

12-15-7-2. Amount of Allowance; Permissible Range - Sec. 2. Fifty-two dollars ($52) monthly may be exempt from...

12-15-7-3. Use of Allowance - Sec. 3. The money described in section 2 of this...

12-15-7-4. Individuals Employed as Part of Habilitation Plan or Working in Sheltered Workshop or Day Activity Center; Amount of Allowance - Sec. 4. The personal allowance for one (1) month described...

12-15-7-5. Retention of Amount Equal to Individual's State and Local Income Tax Liability; Monthly Limitation; Exemption From Income Eligibility Consideration; Use of Amount Retained - Sec. 5. (a) In addition to the amount that may...

12-15-7-6. Payment Calculation for Federal Ssi Recipient; Exemption From Income Eligibility Consideration - Sec. 6. (a) If an individual described in section 1...

Chapter 8. Liens

12-15-8-1. Recipient Asserting Claim Against Another Person for Injury or Illness Resulting From Negligence or Act of Other Person; Lien Against Other Person; Amount of Lien - Sec. 1. Whenever: (1) the office pays medical expenses for...

12-15-8-2. Recipient Asserting Claim Against Insurer; Lien for Medical Expenses Paid or for Medical Services Rendered; Amount - Sec. 2. Whenever: (1) the office pays for medical expenses...

12-15-8-3. Perfection of Lien - Sec. 3. A lien under this chapter is not effective...

12-15-8-4. Notice; Person for Whom Medical Expenses Paid, Insurance Carrier, and Attorney for Injured or Diseased Person - Sec. 4. In addition to the requirements of section 3...

12-15-8-5. Itemized Statement of Medical Expenses Paid; Sending Statement to Person for Whom Expenses Paid and to Attorney for Injured or Diseased Person; Time - Sec. 5. Not more than twenty-one (21) days after the...

12-15-8-6. Actions on Behalf of Injured, Ill, or Diseased Person and to Perfect Lien; Conditions - Sec. 6. (a) The office may, on behalf of an...

12-15-8-7. Recovery Under Lien; Payment of Pro Rata Share of Costs and Expenses Incurred in Asserting Claim - Sec. 7. If the office recovers money under a lien...

12-15-8-8. Attorney's Fees - Sec. 8. (a) This section does not apply to a...

12-15-8-9. Waiver of Right to Lien - Sec. 9. (a) The office may waive the office's right...

Chapter 8.5. Liens on Real Property of Medicaid Recipients

12-15-8.5-1. "Medical Institution" - Sec. 1. As used in this chapter, "medical institution" means...

12-15-8.5-2. Lien for Medicaid Expenditures - Sec. 2. (a) When the office, in accordance with 42...

12-15-8.5-3. Limitations on Lien - Sec. 3. The office may not obtain a lien under...

12-15-8.5-4. Notice Required Before Lien Obtained - Sec. 4. Before obtaining a lien on a Medicaid recipient's...

12-15-8.5-5. Notice Required to Obtain Lien; Filing and Distribution of Notice - Sec. 5. (a) The office shall obtain a lien under...

12-15-8.5-6. Effect of Notice of Lien; Duration of Lien - Sec. 6. (a) Beginning on the date on which a...

12-15-8.5-7. Lien Foreclosure; Automatic Expiration of Lien - Sec. 7. The office may bring proceedings in foreclosure on...

12-15-8.5-8. Limitations on Enforcement of Lien - Sec. 8. The office may not enforce a lien against...

12-15-8.5-9. Release of Lien; Waiver of Filing Fee - Sec. 9. (a) The office shall release a lien imposed...

12-15-8.5-10. Repealed - As added by P.L.178-2002, SEC.81. Repealed by P.L.224-2003, SEC.80.

12-15-8.5-11. Repealed - As added by P.L.178-2002, SEC.81. Repealed by P.L.224-2003, SEC.80.

12-15-8.5-12. Conditions Under Which Lien Is Void - Sec. 12. (a) This section applies: (1) after the death...

12-15-8.5-13. Contracting With Attorney; Attorney's Fees - Sec. 13. (a) The office may contract with an attorney...

Chapter 9. Death and Funeral Expenses; Claims Against an Estate

12-15-9-0.5. "Estate" and "Nonprobate Transfer" - Sec. 0.5. (a) As used in this chapter, "estate" includes:...

12-15-9-0.6. Claim Against Assets Transferred by Nonprobate Transfer; Time Limit - Sec. 0.6. (a) This section applies to the enforcement of...

12-15-9-0.7. Repealed - As added by P.L.178-2002, SEC.84. Amended by P.L.224-2003, SEC.79. Repealed...

12-15-9-0.8. Limitation on Definition of Estate - Sec. 0.8. Any nonprobate assets: (1) that the office determined...

12-15-9-1. Amount of Claim; Preference - Sec. 1. Upon the death of a Medicaid recipient, the...

12-15-9-2. Property Exempt From Enforcement - Sec. 2. A claim may not be enforced against the...

12-15-9-5. Claims Against the Estate of a Recipient's Spouse Prohibited - Sec. 5. The office may not file a claim against...

12-15-9-6. Waiver in Cases of Undue Hardship; Rules - Sec. 6. Notwithstanding sections 2 and 5 of this chapter,...

12-15-9-7. Reimbursement; Proceeds of Annuity Contracts - Sec. 7. A person receiving beneficiary payments from an annuity...

Chapter 10. Selection of Provider

12-15-10-1. Repealed - [Pre-1992 Revision Citation: 12-1-7-14.8 part.] As added by P.L.2-1992, SEC.9....

