Title 12, HUMAN SERVICES

Sec. 4.5. (a) As used in this section, "functional eligibility assessment" means a review of an individual's functional impairment level to determine whether an individual meets the eligibility requirements for the state's Medicaid aged and disabled waiver. (b) As used in this se…

Sec. 5. The state shall provide access to the following long term care services that are appropriate and needed for an individual who is eligible for these services under this chapter: (1) Any home and community based service that is available through: (A) the community and home …

Sec. 7. When possible, the office of the secretary of family and social services shall make use of volunteers and volunteer groups, including faith based groups, when executing its duties under this chapter. As added by P.L.274-2003, SEC.5.

Sec. 9. If the division performs inspections for compliance with state and federal home and community based services requirements, the division shall issue written findings to the person inspected not later than thirty (30) calendar days after the date of inspection. As added by …

Sec. 0.5. This chapter does not apply to a managed care organization that, on or before July 1, 2000, did not directly contract with a hospital (as defined in section 1 of this chapter) for the provision of services under the office's managed care program. As added by P.L.141-200…

Sec. 1. As used in this chapter, "hospital" refers to an acute care hospital provider that: (1) is licensed under IC 16-21; (2) qualifies as a disproportionate share hospital under IC 12-15-16; and (3) is the sole disproportionate share hospital in a city located in a county havi…

Sec. 10. A hospital and the managed care organization of the office shall use the arbitration procedure in section 8 of this chapter for the resolution of all disputed claims that have accrued as of March 17, 2000. As added by P.L.220-2011, SEC.265. Amended by P.L.152-2017, SEC.1…

Sec. 2. The office's managed care organization shall regard a hospital as a contracted provider in the office's managed care program, which provides a capitated prepayment managed care system, for the provision of medical services to each individual who: (1) is eligible to receiv…

Sec. 6. A claim for reimbursement for services shall be treated as a disputed claim under this chapter if: (1) it is submitted within one hundred twenty (120) days after the date that services are rendered; (2) it is denied by the managed care organization; (3) the hospital submi…

Sec. 7. The office's managed care organization must conclude an appeal under section 6(4) of this chapter and notify the hospital of its decision not more than thirty-five (35) days after the managed care organization receives a notice from the hospital disputing the managed care…

Sec. 8. (a) A contract entered into by a hospital with the office's managed care organization for the provision of services under the office's managed care program must include a dispute resolution procedure for all disputed claims. Unless agreed to in writing by the hospital and…

Sec. 9. The arbitration process described in section 8 of this chapter shall also be followed for resolution of disputed claims between a hospital and the office's managed care organization, if the hospital is not a contracted provider in the office's managed health care program.…