2015 Indiana Code TITLE 12. HUMAN SERVICES ARTICLE 15. MEDICAID CHAPTER 1.3. MEDICAID WAIVERS AND PLAN AMENDMENTS
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IC 12-15-1.3
Chapter 1.3. Medicaid Waivers and Plan Amendments
IC 12-15-1.3-1
Waivers to implement intent of P.L.46-1995; expiration of section
Sec. 1. (a) The terms and conditions of any waivers that are
obtained by the state from the United States Department of Health
and Human Services or the United States Department of Agriculture
before January 1, 1995:
(1) are valid;
(2) comply with the legislative intent of P.L.46-1995;
(3) need not be resubmitted for approval; and
(4) may be implemented until the terms and conditions of any
waivers requested under P.L.46-1995 are received and affidavits
are filed with the governor's office and the budget committee
attesting that the necessary waiver requests have been approved.
(b) The office of the secretary and the office of Medicaid policy
and planning shall:
(1) provide the greatest effort possible to secure all federal
waivers required under P.L.46-1995; and
(2) reapply for waivers required under P.L.46-1995 but denied
by:
(A) the Secretary of the United States Department of Health
and Human Services;
(B) the Secretary of the United States Department of
Agriculture; or
(C) both the officials described in clauses (A) and (B).
(c) This section expires on the date that all waivers requested
under P.L.46-1995 have been obtained.
As added by P.L.220-2011, SEC.264.
IC 12-15-1.3-2
Application of waivers under P.L.46-1995 to certain persons;
expiration of section
Sec. 2. (a) Any part of P.L.46-1995 that requires a waiver from the
United States Department of Health and Human Services or the
United States Department of Agriculture does not apply to a person
who first received assistance under IC 12-14 before January 1, 1994.
(b) This section expires on the later of the following:
(1) January 1, 1996.
(2) Ninety (90) days after the date that all waivers required to
implement P.L.46-1995 have been approved.
As added by P.L.220-2011, SEC.264.
IC 12-15-1.3-3
Application of waivers under P.L.46-1995 to certain persons;
expiration of section
Sec. 3. (a) Any part of P.L.46-1995 that requires a waiver from the
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United States Department of Health and Human Services or the
United States Department of Agriculture does not apply to a person
who first received assistance under IC 12-14 after December 31,
1993.
(b) This section expires on the later of the following:
(1) January 1, 1997.
(2) Fifteen (15) months after the date that all waivers required
to implement P.L.46-1995 have been approved.
As added by P.L.220-2011, SEC.264.
IC 12-15-1.3-4
Waivers to implement P.L.257-1997
Sec. 4. The division of family resources shall seek any available
waivers from the Secretary of the United States Department of Health
and Human Services that are required to carry out P.L.257-1997.
As added by P.L.220-2011, SEC.264.
IC 12-15-1.3-5
Expired
(As added by P.L.220-2011, SEC.264. Amended by P.L.229-2011,
SEC.122. Expired 12-31-2011 by P.L.220-2011, SEC.264.)
IC 12-15-1.3-6
Waiver application for prescription drug program for low income
senior citizens; conditions; changes to program approved by
prescription drug advisory committee; limitation of state
expenditures; implementation of waiver
Sec. 6. (a) The office shall develop a federal Medicaid waiver
application under which a prescription drug program may be
established or implemented to provide access to prescription drugs
for low income senior citizens.
(b) Before the office may submit an application for a federal
Medicaid waiver that will affect the Indiana prescription drug
program established under IC 12-10-16, the following must occur:
(1) The office shall submit the proposed Medicaid waiver to the
prescription drug advisory committee.
(2) The prescription drug advisory committee must review,
allow public comment on, and approve the proposed Medicaid
waiver.
(c) A prescription drug program established or implemented by the
office or a contractor of the office under this section may not limit
access to prescription drugs for prescription drug program recipients,
except under the following circumstances:
(1) Access may be limited to the extent that restrictions were in
place in the Medicaid program on March 26, 2002.
(2) Except as provided by IC 12-15-35.5-3(b) and
IC 12-15-35.5-3(c), access may be limited to:
(A) prevent:
(i) fraud;
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(ii) abuse;
(iii) waste;
(iv) overutilization of prescription drugs; and
(v) inappropriate utilization of prescription drugs; or
(B) implement a disease management program.
IC 12-15-35.5-7 applies to a limit implemented under this
subdivision.
(d) Changes to a prescription drug program that:
(1) is established or implemented by the office or a contractor
of the office under this section; and
(2) uses money from the Indiana prescription drug account
established under IC 4-12-8-2;
must be approved by the prescription drug advisory committee.
(e) The office shall apply to the United States Department of
Health and Human Services for approval of any waiver necessary
under the federal Medicaid program to provide access to prescription
drugs for low income senior citizens.
(f) A Medicaid waiver developed under this section must limit a
prescription drug program's state expenditures to funding
appropriated to the Indiana prescription drug account established
under IC 4-12-8-2 from the Indiana tobacco master settlement
agreement fund.
