Title 12, HUMAN SERVICES

Sec. 1. (a) The terms and conditions of any waivers that are obtained by the state from the United States Department of Health and Human Services or the United States Department of Agriculture before January 1, 1995: (1) are valid; (2) comply with the legislative intent of P.L.46…

Sec. 13. (a) The office shall apply to the United States Department of Health and Human Services for any amendment to the state Medicaid plan or demonstration waiver that is needed to provide for presumptive eligibility for a pregnant woman described in IC 12-15-2-13. (b) The off…

Sec. 15. (a) As used in this section, "division" refers to the division of disability, aging, and rehabilitative services established by IC 12-9-1-1. (b) As used in this section, "waiver" refers to any waiver administered by the office and the division under section 1915(c) of th…

Sec. 17.5. The office may not implement any Medicaid state plan amendments, any Medicaid waiver requests, or any revisions to any Medicaid state plan amendments or Medicaid waiver requests unless the office has submitted a written report to the budget committee concerning the imp…

Sec. 18. (a) The definitions set forth in 460 IAC 6-3 as of January 1, 2021, apply to the terms that are used in this section. (b) As used in this section, "benefits" means allowances and services provided by employers to employees as compensation that is in addition to salary an…

Sec. 18.5. (a) As used in this section, "office" includes the following: (1) The office of the secretary of family and social services. (2) A managed care organization that has contracted with the office of Medicaid policy and planning under this article. (3) A person that has co…

Sec. 18.7. (a) Before September 1, 2025, the office of the secretary shall apply to the United States Department of Health and Human Services for an amendment to each home and community based services Medicaid waiver to, when determining eligibility for an individual and the indi…

Sec. 19. (a) Before July 1, 2019, the office of the secretary shall apply to the United States Department of Health and Human Services for an amendment to the family and support services Medicaid waiver to create priority status on the waiver for a child of: (1) an active member;…

Sec. 2. (a) Any part of P.L.46-1995 that requires a waiver from the United States Department of Health and Human Services or the United States Department of Agriculture does not apply to a person who first received assistance under IC 12-14 before January 1, 1994. (b) This sectio…

Sec. 20. (a) Before December 1, 2021, the office shall apply to the United States Department of Health and Human Services for an amendment to the state Medicaid plan that would require reimbursement by: (1) the office; or (2) a contractor of the office; for eligible Medicaid reha…

Sec. 21. (a) As used in this section, "Medicaid rehabilitation option services" means clinical behavioral health services provided to recipients and families of recipients living in the community who need aid intermittently for emotional disturbances, mental illness, and addictio…

Sec. 22. (a) Before September 1, 2025, the office must reapply to the United States Department of Health and Human Services for a state plan amendment that: (1) provides for establishment of the long term care partnership program as described in IC 12-15-39.8; (2) provides that t…

Sec. 23. Before December 1, 2021, the office shall apply to the United States Department of Health and Human Services for an amendment to the state Medicaid plan to require Medicaid reimbursement for the purpose of authorizing Medicaid rehabilitation option services as an eligibl…

Sec. 24. (a) Notwithstanding any other law, the secretary, through the office, may apply to the United States Department of Health and Human Services for a Medicaid waiver to provide Medicaid reimbursement by: (1) the office; or (2) a contractor of the office; for eligible servic…

Sec. 25. (a) As used in this section, "certified community behavioral health clinic" refers to a community behavioral health clinic that has been certified according to criteria established under Section 223 of the federal Protecting Access to Medicare Act of 2014 (42 U.S.C. 1396…

Sec. 26. (a) Not later than September 1, 2026, the office of the secretary shall apply to the United States Department of Health and Human Services for a Medicaid waiver to provide assisted living services effective July 1, 2026, in a waiver separate from the Medicaid home and co…

Sec. 27. (a) Not later than September 1, 2026, the office of the secretary shall apply to the United States Department of Health and Human Services for an amendment to the Medicaid home and community based services waiver concerning the provision of services to individuals who: (…

Sec. 3. (a) Any part of P.L.46-1995 that requires a waiver from the United States Department of Health and Human Services or the United States Department of Agriculture does not apply to a person who first received assistance under IC 12-14 after December 31, 1993. (b) This secti…

Sec. 4. The division of family resources shall seek any available waivers from the Secretary of the United States Department of Health and Human Services that are required to carry out P.L.257-1997. As added by P.L.220-2011, SEC.264.

of state expenditures; implementation of waiver Sec. 6. (a) The office shall develop a federal Medicaid waiver application under which a prescription drug program may be established or implemented to provide access to prescription drugs for low income senior citizens. (b) Before …

Sec. 6.5. Before July 1, 2023, the office shall apply to the United States Department of Health and Human Services to amend the state plan to reimburse a pharmacist for services and prescriptions provided under IC 25-26-25 to an eligible Medicaid recipient. As added by P.L.154-20…

Sec. 0.1. The amendments made to this chapter apply as follows: (1) The amendments made to section 1 of this chapter by P.L.257-1996 apply to provider claims for payment under the Medicaid program under this article after March 31, 1996. (2) The addition of section 1.5 of this ch…

Sec. 0.4. As used in this chapter, "office" includes the following: (1) The office of the secretary of family and social services. (2) A managed care organization that has contracted with the office of Medicaid policy and planning under this article. (3) A person that has contrac…