12-15-10-2. Licensed or Otherwise Qualified Providers; Participation in Medicaid Program - Sec. 2. If a provider is required to be licensed...

12-15-10-3. Individuals Required to Furnish Providers With Medicaid Information; Rules - Sec. 3. The office may by rule require the individual...

12-15-10-4. Furnishing Providers With Information; Forms - Sec. 4. The office shall provide forms for providing information...

12-15-10-5. Documentation of Medicaid Provided; Rules - Sec. 5. The office may by rule require a provider...

12-15-10-6. Selection of Primary Dental Provider Encouraged - Sec. 6. The office shall encourage the parent of a...

Chapter 11. Provider Agreements and Competitive Bidding

12-15-11-1. Physician Services Defined - Sec. 1. (a) As used in this chapter, "physician services"...

12-15-11-2. Provider Agreement; Filing - Sec. 2. A provider desiring to participate in the Medicaid...

12-15-11-2.5. Surety Bond Requirement for Certain Transportation Providers; Requirements; Revocation or Denial of Provider Agreement for Failure to Comply; Demonstration of Compliance; Refund - Sec. 2.5. (a) As used in this section, "transportation provider"...

12-15-11-3. Provider Agreement Requirements - Sec. 3. A provider agreement must do the following: (1)...

12-15-11-4. Provider Agreement to Provide Physician Services; Site Visit for Moderate or High Categorical Risk Designees - Sec. 4. (a) A provider desiring to participate in the...

12-15-11-5. Compliance With Enrollment Requirements; Centralized Credentials Verification Organization - Sec. 5. (a) A provider who participates in the Medicaid...

12-15-11-6. Prohibition on Exclusion of Medicaid Provider From Participation in Medicaid and Other Networks - Sec. 6. (a) After a provider signs a provider agreement...

12-15-11-7. Competitive Bids; Services and Items for Which Bids May Be Sought - Sec. 7. The office may seek competitive bids for the...

12-15-11-8. Use of Provider Identification Number; Prohibition on Limiting Claims for Primary Care Services - Sec. 8. (a) A community mental health center may use...

12-15-11-9. Implementation of Centralized Credentials Verification Organization; Requirements; Prohibition on Requiring Additional Credentialing; Managed Care Organizations; Administrative Review; Rules - Sec. 9. (a) The office shall implement a centralized credentials...

Chapter 11.5. Lake County Disproportionate Share Hospitals

12-15-11.5-0.5. Nonapplicability to Certain Managed Care Organizations - Sec. 0.5. This chapter does not apply to a managed...

12-15-11.5-1. "Hospital" - Sec. 1. As used in this chapter, "hospital" refers to...

12-15-11.5-2. Hospital as Contracted Provider to Eligible Individuals - Sec. 2. The office's managed care organization shall regard a...

12-15-11.5-3. Repealed - As added by P.L.142-2000, SEC.2. Amended by P.L.141-2001, SEC.3; P.L.122-2002,...

12-15-11.5-3.1. Repealed - As added by P.L.145-2005, SEC.1. Repealed by P.L.1-2007, SEC.248.

12-15-11.5-4. Repealed - As added by P.L.142-2000, SEC.2. Repealed by P.L.1-2002, SEC.172.

12-15-11.5-4.1. Repealed - As added by P.L.141-2001, SEC.4. Amended by P.L.122-2002, SEC.2. Repealed...

12-15-11.5-4.2. Repealed - As added by P.L.145-2005, SEC.2. Repealed by P.L.1-2007, SEC.248.

12-15-11.5-5. Repealed - As added by P.L.142-2000, SEC.2. Repealed by P.L.1-2002, SEC.172.

12-15-11.5-6. Claim for Reimbursement Treated as Disputed Claim - Sec. 6. A claim for reimbursement for services shall be...

12-15-11.5-7. Conclusion of Appeal - Sec. 7. The office's managed care organization must conclude an...

12-15-11.5-8. Dispute Resolution Procedure Requirements - Sec. 8. (a) A contract entered into by a hospital...

12-15-11.5-9. Arbitration Process for Dispute Resolution Between Hospital and Managed Care Organization - Sec. 9. The arbitration process described in section 8 of...

12-15-11.5-10. Arbitration of Disputed Claims - Sec. 10. A hospital and the managed care organization of...

Chapter 12. Managed Care

12-15-12-0.3. "Emergency Medical Condition" - Sec. 0.3. As used in this chapter, "emergency medical condition"...

12-15-12-0.5. "Emergency Services" - Sec. 0.5. As used in this chapter, "emergency services" means...

12-15-12-0.7. "Post-Stabilization Care Services" - Sec. 0.7. As used in this chapter, "post-stabilization care services"...

12-15-12-0.9. Applicability; Medicaid Law Controlling Over Conflicting Insurance Law - Sec. 0.9. (a) This section applies only with respect to...

12-15-12-1. Providers From Whom Recipients May Obtain Services Other Than Physician Services; Exceptions - Sec. 1. Except as provided in sections 6, 7, and...

12-15-12-2. Providers From Whom Recipients May Receive Physician Services; Exceptions - Sec. 2. Except as provided in sections 8 and 9...

12-15-12-3. List of Managed Care Providers Furnished Recipient; Providers Included; Exception - Sec. 3. Except as provided in section 9 of this...

12-15-12-4. Failure by Recipient to Select Managed Care Provider Within Reasonable Time; Assignment by Office; Exception - Sec. 4. Except as provided in section 9 of this...

