-IR- Database Guide
-IR- Database: Indiana Register
IAC Titles     Current IR
TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES

Notice of Intent to Readopt
LSA Document #22-205

Readopts rules in anticipation of IC 4-22-2.5-2, providing that an administrative rule adopted under IC 4-22-2 expires January 1 of the seventh year after the year in which the rule takes effect unless the rule contains an earlier expiration date. Effective 30 days after filing with the Publisher.

OVERVIEW: Rules to be readopted without changes are as follows:
  405 IAC 1-1-2  Choice of provider and use of Medicaid card 
  405 IAC 1-1-13  Subrogation of claims 
  405 IAC 1-1-14  Severability; governing provisions; effect of provision inconsistent or invalid with federal law 
  405 IAC 1-1-16  Insurance information; release 
  405 IAC 1-4.3  Additional Rate-Setting Criteria for Nursing Facilities, Community Residential Facilities for the Developmentally Disabled, and Intermediate Care Facilities for the Mentally Retarded 
  405 IAC 1-8-2  Policy; scope 
  405 IAC 1-8-4  Client copayment 
  405 IAC 1-10.5-1  Policy; scope 
  405 IAC 1-10.5-3  Prospective reimbursement methodology 
  405 IAC 1-11.5  Reimbursement for Services Performed by Physicians, Limited License Practitioners, and Nonphysician Practitioners 
  405 IAC 1-12-9  Criteria limiting rate adjustment granted by office 
  405 IAC 1-12-15  Allowable costs; capital return factor; use fee; depreciable life; property basis 
  405 IAC 1-12-19  Allowable costs; wages; costs of employment; record keeping; owner or related party compensation 
  405 IAC 1-12-22  Community residential facilities for the developmentally disabled; allowable costs; compensation; per diem rate 
  405 IAC 1-12-23  Medical or nonmedical supplies and equipment; personal care items 
  405 IAC 1-12-24  Assessment methodology 
  405 IAC 1-12-25  Reimbursement for day services 
  405 IAC 1-12-26  Administrative reconsideration; appeal 
  405 IAC 1-13  Disproportionate Share Hospital Payments 
  405 IAC 1-14.6-5  New provider; initial financial report to office; criteria for establishing initial interim rates 
  405 IAC 1-14.6-16  Unallowable costs; cost adjustments; charity and courtesy allowances; discounts; rebates; refunds of expenses 
  405 IAC 1-14.6-19  Medical or nonmedical supplies and equipment 
  405 IAC 1-14.6-20  Nursing facilities reimbursement for therapy services 
  405 IAC 1-16  Reimbursement for Hospice Services 
  405 IAC 1-17-1  Policy; scope 
  405 IAC 1-17-2  Definitions 
  405 IAC 1-17-4  Financial report to office; annual schedule; prescribed form; extensions 
  405 IAC 1-17-7  Request for rate review; budget component; occupancy level assumptions; effect of inflation assumptions 
  405 IAC 1-17-17  State-owned facilities per diem rate 
  405 IAC 1-18  Reimbursement of Medicare Cross-Over Claims 
  405 IAC 1-19-2  Time and manner of disclosure 
  405 IAC 1-20-1  General 
  405 IAC 1-20-2  Notification requirements 
  405 IAC 1-20-4  Change of ownership effect 
  405 IAC 1-21  Payments for Psychiatric Residential Treatment Facility Services 
  405 IAC 5-1  General Provisions 
  405 IAC 5-2-3  "Attending provider" defined 
  405 IAC 5-2-6  "Covered service" defined 
  405 IAC 5-2-9  "Emergency service" defined 
  405 IAC 5-2-10.5  "HCPCS" defined 
  405 IAC 5-2-11.5  "ICF/IID" defined 
  405 IAC 5-2-12  "Inpatient services" defined 
  405 IAC 5-2-13  "ICD-10-CM" defined 
  405 IAC 5-2-13.2  "IEP nursing services" defined 
  405 IAC 5-2-15  "Level of care" defined 
  405 IAC 5-2-15.5  "Medicaid" defined 
  405 IAC 5-2-16  "Medical policy" defined 
  405 IAC 5-2-17  "Medically necessary service" defined 
  405 IAC 5-2-17.5  "Member" defined 
  405 IAC 5-2-18  "Office" defined 
  405 IAC 5-2-19  "Outpatient services" defined 
  405 IAC 5-2-20  "Prior authorization" defined 
  405 IAC 5-2-21  "Provider" defined 
  405 IAC 5-2-22  "Provider agreement" defined 
  405 IAC 5-2-24  "Reimbursement" defined 
  405 IAC 5-2-29  "Usual and customary charge" defined 
