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IC 12-16-5.5-2
Disclosure of information by provider; immunity
Sec. 2. (a) The provider of medical care to a patient shall provide
information the provider has that would assist in the verification of
indigency of a patient.
(b) A provider that provides information under subsection (a) is
immune from civil and criminal liability for divulging the
information.
As added by P.L.120-2002, SEC.21. Amended by P.L.212-2007,
SEC.19; P.L.218-2007, SEC.30.
IC 12-16-5.5-3
Denial of eligibility claim; notice; eligibility information
Sec. 3. (a) Subject to subsection (b) and IC 12-16-6.5-1.5, if the
division is unable after prompt and diligent efforts to verify
information contained in the application that is reasonably necessary
to determine eligibility, the division may deny assistance under the
hospital care for the indigent program. The pending expiration of the
period specified in IC 12-16-6.5-1.5 is not a valid reason for denying
a person's eligibility for the hospital care for the indigent program.
(b) Before denying assistance under the hospital care for the
indigent program, the division must provide the person and the
provider who submitted a claim under IC 12-16-4.5-8.5 written
notice of:
(1) the specific information or verification needed to determine
eligibility;
(2) the specific efforts undertaken to obtain the information or
verification; and
(3) the statute or rule requiring the information or verification
identified under subdivision (1).
(c) The division must provide the provider who submitted a claim
under IC 12-16-4.5-8.5 a period of time, not less than ten (10) days
beyond the deadline established under IC 12-16-6.5-1.5, to submit to
the division information concerning the person's eligibility. If the
division does not make a determination of the person's eligibility
within ten (10) days after receiving the information under this
subsection, the person is eligible without the division's determination
of the person's eligibility for the hospital care for the indigent care
program under this article.
As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003,
SEC.29; P.L.145-2005, SEC.15; P.L.212-2007, SEC.20;
P.L.218-2007, SEC.31.
IC 12-16-5.5-3.2
Denial of item or service claim; notice; item or service information
Sec. 3.2. (a) Subject to subsection (b) and IC 12-16-6.5-1.7, if the
division is unable after prompt and diligent efforts to determine that
a health care item or service identified in a claim:
(1) was necessitated by one (1) or more of the medical
conditions listed in IC 12-16-3.5-1(a)(1) through
IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through
IC 12-16-3.5-2(a)(3); or
(2) was a direct consequence of one (1) or more of the medical
conditions listed in IC 12-16-3.5-1(a)(1) through
IC 12-16-3.5-1(a)(3);
the division may deny assistance to the person under the hospital care
for the indigent program for that item or service. The pending
expiration of the period specified in IC 12-16-6.5-1.7 is not a valid
reason for determining that an item or a service was not necessitated
by one (1) or more of the medical conditions listed in
IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or
IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3), or was not a
direct consequence of one (1) or more of the medical conditions
listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
(b) Before denying assistance under the hospital care for the
indigent program for an item or a service described in subsection (a),
the division must provide the provider of the item or service written
notice of:
(1) the specific item or service in question; and
(2) an explanation of the basis for the division's inability to
determine that the health care item or service was:
IC 12-16-5.5-4
Notification to person and provider; requirements
Sec. 4. The division shall notify in writing the person and the
provider of the following:
(1) A decision concerning eligibility.
(2) The reasons for a denial of eligibility.
(3) That either party has the right to appeal the decision.
As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003,
SEC.30; P.L.212-2007, SEC.21; P.L.218-2007, SEC.32.
IC 12-16-5.5-5
Repealed
(Repealed by P.L.255-2003, SEC.55.)