12-15-12-4.5. Managed Care Prescription Drug Program Requirements - Sec. 4.5. A managed care provider's contract or provider agreement...

12-15-12-5. Circumstances Permitting Recipient to Receive Physician Services From Provider Other Than Managed Care Provider; Exceptions - Sec. 5. Except as provided in sections 6 and 7...

12-15-12-6. Admission to Hospital by Physician Other Than Managed Care Provider; Notification of Managed Care Provider; Services for Which Payment Made - Sec. 6. (a) A Medicaid recipient may be admitted to...

12-15-12-7. Providers From Whom Recipients May Obtain Eye Care Services Other Than Surgical Services - Sec. 7. A Medicaid recipient may obtain eye care services,...

12-15-12-8. Providers From Whom Recipients May Obtain Foot Care Services - Sec. 8. A Medicaid recipient may obtain foot care services...

12-15-12-9. Providers From Whom Recipients May Obtain Psychiatric Services - Sec. 9. A Medicaid recipient may obtain psychiatric services from...

12-15-12-10. Selection or Assignment of Managed Care Provider; Selection of New Provider; Exception - Sec. 10. (a) A Medicaid recipient who has selected or...

12-15-12-11. Waiver From Department of Health and Human Services; Implementation of Chapter - Sec. 11. The office shall seek the necessary waiver under...

12-15-12-12. Payments to Providers - Sec. 12. For a managed care program or demonstration project...

12-15-12-13. Permitted Forms - Sec. 13. (a) The office and an entity with which...

12-15-12-14. Repealed - As added by P.L.291-2001, SEC.160. Amended by P.L.170-2002, SEC.81; P.L.107-2002,...

12-15-12-15. Coverage for Emergency Services - Sec. 15. A managed care organization shall: (1) cover and...

12-15-12-17. Coverage for Post-Stabilization Care Services - Sec. 17. (a) This section applies to post-stabilization care services...

12-15-12-18. Payment for Emergency Services - Sec. 18. (a) Except as provided in subsection (b), this...

12-15-12-18.5. Reimbursement for Emergency Medical Services Provider Organizations; Implementation - Sec. 18.5. (a) Except as provided in subsection (b), this...

12-15-12-19. Repealed - As added by P.L.291-2001, SEC.161. Amended by P.L.66-2002, SEC.2; P.L.212-2003,...

12-15-12-20. Child Lead Poisoning Screening - Sec. 20. The office shall develop the following: (1) A...

12-15-12-21. Accreditation - Sec. 21. (a) Not later than January 1, 2011, the...

12-15-12-22. Accepting, Receiving, and Processing Electronic Claims - Sec. 22. A: (1) managed care organization that has a...

12-15-12-23. Psychiatrist Practicing in Community Mental Health Center - Sec. 23. A managed care organization may not require a...

Chapter 13. Provider Payment; General

12-15-13-0.1. Application of Certain Amendments to Chapter - Sec. 0.1. The amendments made to this chapter apply as...

12-15-13-0.4. "Office" - Sec. 0.4. As used in this chapter, "office" includes the...

12-15-13-0.5. "Clean Claim" - Sec. 0.5. (a) Except as provided in section 0.6 of...

12-15-13-0.6. "Clean Claim" for Purposes of Ic 12-15-14 - Sec. 0.6. (a) "Clean claim", as the term applies to...

12-15-13-0.7. Addition, Deletion, or Modification of Locators - Sec. 0.7. The office may adopt rules under IC 4-22-2...

12-15-13-1. Payment, Denial, or Suspension of Claims Submitted by Nursing Facilities; Time; Notice of Suspension or Denial - Sec. 1. (a) This section applies only to claims submitted...

12-15-13-1.5. Payment of Interest on Claims Submitted by Nursing Facilities - Sec. 1.5. (a) This section applies only to claims submitted...

12-15-13-1.6. Payment, Denial, or Suspension of Claims; Notice of Suspension or Denial - Sec. 1.6. (a) This section does not apply to claims...

12-15-13-1.7. Timing of Payment or Denial of Claims; Payment of Interest - Sec. 1.7. (a) This section does not apply to claims...

12-15-13-2. Payments to Providers; Requirements; Federal Law or Regulations Specifying Reimbursement Criteria - Sec. 2. (a) Except as provided in IC 12-15-14 and...

12-15-13-3. Repealed - As added by P.L.152-1995, SEC.10. Amended by P.L.107-1996, SEC.9; P.L.257-1996,...

12-15-13-3.5. Recovery of Overpayment to Noninstitutional Provider; Appeal - Sec. 3.5. (a) As used in this section, "noninstitutional provider"...

12-15-13-4. Recovery of Overpayment to Institutional Provider; Appeal - Sec. 4. (a) As used in this section, "institutional provider"...

12-15-13-5. Repealed - As added by P.L.213-2015, SEC.128. Repealed by P.L.12-2016, SEC.9.

12-15-13-6. Notices or Bulletins; Timing; Noncompliance - Sec. 6. (a) Except as provided by IC 12-15-35-50, a...

12-15-13-7. Permitted Forms - Sec. 7. (a) The office and an entity with which...

12-15-13-7.2. Use of Diagnostic or Procedure Codes - Sec. 7.2. (a) As used in this section, "provider" has...

12-15-13-9. Reimbursement for Providers at Federally Qualified Health Centers and Rural Health Clinics - Sec. 9. (a) Subject to subsection (b), the office shall...

