Title 12, HUMAN SERVICES

Sec. 14.7. (a) As used in this section, "office" refers to the office of the secretary of family and social services. (b) The office shall perform a comprehensive review of existing home health services for children with complex medical needs. The office shall assess the home hea…

Sec. 2. (a) As used in this chapter, "home health services" means any of the following items or services furnished to an individual by a home health agency or by others under arrangements with a home health agency on a visiting basis, and except as provided in subsection (b), in …

Sec. 3. Home health services includes items and services furnished to an individual by either of the following: (1) A home health agency. (2) Others under arrangements with a home health agency on a visiting basis and, except for section 4(5) of this chapter, in a place of tempor…

Sec. 4. The items and services under section 2 of this chapter include the following: (1) Part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse. (2) Physical, occupational, or speech therapy or other therapeutic services. (…

Sec. 5. The office and the secretary shall: (1) take action; (2) give directions; and (3) adopt rules under IC 4-22-2; necessary to carry out this chapter and the federal Social Security Act concerning the providing of services and to ensure uniform equitable treatment of all app…

Sec. 6. The office may contract with any of the following to purchase the necessary services to implement this chapter: (1) A state, public, or private agency. (2) A business firm. (3) A corporation. [Pre-1992 Revision Citation: 12-1-7.5-3 part.] As added by P.L.2-1992, SEC.9.…

Sec. 7. A contract made with the following may be for a term not to exceed three (3) years: (1) A public or private agency. (2) A business firm. (3) A foundation. (4) A corporation. [Pre-1992 Revision Citation: 12-1-7.5-3 part.] As added by P.L.2-1992, SEC.9.…

Sec. 8. The office shall assist the Indiana department of administration in the preparation of qualifications and specifications for bidders contracting with the state to administer the fiscal provisions of or to provide services under this chapter. [Pre-1992 Revision Citation: 1…

Sec. 9. A contractor with the state under this chapter may subcontract a part of the contractor's prime contract. However, a subcontract may not extend beyond the term of the prime contract. [Pre-1992 Revision Citation: 12-1-7.5-3 part.] As added by P.L.2-1992, SEC.9.

Sec. 1. As used in this chapter, "appropriate and medically necessary" means drug prescribing, drug dispensing, and patient medication usage in conformity with the criteria and standards developed under this chapter. As added by P.L.75-1992, SEC.19.

Sec. 10. As used in this chapter, "overutilization or underutilization" means the use of a drug in such quantities where the desired therapeutic goal is not achieved. As added by P.L.75-1992, SEC.19.

Sec. 11. As used in this chapter, "pharmacist" means an individual who is licensed as a pharmacist in Indiana under IC 25-26. As added by P.L.75-1992, SEC.19.

Sec. 12. As used in this chapter, "physician" means an individual who is licensed to practice medicine in Indiana under IC 25-22.5. As added by P.L.75-1992, SEC.19.

Sec. 13. As used in this chapter, "prospective DUR" means the part of the drug utilization review program that: (1) is to occur before the drug is dispensed; (2) is designed to screen for potential drug therapy problems based on explicit and predetermined criteria and standards t…

Sec. 14. As used in this chapter, "retrospective DUR" means the part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards that are developed on an ongoing…

Sec. 15. As used in this chapter, "standards" means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the Medicaid recipient database. As added by P.L.75-1992, SEC.19.

Sec. 16. As used in this chapter, "SURS" refers to the surveillance utilization review system of the Medicaid program. As added by P.L.75-1992, SEC.19.

Sec. 17. As used in this chapter, "therapeutic appropriateness" means drug prescribing based on rational drug therapy that is consistent with the criteria and standards developed under this chapter. As added by P.L.75-1992, SEC.19.

Sec. 17.5. As used in this chapter, "therapeutic classification" or "therapeutic category" means a group of pharmacologic agents primarily characterized by a significant similarity of the biochemical or physiological mechanism by which these agents result in the intended clinical…

Sec. 18. As used in this chapter, "therapeutic duplication" means the prescribing and dispensing of: (1) the same drug; or (2) at least two (2) drugs from the same therapeutic class; where overlapping periods of drug administration are involved and where such prescribing or dispe…

Sec. 18.5. This chapter applies to any contractor or vendor of the state responsible for providing or managing any part of the Medicaid outpatient drug program. As added by P.L.76-1994, SEC.2.

Sec. 18.7. A formulary established by a managed care organization is subject to sections 46 and 47 of this chapter. As added by P.L.231-1999, SEC.2. Amended by P.L.152-2017, SEC.25.

Sec. 19. The drug utilization review board is established. As added by P.L.75-1992, SEC.19.

Sec. 2. As used in this chapter, "board" refers to the drug utilization review board created under this chapter. As added by P.L.75-1992, SEC.19.