  405 IAC 5-3-1  Prior authorization; generally 
  405 IAC 5-3-2  Prior authorization by telephone 
  405 IAC 5-3-4  Audit 
  405 IAC 5-3-6  Telephone requests for prior authorization; contents 
  405 IAC 5-3-7  Determination of member eligibility 
  405 IAC 5-3-8  Limitations 
  405 IAC 5-3-9  Prior authorization after services have begun 
  405 IAC 5-3-10  Providers who may submit prior authorization requests 
  405 IAC 5-3-11  Criteria for prior authorization 
  405 IAC 5-3-12  Prior authorization; exceptions 
  405 IAC 5-3-13  Services requiring prior authorization 
  405 IAC 5-3-14  Prior authorization decision; time limit 
  405 IAC 5-5-3  Out-of-state suppliers of medical equipment 
  405 IAC 5-6  Restricted Utilization 
  405 IAC 5-7  Administrative Review and Appeals of Prior Authorization Determinations 
  405 IAC 5-8-2  "Consultation" defined 
  405 IAC 5-8-3  Restrictions 
  405 IAC 5-8-4  Confirmatory consultations 
  405 IAC 5-9-1  Limitations 
  405 IAC 5-9-2  Restrictions 
  405 IAC 5-10-1  Providers eligible for reimbursement 
  405 IAC 5-10-3  Reimbursement parameters 
  405 IAC 5-10-5  Noncovered services 
  405 IAC 5-12-1  Reimbursement 
  405 IAC 5-12-2  Office visits 
  405 IAC 5-12-3  Chiropractic x-ray services 
  405 IAC 5-13-1  Policy; definitions 
  405 IAC 5-13-2  Reimbursement 
  405 IAC 5-13-3  Services included in the per diem rate for large private and small ICFs/IID 
  405 IAC 5-13-6  Reserving beds 
  405 IAC 5-13-7  Admission and placement; large private and small ICFs/IID 
  405 IAC 5-13-8  Admission to large state ICFs/IID 
  405 IAC 5-13-10  Transfer to another ICF/IID 
  405 IAC 5-14-1  Policy 
  405 IAC 5-14-2  Covered services 
  405 IAC 5-14-3  Diagnostic services 
  405 IAC 5-14-4  Topical fluoride 
  405 IAC 5-14-5  Treatment of dental caries 
  405 IAC 5-14-6  Prophylaxis 
  405 IAC 5-14-7  Periodontal root planing and scaling 
  405 IAC 5-14-15  General anesthesia and intravenous sedation 
  405 IAC 5-14-18  Hospital admissions for covered dental services or procedures 
  405 IAC 5-14-19  Prior authorization for early and periodic screening, diagnostic, and treatment covered services 
  405 IAC 5-14-20  Dental services provided in a state owned ICF/IID 
  405 IAC 5-14-21  Maxillofacial surgery 
  405 IAC 5-15-1  Policy 
  405 IAC 5-15-2  Initial screening 
  405 IAC 5-15-3  Periodic screening 
  405 IAC 5-15-4  Treatment 
  405 IAC 5-15-6  Member and provider participation 
  405 IAC 5-16-1  Providers eligible for reimbursement 
  405 IAC 5-16-5  Rural health clinics and federally qualified health clinics; reimbursement 
  405 IAC 5-16-6  Freestanding clinics and surgical centers; limitations 
  405 IAC 5-16.5  Freestanding Birthing Center Services 
  405 IAC 5-17-1  Reimbursement; limitations 
  405 IAC 5-17-2  Prior authorization; generally 
  405 IAC 5-17-4  Physical rehabilitation services 
  405 IAC 5-17-5  Inpatient detoxification, rehabilitation, and aftercare for chemical dependency 
  405 IAC 5-18-3  Inpatient and outpatient laboratory facilities; limitations 
  405 IAC 5-18-4  Nonanatomical laboratory procedures 
  405 IAC 5-19-3  Reimbursement parameters for durable medical equipment 
  405 IAC 5-19-4  Repair of purchased durable medical equipment 
  405 IAC 5-19-5  Reimbursement for replacement durable medical equipment 
  405 IAC 5-19-6  Durable medical equipment subject to prior authorization 
  405 IAC 5-19-8  Ownership of durable medical equipment 
  405 IAC 5-19-9  Wheelchairs and similar motorized vehicles 
  405 IAC 5-19-11  Prosthetic devices 
  405 IAC 5-19-12  Home hemodialysis equipment 
  405 IAC 5-19-14  Hearing aids; maintenance and repair 
  405 IAC 5-19-15  Hearing aids; replacement 
  405 IAC 5-19-16  Augmentative communication devices 
  405 IAC 5-19-17  Pneumatic artificial voicing systems 
  405 IAC 5-20-1  Reimbursement limitations 
  405 IAC 5-20-2  Reserving beds in psychiatric hospitals and psychiatric residential treatment facilities 
  405 IAC 5-20-3  Requirements for psychiatric hospitals 