Chapter 13.5. Medicaid Recovery Audits

12-15-13.5-1. "Office" - Sec. 1. As used in this chapter, "office" refers to...

12-15-13.5-2. Recovery Audit; Contract; Performance - Sec. 2. (a) The office and a managed care organization...

12-15-13.5-3. Audit Period - Sec. 3. A recovery audit under this chapter must include...

12-15-13.5-4. Annual Provider Education - Sec. 4. The managed care organization or the auditing entity,...

12-15-13.5-6. Recovery Audits; Development, Review, and Certification of Plans of Treatment - Sec. 6. (a) Subject to subsection (b), a recovery audit...

Chapter 13.6. Audit of Prescription Drug Cost Sharing

12-15-13.6-1. Audit of Medicaid Prescription Drug Cost Sharing - Sec. 1. Once every three (3) state fiscal years: (1)...

12-15-13.6-2. Look Back Period - Sec. 2. For an audit conducted under section 1 of...

12-15-13.6-3. Audit Requirements - Sec. 3. An audit conducted under section 1 of this...

12-15-13.6-4. Audit Results - Sec. 4. The results of an audit conducted under section...

Chapter 14. Payment to Nursing Facilities

12-15-14-1. Payment Criteria; Uniformity - Sec. 1. (a) Except as provided in subsection (b), payment...

12-15-14-2. Payment of Nursing Facilities Under 42 u.s.c. 1396a(a)(13)(a); Non-Medicaid Revenue Information; Complete Balance Sheet Data - Sec. 2. (a) Payment of nursing facility services shall be...

12-15-14-2.5. Prohibition on Reimbursement for Reservation of Bed for Hospitalized or Otherwise Absent Medicaid Recipient - Sec. 2.5. (a) The office may not reimburse a nursing...

12-15-14-3. Repealed - As added by P.L.152-1995, SEC.12. Repealed by P.L.2-1997, SEC.89.

12-15-14-4. Repealed - As added by P.L.152-1995, SEC.13. Repealed by P.L.2-1997, SEC.89.

12-15-14-5. Repealed - As added by P.L.152-1995, SEC.14. Repealed by P.L.2-1997, SEC.89.

12-15-14-8. Use of Rug-Iv, 48-Group Model for Payments; Public Notice if Reduction in Reimbursement - Sec. 8. (a) Beginning July 1, 2018, the office may...

Chapter 14.5. Repealed - Repealed by P.L.153-2011, SEC.20.

Chapter 15. Payment to Hospitals; General

12-15-15-1. Services at Hospitals Licensed Under Ic 16-21; Rates Established Under Rules - Sec. 1. Payment of a service provided in a hospital...

12-15-15-1.1. Reimbursement to Hospitals for Inpatient Hospital Services; Intergovernmental Transfers; Calculating Medicaid Shortfall - Sec. 1.1. (a) This section applies to a hospital that...

12-15-15-1.2. Reimbursement for Children's Hospital Bordering Indiana; Limitations; Expiration - Sec. 1.2. (a) This section applies only to state fiscal...

12-15-15-1.3. Reimbursement to Hospitals for Outpatient Hospital Services; Intergovernmental Transfers; Calculating Medicaid Shortfall - Sec. 1.3. (a) This section applies to a hospital that...

12-15-15-1.5. Additional Reimbursements to Certain Hospitals; Appeal of Amount of Distribution - Sec. 1.5. (a) This section applies to a hospital that:...

12-15-15-1.6. Alternative Payment Methodology for Payments to Hospitals - Sec. 1.6. (a) This section applies only if the office...

12-15-15-2. Rates Adopted for Hospital Licensed Under Ic 16-21; Prospective or Retrospective Application - Sec. 2. The rates adopted under this chapter for a...

12-15-15-2.5. Payment for Physician Services in Emergency Department - Sec. 2.5. (a) Payment for physician services provided in the...

12-15-15-3. Services Provided at Hospitals Operating Under Ic 16-24-1; Prospective Payment Rate - Sec. 3. Payment of a service provided in a hospital...

12-15-15-4. Per Diem Rate for Services Provided in Hospitals Operating Under Ic 16-24-1 - Sec. 4. The office shall establish a per diem rate...

12-15-15-4.5. Payment for HIV Test; Limitation - Sec. 4.5. Payment to a hospital for a test required...

12-15-15-5. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.6(c) part.] As added by P.L.2-1992, SEC.9....

12-15-15-6. Fees in Addition to Infant Delivery Fees - Sec. 6. (a) In addition to a payment due to...

12-15-15-8. Repealed - As added by P.L.277-1993(ss), SEC.70. Amended by P.L.156-1995, SEC.1. Repealed...

12-15-15-9. Attribution of Payable Claim to County; Amount of Payment on Payable Claims; Conditions on Payments; Funds Available for Payments - Sec. 9. (a) For purposes of this section and IC...

12-15-15-9.5. Attribution of Payable Claim to County; Funds Available for Payments; Limitation on Payments - Sec. 9.5. (a) For purposes of this section and IC...

12-15-15-9.6. Limitation on Total Amount of Payments - Sec. 9.6. For state fiscal years beginning after June 30,...

12-15-15-9.8. Repealed - As added by P.L.78-2004, SEC.7. Repealed by P.L.212-2007, SEC.31; P.L.218-2007,...

12-15-15-10. Payments to Providers Under Medicaid Disproportionate Share Provider Program - Sec. 10. (a) This section applies to a hospital that:...

12-15-15-11. Nominal Charge Hospitals - Sec. 11. Hospitals licensed under IC 16-21 that are established...