Sec. 20. The board is composed of the following: (1) Four (4) individuals licensed and actively engaged in the practice of medicine or osteopathic medicine in Indiana under IC 25-22.5. (2) Four (4) individuals licensed under IC 25-26 and actively engaged in the practice of pharma…

Sec. 20.1. (a) Each board member and each therapeutics committee member shall fully disclose any potential conflicts of interest, financial or otherwise, relating to an issue that comes before the board or committee for recommendation or other action. (b) A board member or therap…

Sec. 20.5. (a) The therapeutics committee is established as a subcommittee of the board. (b) The chairperson of the board elected under section 25 of this chapter shall, with the approval of a majority of a quorum of the board, appoint the members of the therapeutics committee. (…

Sec. 21. (a) The members of the board shall be appointed by the governor and serve a term of three (3) years. (b) The governor shall fill a vacancy on the board by appointing a new member to serve the remainder of the unexpired term. (c) The governor may remove a member for cause…

Sec. 22. Board members must have expertise in one (1) or more of the following: (1) Clinically appropriate prescribing of outpatient drugs. (2) Clinically appropriate dispensing and monitoring of outpatient drugs. (3) Drug utilization review, evaluation, and intervention. (4) Med…

Sec. 23. In making the physician appointments, the governor shall provide for geographic balance. As added by P.L.75-1992, SEC.19.

Sec. 24. An individual appointed to the board may be reappointed upon the completion of the individual's term. As added by P.L.75-1992, SEC.19.

Sec. 25. (a) The board shall annually elect a chairman from the members of the board. (b) The chairman may be re-elected to serve consecutive terms as chairman. (c) A member of the board who is not a state employee is entitled to the minimum salary per diem as provided by IC 4-10…

Sec. 26. (a) The secretary shall provide additional staff to the board. (b) The secretary shall provide staff for the therapeutics committee. As added by P.L.75-1992, SEC.19. Amended by P.L.291-2001, SEC.162; P.L.107-2002, SEC.16.

Sec. 27. The board is responsible for the oversight of the retrospective and prospective DUR program. As added by P.L.75-1992, SEC.19.

Sec. 28. (a) The board has the following duties: (1) The implementation of a Medicaid retrospective and prospective DUR program as outlined in this chapter, including the approval of software programs to be used by the pharmacist for prospective DUR and recommendations concerning…

Sec. 28.5. The therapeutics committee established under section 20.5 of this chapter shall do the following: (1) Advise and make recommendations to the board in the board's development and maintenance of a preferred drug list under section 28 of this chapter. (2) Submit to the bo…

Sec. 28.7. (a) The board shall submit the initial approved preferred drug list to the office not later than August 1, 2002. (b) Except as permitted under subsection (g), the office may not further restrict the status of a drug in the Medicaid program or the children's health insu…

Sec. 29. (a) A quorum consists of six (6) voting members of the board. (b) DUR criteria and standards for appropriate prescribing may only be implemented with the approval of a majority of the quorum of the board. The majority vote must include at least three (3) of the four (4) …

Sec. 3. As used in this chapter, "compendia" means those resources widely accepted by the medical profession in the efficacious use of drugs, including the following sources: (1) The American Hospital Formulary Services Drug Information. (2) The U.S. Pharmacopeia-Drug Information…

Sec. 30. The criteria and standards developed under section 28(a)(3) of this chapter for appropriate prescribing that are implemented must reflect the local practices of physicians to monitor the following: (1) Therapeutic appropriateness. (2) Overutilization or underutilization.…

Sec. 31. (a) An intervention developed under section 28(a)(4) of this chapter that involves a physician must be approved by at least three (3) of the four (4) physician members of the board before implementation. (b) An intervention that involves a pharmacist must be approved by …

Sec. 32.1. The annual report under section 28 of this chapter shall include information on the following: (1) A description of the nature and scope of the prospective drug review program. (2) A description of how pharmacies performing prospective DUR without computers are expecte…

Sec. 34. (a) Information that identifies an individual collected under this chapter is confidential and may not be disclosed by the board. (b) The board may have access to identifying information for purposes of carrying out intervention activities. The identifying information ma…

Sec. 35. (a) Except as provided in IC 12-15-35.5-9, before the board develops a program to place a single source drug on prior approval, restrict the drug in its use, or establish a drug monitoring process or program to measure or restrict utilization of single source drugs other…

Sec. 36. The board may establish advisory committees to assist the board in carrying out the board's duties under this chapter. As added by P.L.75-1992, SEC.19.

Sec. 37. The board shall, in cooperation with the secretary, include in the Medicaid state plan the creation and implementation of a retrospective and prospective DUR program for Medicaid outpatient drugs to ensure that the prescriptions are appropriate, medically necessary, and …