Title 12, HUMAN SERVICES

Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027. Sec. 2. As used in this chapter, "commission" refers to the nonemergency medical transportation commission established by section 7 of this chapter. As added by …

Sec. 3. As used in this chapter, "nonemergency medical transportation" means medically necessary transportation to Medicaid covered services for an eligible Medicaid recipient who: (1) participates in the Medicaid fee-for-service program; and (2) does not have available transport…

Sec. 4. (a) A broker must do the following: (1) Submit monthly reports to the office of the secretary for the office of the secretary to post on the office of the secretary's website of the following: (A) A list and map by county of the number of vehicles, by vehicle type, that a…

Sec. 5. (a) A broker shall establish, implement, and maintain the following: (1) One (1) toll free telephone number clearly identified for the handling of complaints concerning the nonemergency medical transportation services. (2) A link on the home page of the broker's website t…

Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027. Sec. 6. (a) Before October 1, 2019, the office of the secretary shall prepare a report containing the number of Medicaid fee-for-service nonemergency medical tra…

Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027. Sec. 7. (a) The nonemergency medical transportation commission is established for the purpose of overseeing the provision of nonemergency medical transportation …

Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027. Sec. 8. (a) Each member of the commission who is not a state employee is entitled to the minimum salary per diem provided by IC 4-10-11-2.1(b). Such a member is …

Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027. Sec. 9. The commission shall meet at least two (2) times per year at a public meeting to do the following: (1) Review a report submitted under this chapter. (2) …

Sec. 1. At least once every two (2) years, the office shall conduct a survey of pharmacy providers to assess the appropriate level of dispensing fees to be paid to providers for prescribed drugs. As added by P.L.15-2002, SEC.1.

Sec. 2. A survey under section 1 of this chapter must include an evaluation of dispensing fees in other states and the policies of the federal Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration). As added by P.L.15-2002, SEC.1.

Sec. 3. A dispensing fee shall be evaluated based upon the following information concerning the costs of pharmacy operation: (1) Operational data. (2) Professional services data. (3) Overhead data. (4) Profit data. As added by P.L.15-2002, SEC.1.

Sec. 4. If an adjustment in dispensing fees is made following a survey conducted under section 1 of this chapter, the secretary shall commence the rulemaking process under IC 4-22-2 to make the adjustment not later than November 1 of the year in which the survey was conducted. As…

Sec. 1. As used in this chapter, "commission" refers to the Medicaid beneficiary advisory commission created by section 2 of this chapter. As added by P.L.26-2025, SEC.11.

Sec. 2. The Medicaid beneficiary advisory commission is created under the executive branch of government to act in an advisory capacity to the office in matters related to policy development and in the effective administration of the Medicaid program. As added by P.L.26-2025, SEC…

Sec. 3. (a) The commission is composed of individuals who: (1) are: (A) current and former Medicaid beneficiaries; and (B) family members and caregivers of current and former Medicaid beneficiaries; and (2) are appointed as follows: (A) Four (4) members appointed by the administr…

Sec. 4. (a) Except as provided in subsection (b), and subject to subsection (c), an appointment to the commission is for a four (4) year term that expires as follows: (1) For a member appointed under section 3(a)(2)(A) of this chapter, December 31, 2027, and every fourth year the…

Sec. 5. The office shall provide staff support to the commission. As added by P.L.26-2025, SEC.11.

Sec. 6. The commission shall: (1) meet at least four (4) times each year, with one (1) meeting held in each calendar quarter; and (2) hold special meetings at the request of the commission or the secretary. As added by P.L.26-2025, SEC.11.

Sec. 7. (a) Each member of the commission who is not a state employee is entitled to the minimum salary per diem provided by IC 4-10-11-2.1(b). The member is also entitled to reimbursement for mileage, traveling expenses as provided under IC 4-13-1-4, and other expenses actually …

Sec. 1. As used in this chapter, "committee" refers to the Medicaid clinical advisory committee established under this chapter. As added by P.L.42-1995, SEC.25.

Sec. 2. The office shall establish a clinical advisory committee to provide clinical insights and applications of clinical policy issues related to programs administered by the office, including issues related to: (1) current standards of care; (2) quality of care; (3) accessibil…

Sec. 3. (a) The committee consists of at least seven (7) members and not more than thirteen (13) members. (b) The office's medical consultant shall serve as the chairperson of the committee. (c) The committee shall include at least seven (7) physicians who are: (1) licensed under…

Sec. 1. This chapter applies to: (1) the Medicaid program under this article; and (2) the children's health insurance program under IC 12-17.6. As added by P.L.6-2002, SEC.4. Amended by P.L.101-2005, SEC.5.