12-15-15-12. Budget Committee Review of Medicaid Reimbursement to Children's Hospitals Bordering Indiana; Provision of Information; Expiration - Sec. 12. (a) By November 1, 2022, and by November...

Chapter 16. Disproportionate Share Providers; Eligibility

12-15-16-1. Disproportionate Share Provider Status - Sec. 1. (a) A provider that is an acute care...

12-15-16-2. Inpatient Utilization Rate - Sec. 2. (a) For purposes of disproportionate share eligibility, a...

12-15-16-3. Low Income Utilization Rate; Contractual Allowances and Discounts - Sec. 3. (a) For purposes of disproportionate share eligibility, a...

12-15-16-4. Repealed - [Pre-1992 Revision Citation: 12-1-7-60(d).] As added by P.L.2-1992, SEC.9. Repealed...

12-15-16-5. Implementation; Federal Health Care Financing Administration Approval; Percentage Reduction of Payments to Medicaid Indigent Care Trust Fund - Sec. 5. (a) The office may not implement this chapter,...

12-15-16-6. Basic Disproportionate Payments to Hospitals; Amount - Sec. 6. (a) As used in this section, "low income...

12-15-16-7. Disproportionate Share Payments if Hospital Assessment Fees Are Used as State Share Dollars; Eligible Providers; State Plan Amendments - Sec. 7. (a) Except as provided in sections 7.5 and...

12-15-16-7.7. Disproportionate Share Payment Plan for Reduced Federal Dsh Allotment; Default Plan; State Fiscal Year Beginning July 1, 2020 - Sec. 7.7. (a) As used in this section, "CMS" refers...

Chapter 17. Disproportionate Share Providers; Disproportionate Share Payments

12-15-17-1. Providers Servicing Disproportionate Share of Medicaid Recipients and Low Income Patients; Basic Rate; Minimum Medicaid Inpatient Utilization Rate Required - Sec. 1. A disproportionate share payment shall be made to:...

12-15-17-2. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.6(e).] As added by P.L.2-1992, SEC.9. Amended...

12-15-17-3. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.6(f).] As added by P.L.2-1992, SEC.9. Repealed...

Chapter 18. Disproportionate Share Providers; Assessments

12-15-18-1. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.7(a)(1).] As added by P.L.2-1992, SEC.9. Repealed...

12-15-18-2. "Hospital" Defined - Sec. 2. (a) As used in this chapter, "hospital" has...

12-15-18-3. "Private Psychiatric Institution" Defined - Sec. 3. As used in this chapter, "private psychiatric institution"...

12-15-18-3.5. "Trustees" Defined - Sec. 3.5. As used in this chapter, "trustees" refers to...

12-15-18-4. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.7(b).] As added by P.L.2-1992, SEC.9. Amended...

12-15-18-5. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.7(c).] As added by P.L.2-1992, SEC.9. Amended...

12-15-18-5.1. Intergovernmental Transfers for State Fiscal Years Ending on or After June 30, 1998; Coordination of Transfers; Transfers by Municipal Disproportionate Share Providers; Certification by County - Sec. 5.1. (a) For state fiscal years ending on or...

12-15-18-6. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.7(d).] As added by P.L.2-1992, SEC.9. Repealed...

Chapter 19. Disproportionate Share Providers; Enhanced Disproportionate Share Payments

12-15-19-1. Enhanced Disproportionate Share Payment Methodology for State Fiscal Years Ending June 30, 1998, and June 30, 1999; Limits on Basic and Enhanced Disproportionate Share Payments to Hospitals - Sec. 1. (a) For the state fiscal years ending on...

12-15-19-2. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.8(b).] As added by P.L.2-1992, SEC.9. Amended...

12-15-19-2.1. Disproportionate Share Payment Methodology for State Fiscal Years Ending on or After June 30, 2000; Limits on Total Disproportionate Share Payments to Hospitals - Sec. 2.1. (a) This section does not apply during the...

12-15-19-3. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.8(c) part.] As added by P.L.2-1992, SEC.9....

12-15-19-4. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.8(c) part.] As added by P.L.2-1992, SEC.9....

12-15-19-5. Federal Financial Participation Unavailable; Withholding Disproportionate Share Payment Adjustments - Sec. 5. Except as provided in section 6 of this...

12-15-19-6. Deposits in Fund; Insufficiency; Suspension or Reduction of Payments to Eligible Institutions - Sec. 6. (a) This section does not apply during the...

12-15-19-7. Repealed - [Pre-1992 Revision Citation: 12-1-7-17.9.] As added by P.L.2-1992, SEC.9. Repealed...

12-15-19-8. Disproportionate Share Adjustments Received by Municipal Disproportionate Share Providers; Limits on Total Disproportionate Share Payments - Sec. 8. (a) This section does not apply during the...

12-15-19-9. Repealed - As added by P.L.126-1998, SEC.13. Amended by P.L.113-2000, SEC.16. Repealed...

12-15-19-10. Priorities of Payments - Sec. 10. This section does not apply during the period...

12-15-19-10.1. Repealed - As added by P.L.113-2000, SEC.18. Repealed by P.L.283-2001, SEC.39.

Chapter 20. Indigent Care Trust Fund

12-15-20-1. Fund Defined - Sec. 1. As used in this chapter, "fund" refers to...

12-15-20-2. Establishment of Fund; Payments From Fund; Priority - Sec. 2. The Medicaid indigent care trust fund is established...

12-15-20-3. Expenses of Administration - Sec. 3. The expenses of administering the fund shall be...