  405 IAC 5-20-3.1  PRTF; requirements 
  405 IAC 5-20-4  Individually developed plan of care 
  405 IAC 5-20-5  Certification of need for admission 
  405 IAC 5-20-7  Unnecessary services 
  405 IAC 5-20-8  Outpatient mental health services 
  405 IAC 5-21.5-1  Definitions 
  405 IAC 5-21.5-2  Reimbursement 
  405 IAC 5-21.5-3  Behavioral health rehabilitation services 
  405 IAC 5-21.5-4  Behavioral health counseling and therapy 
  405 IAC 5-21.5-5  Medication training and support 
  405 IAC 5-21.5-6  Skills training and development 
  405 IAC 5-21.5-7  Behavioral health level of need redetermination 
  405 IAC 5-21.5-8  Crisis intervention 
  405 IAC 5-21.5-9  Child and adolescent intensive resiliency services 
  405 IAC 5-21.5-10  Adult intensive rehabilitative services 
  405 IAC 5-21.5-11  Intensive alcohol or drug (substance-related disorder) outpatient treatment 
  405 IAC 5-21.5-12  Alcohol or drug (substance-related disorder) counseling 
  405 IAC 5-21.5-13  Peer recovery services 
  405 IAC 5-21.5-14  Case management services 
  405 IAC 5-21.5-15  Psychiatric assessment and intervention 
  405 IAC 5-21.5-17  Prior authorization 
  405 IAC 5-21.6-2  Definitions 
  405 IAC 5-21.6-3  Applicants and the application process 
  405 IAC 5-21.6-4  Eligibility 
  405 IAC 5-21.6-5  Eligibility period; renewal 
  405 IAC 5-21.6-6  Clinical documentation requirements 
  405 IAC 5-21.6-7  Coverage requirements; limits 
  405 IAC 5-21.6-8  Adult day services 
  405 IAC 5-21.6-9  Home and community-based habilitation and support services 
  405 IAC 5-21.6-10  Respite care services 
  405 IAC 5-21.6-11  Therapy and behavioral support services 
  405 IAC 5-21.6-12  Addiction counseling services 
  405 IAC 5-21.6-13  Peer support services 
  405 IAC 5-21.6-14  Supported community engagement services 
  405 IAC 5-21.6-15  Care coordination services 
  405 IAC 5-21.6-16  Medication training and support services 
  405 IAC 5-21.6-17  AMHH provider agency requirements 
  405 IAC 5-21.6-18  Fair hearings and appeals 
  405 IAC 5-21.6-19  Complaints and grievances 
  405 IAC 5-21.7-1  General provisions 
  405 IAC 5-21.7-2  Definitions 
  405 IAC 5-21.7-3  Applicants and the application process 
  405 IAC 5-21.7-4  Independent assessment and evaluation 
  405 IAC 5-21.7-5  Eligibility and needs-based criteria 
  405 IAC 5-21.7-6  Individualized plan of care 
  405 IAC 5-21.7-7  Member freedom of choice 
  405 IAC 5-21.7-8  Eligibility period 
  405 IAC 5-21.7-9  Coverage requirements and limits 
  405 IAC 5-21.7-10  Provider certification and application process 
  405 IAC 5-21.7-11  Provider authorization and service provider qualifications 
  405 IAC 5-21.7-12  Provider training 
  405 IAC 5-21.7-13  Provider reauthorization 
  405 IAC 5-21.7-15  Services: general provisions 
  405 IAC 5-21.7-16  Wraparound facilitation services 
  405 IAC 5-21.7-17  Habilitation services 
  405 IAC 5-21.7-18  Respite care services 
  405 IAC 5-21.7-19  Training and support for unpaid caregiver services 
  405 IAC 5-21.7-20  Fair hearings and appeals 
  405 IAC 5-21.7-21  Complaints and grievances 
  405 IAC 5-21.8-2  Definitions 
  405 IAC 5-21.8-3  Applicants and the application process 
  405 IAC 5-21.8-4  Eligibility 
  405 IAC 5-21.8-5  IICP authorization period; renewal 
  405 IAC 5-21.8-6  Clinical documentation requirements 
  405 IAC 5-21.8-7  BPHC services; general provisions 
  405 IAC 5-21.8-8  BPHC activities 
  405 IAC 5-21.8-9  BPHC provider agency requirements 
  405 IAC 5-21.8-10  Fair hearings and appeals 
  405 IAC 5-21.8-11  Complaints and grievances 
  405 IAC 5-22-1  Definitions 
  405 IAC 5-22-2  Nursing services; prior authorization requirements 
  405 IAC 5-22-3  Certified nurse midwife services 
  405 IAC 5-22-7  Audiology services 
  405 IAC 5-22-8  Physical therapy services 
  405 IAC 5-22-9  Speech pathology services 
  405 IAC 5-22-10  Respiratory therapy services 
  405 IAC 5-22-11  Occupational therapy services 
  405 IAC 5-23-2  Initial examinations 
  405 IAC 5-23-3  Covered vision care services 