Sec. 10. (a) As used in this section, "340B covered entity" means an entity authorized to participate in the federal 340B Drug Pricing Program under Section 340B(a)(4) of the federal Public Health Service Act (42 U.S.C. 256b(a)(4)) and includes any pharmacy under contract with th…

Sec. 2. As used in this chapter, "cross-indicated drug" means a drug that is used for a purpose generally held to be reasonable, appropriate, and within the community standards of practice even though the use is not included in the federal Food and Drug Administration's approved …

Sec. 2.6. As used in this chapter, "waste" means inappropriate: (1) overprescribing; (2) underprescribing; (3) overutilization; (4) underutilization; (5) recipient noncompliance with the prescribed regimen; or (6) clinically unjustified utilization; of a prescription drug. As add…

Sec. 3. The office may establish prior authorization requirements for drugs covered under a program described in section 1 of this chapter. As added by P.L.6-2002, SEC.4. Amended by P.L.101-2005, SEC.6; P.L.1-2009, SEC.104; P.L.229-2011, SEC.143; P.L.154-2015, SEC.3; P.L.213-2025…

Sec. 4. Prior authorization requirements developed under this chapter must: (1) comply with all applicable state and federal laws, including the provisions of 405 IAC 5-3 and 42 U.S.C. 1396r-8(d)(5); and (2) provide that the prior authorization number assigned to an approved requ…

Sec. 5. Before requiring prior authorization for a single source drug, the office shall seek the advice of the drug utilization review board, established by IC 12-15-35-19, at a public meeting of the board. As added by P.L.6-2002, SEC.4.

Sec. 6. (a) The office shall publish the decision to require prior authorization for a single source drug in a provider bulletin. (b) IC 12-15-13-6 applies to a provider bulletin described in subsection (a). As added by P.L.6-2002, SEC.4.

Sec. 7. (a) Subject to subsection (b), the office may place limits on quantities dispensed or the frequency of refills for any covered drug as required by law or for the purpose of: (1) preventing fraud, abuse, or waste; (2) preventing overutilization, inappropriate utilization, …

Sec. 7.5. (a) The office may reimburse under Medicaid for methadone if the drug was prescribed for the treatment of pain or pain management only as follows: (1) If the daily dosage is not more than sixty (60) milligrams. (2) If the daily dosage is more than sixty (60) milligrams,…

Sec. 8. In addition to the limits described in section 7 of this chapter, the office may restrict a mental health drug described in section 3 of this chapter that is prescribed for an individual who is less than eighteen (18) years of age if federal financial participation is not…

Sec. 9. The office may not reimburse under Medicaid for Subutex, Suboxone, or a similar trade name or generic of the drug if the drug is only indicated for addiction treatment and was prescribed for the treatment of pain or pain management. As added by P.L.37-2016, SEC.2. Amended…

Sec. 0.5. (a) Notwithstanding IC 12-15-39.8, the asset disregard under section 10 of this chapter applies to any qualified long term care policy to which this chapter applies. (b) This chapter does not apply to a qualified long term care policy issued after the long term care pro…

Sec. 1. As used in this chapter, "long term care" means the provision of the following services in a setting other than an acute care wing of a hospital to enable individuals whose functional capacities are chronically impaired to be maintained at their maximum level of health an…

Sec. 10. (a) As used in this section, "asset disregard" means one (1) of the following: (1) A one dollar ($1) increase in the amount of assets an individual who: (A) purchases a qualified long term care policy; and (B) meets the requirements under section 8 of this chapter; may r…

Sec. 11. A public program administered by the state that: (1) provides long term care services; and (2) bases eligibility upon the amount of the individual's assets; must apply the asset disregard under section 10 of this chapter in determining the amount of the individual's asse…

Sec. 12. If the Indiana long term care program is discontinued, an individual who purchased a qualified long term care policy prior to the date the program is discontinued is eligible to receive an asset disregard as defined under section 10 of this chapter. As added by P.L.24-19…

Sec. 13. The office of Medicaid policy and planning may enter into reciprocal agreements with other states to extend the asset disregard under section 10 of this chapter to Indiana residents who had purchased qualified long term care policies in other states. As added by P.L.24-1…

Sec. 14. The secretary of family and social services may adopt rules under IC 4-22-2 necessary to implement this chapter. As added by P.L.24-1997, SEC.53.

Sec. 15. An individual who: (1) owns, as of January 1, 1998, a qualified long term care policy; and (2) has not exhausted the benefits of the qualified long term care policy described in subdivision (1); is entitled to receive an asset disregard as provided in section 10 of this …

Sec. 2. As used in this chapter, "long term care facility" means a facility licensed under IC 16-28. As added by P.L.24-1997, SEC.53.

Sec. 3. (a) As used in this chapter, "long term care insurance" means insurance coverage for at least twelve (12) consecutive months for each covered person on an expense incurred, indemnity, or prepaid basis for one (1) or more necessary long term care services provided in a set…

Sec. 4. As used in this chapter, "health maintenance organization" has the meaning set forth in IC 27-13-1-19. As added by P.L.24-1997, SEC.53.

Sec. 5. As used in this chapter, "qualified long term care policy" means an insurance policy that: (1) provides long term care insurance; (2) meets: (A) the definition set forth in IC 27-8-12-5; and (B) the standards established under IC 27-8-12-7.1; and (3) is issued by an insur…