12-15-20-4. Investment of Fund Money - Sec. 4. (a) The treasurer of state shall invest the...

12-15-20-5. Records; Balance in Fund; Investment Earnings - Sec. 5. The office shall maintain records that show the...

12-15-20-6. Money Not to Revert to General Fund - Sec. 6. Money in the fund at the end of...

12-15-20-7. Use of Fund Money; Availability of Matching Federal Financial Participation - Sec. 7. Money in the fund may only be used...

12-15-20-8. Repealed - [Pre-1992 Revision Citation: 12-1-7-61(e) part.] As added by P.L.2-1992, SEC.9....

Chapter 20.5. Disproportionate Share Providers

12-15-20.5-1. Unavailability of Federal Matching Funds; Nonimplementation of State Laws - Sec. 1. The office is not required to implement or...

Chapter 20.7. Payment Schedule

12-15-20.7-1. Definitions - Sec. 1. As used in this chapter: (1) "Medicaid inpatient...

12-15-20.7-2. Order of Payments - Sec. 2. (a) This section does not apply during the...

12-15-20.7-3. Repealed - As added by P.L.255-2003, SEC.23. Repealed by P.L.212-2007, SEC.31; P.L.218-2007,...

Chapter 21. Rules

12-15-21-1. Acceptance by Provider of Medicaid Claim Payment; Agreement to Comply With Statutes and Rules - Sec. 1. A provider who accepts payment of a claim...

12-15-21-2. Secretary to Adopt Rules; Consistency With Title Xix of Social Security Act - Sec. 2. The secretary shall, with the advice of the...

12-15-21-3. Required Rules - Sec. 3. The rules adopted under section 2 of this...

12-15-21-4. Rules Not to Eliminate Type of Provider Licensed to Provide Services - Sec. 4. The rules adopted by the secretary may not...

12-15-21-5. Rules Not to Be More Restrictive Than Federal Medicaid Reimbursement Requirements - Sec. 5. (a) As used in this section, "facility" refers...

12-15-21-6. Amendment of Prior Authorization Rule - Sec. 6. (a) IC 4-22-2 does not apply to a...

12-15-21-6.5. Family Practice Residency Program - Sec. 6.5. A family practice residency program may choose to...

12-15-21-7. Rules Not to Be More Stringent Than Prior Authorization Rule Effective January 1, 1996 - Sec. 7. The office may not amend a prior authorization...

Chapter 22. Provider Sanctions

12-15-22-1. Sanctions for Violations - Sec. 1. If after investigation the office determines that a...

12-15-22-1.5. Ineligibility After Conviction - Sec. 1.5. In addition to any sanction imposed on a...

12-15-22-2. Administrative Appeals; Rules - Sec. 2. A provider may appeal a sanction under section...

12-15-22-3. Judicial Review - Sec. 3. After exhausting all administrative remedies, a provider may...

12-15-22-4. Denial of Payment or Termination of Provider Agreement; Obligation of Provider to Inform Individual Services Recipients - Sec. 4. A final directive made by the office that:...

12-15-22-5. Denial of Payment, Rejection of Participation Application or Provider Agreement Termination; Time to Correct Deficiencies - Sec. 5. Subject to section 6 of this chapter, a...

12-15-22-6. Eligibility; Repayment of Excess Payments; Payment of Penalties - Sec. 6. A provider may not be declared to be...

12-15-22-7. Provider Subjected to Sanction; Agreement as Provided in Ic 12-15-11 - Sec. 7. Except as provided in section 8 of this...

12-15-22-8. Eligibility to Submit Medicaid Claims; Criminal Convictions; Repeated Imposition of Sanctions - Sec. 8. A provider who: (1) has been convicted of...

Chapter 23. Improper Payments

12-15-23-1. Reasonable Grounds to Suspect That Provider Has Received Payments to Which It Is Not Entitled; Certification of Evidence to Medicaid Fraud Control Unit; Exception - Sec. 1. Except as provided in section 2 of this...

12-15-23-2. Agreement for Overpayment to Be Deducted From Subsequent Payments; Authorization - Sec. 2. (a) If the office of the secretary of...

12-15-23-3. Agreements to Deduct Overpayments From Subsequent Payments; Interest Provisions; Other Provisions - Sec. 3. An agreement under section 2 of this chapter:...

12-15-23-4. Rules - Sec. 4. The secretary may adopt rules under IC 4-22-2...

12-15-23-5. Discovery of Overpayment; Time for Entering Into Agreement; Certification of Facts to Medicaid Fraud Control Unit - Sec. 5. If the administrator and a provider fail to...

12-15-23-6. Determination by Medicaid Fraud Control Unit; Certification of Facts to Prosecuting Attorney; Reference of Matter to Attorney General - Sec. 6. (a) If the state Medicaid fraud control unit...

12-15-23-7. Action by Attorney General; Reference to Administrator - Sec. 7. The attorney general may do either of the...

12-15-23-8. Civil Action; Finding in Favor of Attorney General; Treble Damages; Civil Penalties; Reimbursement of Investigation Costs - Sec. 8. (a) Subject to subsection (b), if the court...

12-15-23-9. Meritorious Action; Money Recoverable Exceeding Cost of Action - Sec. 9. In determining whether an action is meritorious, the...

12-15-23-10. Action by Attorney General; Compromise - Sec. 10. An action brought under section 7 of this...

Chapter 23.5. Coordination of Benefits Study

12-15-23.5-1. "Covered Entity" - Sec. 1. As used in this chapter, "covered entity" has...

