Title 12, TITLE 12. HUMAN SERVICES

Sec. 7. The secretary may adopt rules under IC 4-22-2 to do the following: (1) Establish criteria based on the functioning level of the residents. (2) Determine the personal allowance to which each resident is entitled. [Pre-1992 Revision Citation: 12-1-7.3-4(b).] As added by P.L…

exemption Sec. 8. A personal allowance is exempt from income eligibility consideration by the office. [Pre-1992 Revision Citation: 12-1-7.3-4(c).] As added by P.L.2-1992, SEC.9.

habilitation plan or working in sheltered workshop or day activity center Sec. 9. The personal allowance for one (1) month for an individual described in section 6 of this chapter whose employment is part of the individual's habilitation plan or who is working in a sheltered work…

Sec. 1. As used in this chapter, "committee" refers to the Medicaid advisory committee created by this chapter. [1992 Revision Citation: New.] As added by P.L.2-1992, SEC.9.

Sec. 10. (a) Appointed members of the committee other than members of the general assembly are entitled to receive travel allowance to and from regular or special meetings in accordance with the amounts set by and the provisions of the budget committee for state employees. (b) Ea…

Sec. 2. The Medicaid advisory committee is created to act in an advisory capacity to the following: (1) The office in the administration of the Medicaid program. (2) The children's health policy board established by IC 4-23-27-2 in the board's responsibility to direct policy coor…

Sec. 3. (a) The committee shall be appointed as follows: (1) One (1) member shall be appointed by the administrator of the office to represent each of the following organizations: (A) Indiana Council of Community Mental Health Centers. (B) Indiana State Medical Association. (C) I…

Sec. 4. An appointment to the committee terminates July 1 of the year in which the appointment expires, but a member serves until the member's successor is designated. [Pre-1992 Revision Citation: 12-1-13-1(d) part.] As added by P.L.2-1992, SEC.9.

Sec. 5. An appointment to the committee is for a four (4) year term, except the representatives of the senate and house of representatives, whose terms coincide with the representative's or senator's respective legislative terms. [Pre-1992 Revision Citation: 12-1-13-1(d) part.] A…

Sec. 6. The following shall serve as ex officio members of the committee: (1) The state health commissioner or the commissioner's designee. (2) The director of the division of mental health and addiction or the director's designee. (3) The administrator of the office. [Pre-1992 R…

Sec. 7. The administrator of the office shall serve as secretary of the committee. [Pre-1992 Revision Citation: 12-1-13-1(d) part.] As added by P.L.2-1992, SEC.9.

Sec. 8. (a) A subcommittee may be created as the committee considers necessary. (b) The committee shall create a standing fiscal subcommittee. (c) The chairman of each subcommittee must be a member of the committee. (d) Subcommittees may convene as often as needed. [Pre-1992 Revi…

Sec. 9. The committee shall do the following: (1) Meet at least four (4) times each year, one (1) time in each calendar quarter. (2) Hold special meetings that the committee or the secretary requests. [Pre-1992 Revision Citation: 12-1-13-1(f).] As added by P.L.2-1992, SEC.9.…

As added by P.L.140-2019, SEC.3. Amended by P.L.227-2019, SEC.1. Expired 7-1-2021 by P.L.140-2019, SEC.3.

Sec. 1. As used in this chapter, "home health agency" means a public or private organization, whether owned or operated by one (1) or more persons, that furnishes or offers to furnish home health services. [Pre-1992 Revision Citation: 12-1-7.5-1(a) part.] As added by P.L.2-1992, …

Sec. 10. A subcontract let by a prime contractor must be approved by the office and the Indiana department of administration. [Pre-1992 Revision Citation: 12-1-7.5-3 part.] As added by P.L.2-1992, SEC.9.

Sec. 11. The contractor or the subcontractor shall furnish the following information to the office: (1) The amount of the subcontract. (2) The qualifications of the subcontractor for guaranteeing performance. (3) Other data required by the state. [Pre-1992 Revision Citation: 12-1…

Sec. 12. Upon request, a contract or subcontract shall be made available to the legislative council or the council's representative for inspection and examination. [Pre-1992 Revision Citation: 12-1-7.5-3 part.] As added by P.L.2-1992, SEC.9.

Sec. 13. The office shall include in the division's state plan for the purchase of services under IC 4-23-17-9.3 (repealed) a comprehensive program for the provision of home health services to an individual who is eligible for Medicaid. [Pre-1992 Revision Citation: 12-1-7.5-4.] A…

Sec. 14. The office shall develop adequate utilization review procedures for home health agencies to conform to federal guidelines. [Pre-1992 Revision Citation: 12-1-7.5-5.] As added by P.L.2-1992, SEC.9.

Sec. 14.5. (a) This section is effective beginning July 1, 2017. (b) The office of the secretary may not reduce reimbursement for home health services. (c) 405 IAC 1-4.2-4(l) and any successor rule concerning reducing home health services reimbursement are void and may not be ren…

medical needs 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 asses…

As added by P.L.224-2017, SEC.5. Expired 12-31-2018 by P.L.224-2017, SEC.5.

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 …

by others under arrangements with home health agency; exception 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 an…

home health services 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 th…

of services and ensuring uniform equitable treatment of applicants and recipients 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 concern…

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. IC 12-15-35-16 "SURS" defined Sec. 16. As used in t…

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…

terms; votes; meetings 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 th…

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…