Sec. 0.5. (a) Except as provided in section 0.6 of this chapter, as used in this chapter, "clean claim" means a claim submitted by a provider for payment under the Medicaid program that can be processed without obtaining additional information from: (1) the provider of the servic…

Sec. 0.6. (a) "Clean claim", as the term applies to payments to nursing facilities under IC 12-15-14, means a claim submitted by a provider for payment that meets the following conditions: (1) Contains the following locators: (A) Type of bill. (B) Coverage dates. (C) Bill status.…

Sec. 0.7. The office may adopt rules under IC 4-22-2 that add, delete, or modify the locators contained in section 0.6(a)(1) of this chapter as necessary to conform with: (1) changes in federal law or regulation; or (2) directives from the United States Centers for Medicare and M…

Sec. 1. (a) This section applies only to claims submitted for payment by nursing facilities. (b) The office shall pay, deny, or suspend each claim submitted by a provider for payment under the Medicaid program not more than: (1) twenty-one (21) days after the date a claim that is…

Sec. 1.5. (a) This section applies only to claims submitted for payment by nursing facilities. (b) If the office: (1) fails to pay a clean claim in the time required under section 1(b) of this chapter; or (2) denies or suspends a claim that is subsequently determined to have been…

Sec. 1.6. (a) This section does not apply to claims submitted for payment by nursing facilities. (b) The office shall pay or deny each clean claim in accordance with section 1.7 of this chapter. (c) The office shall deny or suspend each claim that is not a clean claim in accordan…

Sec. 1.7. (a) This section does not apply to claims submitted for payment by nursing facilities. (b) The office shall pay or deny each clean claim as follows: (1) If the claim is filed electronically, within twenty-one (21) days after the date the claim is received by: (A) the of…

Sec. 1.8. (a) As used in this section, "covered population" means all Medicaid recipients who meet the criteria set forth in subsection (b). (b) Except as provided in subsection (e), an individual is a member of the covered population if the individual: (1) is eligible to partici…

Sec. 10. (a) This section applies to a home health agency that is: (1) licensed under IC 16-27-1; (2) enrolled as a Medicaid provider; and (3) in good standing as a Medicaid provider, as determined by the office of the secretary. (b) Notwithstanding any other law, rule, or bullet…

Sec. 2. (a) Except as provided in IC 12-15-14 and IC 12-15-15, payments to Medicaid providers must be: (1) consistent with efficiency, economy, and quality of care; and (2) sufficient to enlist enough providers so that care and services are available under Medicaid, at least to t…

Sec. 3.5. (a) As used in this section, "noninstitutional provider" means any Medicaid provider other than the following: (1) A health facility licensed under IC 16-28. (2) An ICF/IID (as defined in IC 16-29-4-2). (b) If the office of the secretary or the office of the secretary's…

Sec. 4. (a) As used in this section, "institutional provider" means the following: (1) A health facility that is licensed under IC 16-28. (2) An ICF/IID (as defined in IC 16-29-4-2). (b) If the office of the secretary or the office of the secretary's designee believes that an ove…

Sec. 6. (a) Except as provided by IC 12-15-35-50, a notice or bulletin that is issued by: (1) the office; (2) a contractor of the office; or (3) a managed care organization; concerning a change to the Medicaid program, including a change to prior authorization, claims processing,…

Sec. 7. (a) The office and an entity with which the office contracts for the payment of claims shall accept claims submitted on any of the following forms by an individual or organization that is a contractor or subcontractor of the office: (1) CMS-1500 or its subsequent form. (2…

Sec. 7.2. (a) As used in this section, "provider" has the meaning set forth in IC 27-8-11-1. (b) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection: (1) the office shall for all purposes begin using the most curr…

Sec. 9. (a) Subject to subsection (b), the office shall reimburse the following providers if the providers are providing Medicaid covered services at a federally-qualified health center (as defined in 42 U.S.C. 1396d(l)(2)(B)) or a rural health clinic (as defined in 42 U.S.C. 139…

Sec. 1. As used in this chapter, "applicant" means an organization that applies to the division for a grant for either of the following purposes: (1) To establish and operate a preschool child care program. (2) To maintain an existing preschool child care program. [Pre-1992 Revis…

Sec. 2. As used in this chapter, "facility" means a school or other building in which a preschool child care program is operated. [Pre-1992 Revision Citation: 4-28-6.2-2.] As added by P.L.2-1992, SEC.11.

Sec. 3. As used in this chapter, "preschool child care program" means a program operated by an organization that offers care to children who are: (1) less than six (6) years of age; and (2) not eligible to enroll in a public school. [Pre-1992 Revision Citation: 4-28-6.2-3.] As ad…

Sec. 4. The division may apply for federal and state money to assist applicants under this chapter. [Pre-1992 Revision Citation: 4-28-6.2-4.] As added by P.L.2-1992, SEC.11.

Sec. 5. The division may approve a grant to an applicant if the applicant demonstrates to the division that the applicant can do the following: (1) Provide a physical environment that is safe and appropriate to the various age levels of the children to be served. (2) Meet licensi…

Sec. 6. The division may not approve a grant to an applicant unless the applicant agrees to do both of the following: (1) Serve children whose family income does not exceed one hundred fifty percent (150%) of the official poverty income guidelines established by the Office of Man…