  405 IAC 5-23-4  Frames and lenses; limitations 
  405 IAC 5-23-5  Contact lenses 
  405 IAC 5-24-1  Reimbursement policy 
  405 IAC 5-24-3  Coverage of legend drugs 
  405 IAC 5-24-8  Prior authorization; brand name drugs 
  405 IAC 5-24-9  Food supplements, nutritional supplements, and infant formulas 
  405 IAC 5-24-13  Legend and nonlegend solutions for nursing facility residents 
  405 IAC 5-24-14  Skin protectants, sealants, moisturizers, and ointments for nursing facility residents 
  405 IAC 5-25-1  Applicability 
  405 IAC 5-25-2  Reimbursement exclusions and limitations 
  405 IAC 5-25-4  Injections administered by physicians 
  405 IAC 5-26-2  General restrictions 
  405 IAC 5-26-7  Podiatric office visits 
  405 IAC 5-26-8  Doppler evaluations 
  405 IAC 5-26-10  Surgical procedures; confirmatory consultations 
  405 IAC 5-28-1  Reimbursement limitations 
  405 IAC 5-28-4  Single-chamber cardiac pacemaker implantation 
  405 IAC 5-28-5  Dual-chamber cardiac pacemaker implantation 
  405 IAC 5-28-8  Sterilization 
  405 IAC 5-28-9  Hysterectomy 
  405 IAC 5-29  Services Not Covered by Medicaid 
  405 IAC 5-30-1  Reimbursement restrictions 
  405 IAC 5-30-2  Copayments for transportation services 
  405 IAC 5-30-3  Noncovered transportation services 
  405 IAC 5-30-4  Prior authorization 
  405 IAC 5-30-5  Ambulance services 
  405 IAC 5-30-6  Intrastate wheelchair/nonambulatory services 
  405 IAC 5-30-7  Intrastate commercial ambulatory services 
  405 IAC 5-30-8  Reimbursement for additional passengers 
  405 IAC 5-30-9  Reimbursement for family member transportation services 
  405 IAC 5-30-10  Reimbursement for other transportation services 
  405 IAC 5-31-1  Reimbursement 
  405 IAC 5-31-1.1  "Nursing facility services" defined 
  405 IAC 5-31-4  Per diem services 
  405 IAC 5-31-4.5  Per diem services, state nursing facility 
  405 IAC 5-31-5  Legend and prescription items 
  405 IAC 5-31-9  Prior authorization for services rendered outside the state nursing facility 
  405 IAC 5-34-1  Policy 
  405 IAC 5-34-2  Provider enrollment 
  405 IAC 5-34-4  Hospice authorization and benefit periods 
  405 IAC 5-34-4.1  Appeals of hospice authorization determinations 
  405 IAC 5-34-4.2  Audit 
  405 IAC 5-34-5  Physician certification 
  405 IAC 5-34-6  Election of hospice services 
  405 IAC 5-34-7  Plan of care 
  405 IAC 5-34-8  Covered services 
  405 IAC 5-34-9  Levels of care 
  405 IAC 5-34-10  Location of care 
  405 IAC 5-34-11  Prior authorization for nonhospice services 
  405 IAC 5-34-12  Reservation of beds for hospice members in nursing facilities 
  405 IAC 5-36-1  DSMT policy; definitions 
  405 IAC 5-36-3  Limitations on coverage of DSMT 
  405 IAC 5-37  Tobacco Dependence Treatment Policy 

Requests for any part of this readoption to be separate from this action must be made in writing within 30 days of this publication. Send written comments to the Small Business Regulatory Coordinator for this rule (see IC 4-22-2-28.1):
William Martin
Office of General Counsel
Indiana Family and Social Services Administration
Indiana Government Center South
402 West Washington Street, Room W451
Indianapolis, IN 46204
(317) 232-8208
william.martin@fssa.in.gov

For purposes of IC 4-22-2-28.1, the Small Business Ombudsman designated by IC 5-28-17-6 is:
Emily Totten
Small Business Ombudsman
Indiana Economic Development Corporation
One North Capitol, Suite 700
Indianapolis, IN 46204
(317) 402-3062
etotten@iedc.in.gov
Resources available to regulated entities through the small business ombudsman include the ombudsman's duties stated in IC 5-28-17-6, specifically IC 5-28-17-6(9), investigating and attempting to resolve any matter regarding compliance by a small business with a law, rule, or policy administered by a state agency, either as a party to a proceeding or as a mediator.

Posted: 06/08/2022 by Legislative Services Agency

DIN: 20220608-IR-405220205RNA
Composed: Apr 19,2024 1:45:27AM EDT
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