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IC 12-16-6.5-1.2
Appeal; notice
Sec. 1.2. (a) If the division determines that an item or service
identified in a claim:
(1) 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
(2) 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);
the affected person or provider may appeal to the division not later
than ninety (90) days after the mailing of the notice of that
determination to the affected person or provider to the last known
address of the person or provider.
(b) If the division determines that an 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);
but the affected provider disagrees with the amount of the claim
calculated by the division under IC 12-16-5.5-1.2(b), the affected
provider may appeal the calculation to the division not later than
ninety (90) days after the mailing of the notice of that calculation to
the affected provider to the last known address of the provider.
As added by P.L.145-2005, SEC.18. Amended by P.L.212-2007,
SEC.23; P.L.218-2007, SEC.34.
IC 12-16-6.5-1.5
Patient eligibility determination
Sec. 1.5. Subject to IC 12-16-5.5-3(c), if the division fails to
complete an investigation and determination of a person's eligibility
for the hospital care for the indigent program not later than forty-five
(45) days after receipt of the application filed under IC 12-16-4.5, the
person is considered to be eligible without the division's
determination of assistance under the program.
As added by P.L.145-2005, SEC.19.
IC 12-16-6.5-1.7
Item or service eligibility determination
Sec. 1.7. Subject to IC 12-16-5.5-3.2(c), if the division fails to
complete an investigation and determination of one (1) or more
health care items or services identified in a claim within forty-five
(45) days after receipt of the claim filed under IC 12-16-4.5, the item
or service is considered to have been:
(1) 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) 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).
As added by P.L.145-2005, SEC.20.
IC 12-16-6.5-2
Repealed
(Repealed by P.L.145-2005, SEC.31.)
IC 12-16-6.5-3
Hearing
Sec. 3. The division shall fix a time and place for a hearing before
a hearing officer appointed by the director of the division.
As added by P.L.120-2002, SEC.22.
IC 12-16-6.5-4
Notice of hearing
Sec. 4. A notice of the hearing shall be served upon all persons
interested in the matter, including any affected provider, at least
twenty (20) days before the time fixed for the hearing.
As added by P.L.120-2002, SEC.22. Amended by P.L.255-2003,
SEC.33; P.L.212-2007, SEC.24; P.L.218-2007, SEC.35.
IC 12-16-6.5-5
Determination of eligibility for assistance and health care items or
services; entitled to assistance
Sec. 5. (a) If the division receives an application that was filed on
behalf of a person under IC 12-16-4.5, the division shall determine:
(1) the eligibility of the person for assistance under the hospital
care for the indigent program; and
(2) if the health care items or services provided to the person
and identified in a claim filed with the division under
IC 12-16-4.5 were:
IC 12-16-6.5-6
Appeal
Sec. 6. A person, hospital, physician, or transportation provider
aggrieved by a determination of an appeal taken under section 1 or
1.2 of this chapter may appeal the determination under IC 4-21.5.
As added by P.L.120-2002, SEC.22. Amended by P.L.145-2005,
SEC.22.
IC 12-16-6.5-7
Rules; administrative appeal procedure; provisions
Sec. 7. (a) The division shall adopt rules under IC 4-22-2 that
provide for an administrative appeal procedure that is responsive to
the needs of patients and providers.
(b) The procedure must provide for the following:
(1) The location of hearings.
(2) The presentation of evidence.
(3) The use of telecommunications.
As added by P.L.120-2002, SEC.22.
IC 12-16-6.5-8
Repealed
(Repealed by P.L.255-2003, SEC.55.)