TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES

Amends 405 IAC 5-20-5 and 405 IAC 5-24-8 to clarify the validity of electronically written notes and signatures in compliance with IC 26-2-8-106. Effective 30 days after filing with the publisher.

SECTION 1. 405 IAC 5-20-5 IS AMENDED TO READ AS FOLLOWS:

Affected: IC 12-13-7-3; IC 12-15; IC 26-2-8-106

Sec. 5. Medicaid reimbursement is available for services in an inpatient psychiatric facility only when the member's need for admission has been certified. The certification of need must be completed as follows:

(1) By the attending physician or staff physician for a member between twenty-two (22) and sixty-five (65) years of age in a psychiatric hospital of sixteen (16) beds or less and for a member sixty-five (65) years of age and over.

(2) In accordance with 42 CFR 441.152(a), effective October 1, 1995 (not including secondary Code of Federal Regulations citations therein), and 42 CFR 441.153, effective October 1, 1995 (not including tertiary Code of Federal Regulations citations resulting therefrom), for an individual twenty-one (21) years of age and under.

(3) By telephone precertification review prior to admission for an individual who is a member of Medicaid when admitted to the facility as a nonemergency admission, to be followed by a written certification of need within ten (10) working days of admission.

(4) By telephone precertification review within forty-eight (48) hours of an emergency admission, not including Saturdays, Sundays, and legal holidays, to be followed by a written certification of need within fourteen (14) working days of admission. If the provider fails to call within forty-eight (48) hours of an emergency admission, not including Saturdays, Sundays, and legal holidays, Medicaid reimbursement shall be denied for the period from admission to the actual date of notification.

(5) In writing handwriting or electronically, consistent with IC 26-2-8-106, within ten (10) working days after receiving notification of an eligibility determination for an individual applying for Medicaid while in the facility and covering the entire period for which Medicaid reimbursement is being sought.

(6) In writing handwriting or electronically, consistent with IC 26-2-8-106, at least every sixty (60) days after admission, or as requested by the office to recertify that the member continues to require inpatient psychiatric hospital services.

SECTION 2. 405 IAC 5-24-8 IS AMENDED TO READ AS FOLLOWS:

Affected: IC 12-13-7-3; IC 12-15; IC 26-2-8-106

Sec. 8. (a) Prior authorization is required for a brand name drug that:

(1) is subject to generic substitution under Indiana law; and

(2) the prescriber has indicated is "brand medically necessary", either orally or in writing handwriting on the prescription or drug order, or typed in the comments of an electronic prescription.

(b) In order for prior authorization to be granted for a brand name drug, in such instances, the prescriber must:

(1) indicate on the prescription or drug order, in the prescriber's own handwriting or electronically typed in the comments of an electronic prescription, the phrase "brand medically necessary"; and

(2) seek prior authorization by substantiating the brand name drug is medically necessary as opposed to the less costly generic equivalent.

DIN: 20231101-IR-405230367FRA

Composed: May 19,2024 4:04:47PM EDT

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