12-15-23.5-2. Examination and Recovery of Medicaid Claims - Sec. 2. (a) Before January 1, 2008, the office shall:...

12-15-23.5-3. Coordination of Benefits Procedures - Sec. 3. If at least one percent (1%) of the...

12-15-23.5-4. Procedure Requirements - Sec. 4. If a procedure is developed and implemented under...

Chapter 24. Theft; Kickbacks and Bribes

12-15-24-1. Intent to Deprive State of Money or Benefits; Prima Facie Evidence for Purposes of Ic 35-43-4-2 - Sec. 1. Evidence that a person or provider received money...

12-15-24-2. Soliciting, Offering, or Receiving Kickbacks, Bribes, or Fee or Charge Rebates; Classification of Violation - Sec. 2. A person who furnishes items or services to...

Chapter 25. Solicitation of Nonresidents

12-15-25-1. Solicitation Defined; Prohibition - Sec. 1. (a) As used in this section, "solicitation" means...

12-15-25-2. Marketing or Advertising Not Precluded - Sec. 2. This chapter does not preclude a provider from...

12-15-25-3. Violations; Sanctions - Sec. 3. A provider that violates this chapter is subject...

Chapter 26. Prior Authorization

12-15-26-1. Prior Authorization for Mental Health Services; Providers Licensed Under Ic 25-33-1 - Sec. 1. A health service provider in psychology licensed under...

12-15-26-2. Psychiatrists Practicing in Employment of Community Mental Health Centers - Sec. 2. A psychiatrist practicing in the employment of a...

Chapter 27. Confidentiality and Release of Information

12-15-27-1. Medicaid Applicants and Recipients; Confidential Records and Documents - Sec. 1. The following concerning a Medicaid applicant or recipient...

12-15-27-2. Use and Disclosure of Information; Provision of Information to Legislative Services Agency - Sec. 2. (a) The use and the disclosure of the...

12-15-27-3. Release and Use of General Information - Sec. 3. (a) The release and use of information of...

12-15-27-4. Repealed - [Pre-1992 Revision Citation: 12-1-7-28(e).] As added by P.L.2-1992, SEC.9. Repealed...

12-15-27-5. Eligibility for Federal Financial Participation; Limitations on Chapter; Rules - Sec. 5. (a) If it is established that this chapter...

12-15-27-6. Eligibility Information; Immediate Access Systems - Sec. 6. The office shall make available the following for...

12-15-27-7. Limitations on Eligibility Information Available Through Immediate Access Systems - Sec. 7. Information released under section 6 of this chapter...

12-15-27-8. Eligibility Information Obtained by Health Care Providers; Confidentiality - Sec. 8. Information obtained by a health care provider under...

12-15-27-8.5. Use and Disclosure of Voter Registration Records - Sec. 8.5. A person may not examine, disclose, or use...

12-15-27-9. Eligibility Information Access and Confidentiality; Rules - Sec. 9. The secretary shall adopt rules under IC 4-22-2...

Chapter 28. Appeals and Hearings

12-15-28-1. Decisions Appealable to Office - Sec. 1. An applicant for or a recipient of Medicaid...

12-15-28-2. Secretary to Conduct Hearings Under Ic 4-21.5 - Sec. 2. The secretary shall conduct hearings and appeals concerning...

12-15-28-3. Notice of Appeal; Setting Matter for Hearing; Opportunity for Hearing; Location - Sec. 3. The office shall, upon receipt of notice of...

12-15-28-4. Hearing; Introduction of Evidence - Sec. 4. At the hearing, the applicant and county office...

12-15-28-5. Conduct of Hearing; Rules - Sec. 5. The hearing shall be conducted under rules adopted...

12-15-28-6. Additional Investigations by Office; Decision by Office to Grant Medicaid - Sec. 6. The office: (1) may make necessary additional investigations;...

12-15-28-7. Decision by Office to Grant Medicaid Assistance; Effect - Sec. 7. A decision of the office made in conformity...

Chapter 29. Insurance

12-15-29-0.5. "Insurer" - Sec. 0.5. As used in this chapter, "insurer" includes a...

12-15-29-1. Insurers; Authorization to Release Information - Sec. 1. An applicant for or a recipient of Medicaid...

12-15-29-2. Requests for Information From Insurers; Limitation - Sec. 2. (a) Subject to subsection (b), an insurer shall...

12-15-29-3. Guidelines for Information Requests - Sec. 3. The administrator and the insurance commissioner shall establish...

12-15-29-4. Direct Payments by Insurers to Office; Amount of Payments - Sec. 4. (a) If: (1) an insurer has not discharged...

12-15-29-4.5. Insurer's Acceptance of Medicaid Claims - Sec. 4.5. (a) An insurer shall accept a Medicaid claim...

12-15-29-5. Medicaid Furnished by Office; Insurer Put on Notice of Claim by Office; Insurer Paying Person or Entity Other Than Office; Office's Claim Not Discharged - Sec. 5. An insurer: (1) that is put on notice...

12-15-29-6. Payment by Insurer to Office; Discharge of Obligation - Sec. 6. Payment to the office by an insurer under...

12-15-29-7. Notice to Insurer That Medicaid Has Been Furnished; Requirements; Notification Given Office by Insurer; Payment of Claim - Sec. 7. (a) The notice requirements of section 4 of...

12-15-29-8. Unlawful Insurance Clause - Sec. 8. A clause of an insurance contract, plan, or...

12-15-29-9. State's Acquisition of Person's Right to Payment - Sec. 9. (a) IC 27-8-23 applies to this section. (b)...

12-15-29-10. Employer Sponsored Health Insurance to Include Coverage for Child - Sec. 10. (a) IC 27-8-23 and IC 31-16-15 apply to...

Chapter 30. Contracting

12-15-30-1. Authorization of Contracts for Administration of Program - Sec. 1. The office may contract with another state agency...

12-15-30-2. Contract Requirements and Qualifications; Preparation of Bid Specifications - Sec. 2. The office shall do the following: (1) Prepare...

12-15-30-3. Medicaid Claims; Finance and Administration; Plan Options - Sec. 3. The office shall select an approach to finance...

12-15-30-4. Term of Contracts; Extensions - Sec. 4. (a) A contract to administer any part of...

12-15-30-5. Subcontracts - Sec. 5. (a) A contractor with the state under this...

12-15-30-6. Statement of Adjusted Actual Medicaid Provider Costs and Insurance Premiums; Certification to Auditor of State; Payment by Auditor of State - Sec. 6. (a) A contractor under section 1 of this...

12-15-30-7. Statement Requesting Payment for Fees for Performance of Administrative Responsibilities; Certification to Auditor of State - Sec. 7. (a) A contractor under section 1 of this...

Chapter 30.5. Nonemergency Medical Transportation

12-15-30.5-1. "Broker" - Sec. 1. As used in this chapter, "broker" means a...

12-15-30.5-2. "Commission" - Sec. 2. As used in this chapter, "commission" refers to...

12-15-30.5-3. "Nonemergency Medical Transportation" - Sec. 3. As used in this chapter, "nonemergency medical transportation"...

12-15-30.5-4. Reporting; Duties When Assignment for Request Not Made Within 48 Hours - Sec. 4. (a) A broker must do the following: (1)...

12-15-30.5-5. Broker Requirements; Confidentiality; Remediation Plan - Sec. 5. (a) A broker shall establish, implement, and maintain...

12-15-30.5-6. Report on Claims - Sec. 6. (a) Before October 1, 2019, the office of...

12-15-30.5-7. Commission; Membership; Term; Staffing - Sec. 7. (a) The nonemergency medical transportation commission is established...

12-15-30.5-8. Commission Member per Diem and Travel - Sec. 8. (a) Each member of the commission who is...

12-15-30.5-9. Meetings - Sec. 9. The commission shall meet at least two (2)...

Chapter 31. Repealed - [Pre-1992 Revision Citations: Repealed by P.L.291-2001, SEC.211.

Chapter 31.1. Adjustment of Pharmacy Dispensing Fees

12-15-31.1-1. Dispensing Fee Surveys - Sec. 1. At least once every two (2) years, the...

12-15-31.1-2. Evaluation of Other Dispensing Fees - Sec. 2. A survey under section 1 of this chapter...

12-15-31.1-3. Dispensing Fee Criteria - Sec. 3. A dispensing fee shall be evaluated based upon...

12-15-31.1-4. Adjustment of Dispensing Fees - Sec. 4. If an adjustment in dispensing fees is made...

Chapter 32. Community Residential Facilities for the Developmentally Disabled

12-15-32-1. "Facility" - Sec. 1. As used in this chapter, "facility" means a...

12-15-32-2. Reimbursement; Voiding of Administrative Rule - Sec. 2. (a) The office shall reimburse community residential facilities...

12-15-32-3. Repealed - [Pre-1992 Revision Citation: 12-1-7.3-2(b) part.] As added by P.L.2-1992, SEC.9....

12-15-32-4. Reimbursement Rate Criteria; Necessary Factors - Sec. 4. The criteria for reimbursement under this chapter must...

12-15-32-4.5. Reimbursement for Staff Hours of Employees - Sec. 4.5. (a) This section applies to a community residential...

12-15-32-5. Special Interim Rates - Sec. 5. The office may establish a special interim rate...

12-15-32-6. Facility Residents; Personal Allowance; Range of Amounts - Sec. 6. The office shall allow a resident of a...

12-15-32-6.5. Payment Calculation for Federal Ssi Recipient; Exemption From Income Eligibility Consideration - Sec. 6.5. (a) If a resident of a facility: (1)...

12-15-32-7. Rules; Functioning Level of Resident; Personal Allowance - Sec. 7. The secretary may adopt rules under IC 4-22-2...

12-15-32-8. Personal Allowance; Income Eligibility Consideration; Exemption - Sec. 8. A personal allowance is exempt from income eligibility...

12-15-32-9. Personal Allowance; Individuals Employed as Part of Habilitation Plan or Working in Sheltered Workshop or Day Activity Center - Sec. 9. The personal allowance for one (1) month for...

12-15-32-10. Placement in Facility; Diagnostic Evaluations - Sec. 10. (a) An applicant for Medicaid who desires to...

12-15-32-11. Assessment Upon Total Annual Revenue of Certain Nonstate Facilities; Medicaid Assessment Account; Unavailability of Federal Matching Funds - Sec. 11. (a) The office may assess community residential facilities...

Chapter 33. Medicaid Advisory Committee

12-15-33-1. Committee Defined - Sec. 1. As used in this chapter, "committee" refers to...

12-15-33-2. Committee Created - Sec. 2. The Medicaid advisory committee is created to act...

12-15-33-3. Membership; Appointment - Sec. 3. (a) The committee shall be appointed as follows:...

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Indiana Code Title 12. Human Services Article 15. Medicaid

Indiana Code
Title 12. Human Services
Article 15. Medicaid