(g) The office may not implement a waiver under this section until
the office files an affidavit with the governor attesting that the federal
waiver applied for under this section is in effect. The office shall file
the affidavit under this subsection not later than five (5) days after the
office is notified that the waiver is approved.
(h) If the office receives a waiver under this section from the
United States Department of Health and Human Services and the
governor receives the affidavit filed under subsection (g), the office
shall implement the waiver not more than sixty (60) days after the
governor receives the affidavit.
As added by P.L.220-2011, SEC.264.
IC 12-15-1.3-7
Expired
(As added by P.L.220-2011, SEC.264. Expired 12-31-2012 by
P.L.220-2011, SEC.264.)
IC 12-15-1.3-8
Expired
(As added by P.L.220-2011, SEC.264. Expired 12-31-2012 by
P.L.220-2011, SEC.264.)
IC 12-15-1.3-9
Expired
(As added by P.L.220-2011, SEC.264. Expired 12-31-2013 by
P.L.220-2011, SEC.264.)
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IC 12-15-1.3-10
Expired
(As added by P.L.220-2011, SEC.264. Expired 7-1-2013 by
P.L.220-2011, SEC.264.)
IC 12-15-1.3-11
Expired
(As added by P.L.220-2011, SEC.264. Expired 1-1-2013 by
P.L.220-2011, SEC.264.)
IC 12-15-1.3-12
Expired
(As added by P.L.220-2011, SEC.264. Expired 12-31-2013 by
P.L.220-2011, SEC.264.)
IC 12-15-1.3-13
Application for waiver to provide presumptive eligibility for
certain pregnant women; implementation of waiver; rules
Sec. 13. (a) The office shall apply to the United States Department
of Health and Human Services for any amendment to the state
Medicaid plan or demonstration waiver that is needed to provide for
presumptive eligibility for a pregnant woman described in
IC 12-15-2-13.
(b) The office may not implement the amendment or waiver until
the office files an affidavit with the governor attesting that the
amendment or waiver applied for under this section is in effect. The
office shall file the affidavit under this subsection not more than five
(5) days after the office is notified that the amendment or waiver is
approved.
(c) If the office receives approval for the amendment or waiver
under this section from the United States Department of Health and
Human Services and the governor receives the affidavit filed under
subsection (b), the office shall implement the amendment or waiver
not more than sixty (60) days after the governor receives the
affidavit.
(d) The office may adopt rules under IC 4-22-2 to implement this
section.
As added by P.L.220-2011, SEC.264.
IC 12-15-1.3-13.5
Report on use of qualified providers and presumptive eligibility;
requirements
Sec. 13.5. (a) As used in this section, "qualified provider" refers
to a health provider authorized by the office to provide Medicaid
presumptive eligibility services.
(b) The office shall present a report to the interim study committee
on public health, behavioral health, and human services not later than
September 30 of each year, regarding the use of qualified providers
to undertake presumptive eligibility services under the Medicaid
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program.
(c) The report must include the following:
(1) The number of presumptive eligibility qualified providers
and their location and distribution in the state.
(2) The number of presumptive eligibility applications
submitted and in a per provider format.
(3) The number and percent of presumptive eligibility
applications submitted that were approved or denied and the
information in a per provider and by county format.
(4) The number and percent of presumptive eligibility
applications that resulted in a Medicaid application submission
and the information in a per provider and by county format.
(5) The number and percent of presumptive eligibility
applications that were subsequently approved or denied for full
coverage and the information in a per provider and by county
format.
(6) The method the office used to communicate presumptive
eligibility opportunities to qualified providers and health
consumers.
(7) The error rate of qualified providers in accepting
presumptive eligibility applications that were subsequently
determined to be ineligible.
(8) The education and technical assistance and availability
provided by the office for ongoing training and retention of
qualified providers.
(9) Any other information the office considers relevant on the
use of qualified providers in carrying out presumptive eligibility
services under the Medicaid program.
(d) This section expires January 1, 2018.
As added by P.L.185-2015, SEC.10.
IC 12-15-1.3-14
Expired
(As added by P.L.220-2011, SEC.264. Expired 12-31-2013 by
P.L.220-2011, SEC.264.)
IC 12-15-1.3-15
Waiver amendment; emergency placement priority
Sec. 15. (a) As used in this section, "division" refers to the
division of disability and rehabilitative services established by
IC 12-9-1-1.
(b) As used in this section, "waiver" refers to any waiver
administered by the office and the division under section 1915(c) of
the federal Social Security Act.
(c) Before October 1, 2011, the office shall apply to the United
States Department of Health and Human Services for approval to
amend a waiver to set an emergency placement priority for
individuals in the following situations:
(1) Death of a primary caregiver where alternative placement in
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a supervised group living setting:
(A) is not available; or
(B) is determined by the division to be an inappropriate
option.
(2) A situation in which:
(A) the primary caregiver is at least eighty (80) years of age;
and
(B) alternate placement in a supervised group living setting
is not available or is determined by the division to be an
inappropriate option.
(3) There is evidence of abuse or neglect in the current
institutional or home placement, and alternate placement in a
supervised group living setting is not available or is determined
by the division to be an inappropriate option.
(4) There are other health and safety risks, as determined by the
division director, and alternate placement in a supervised group
living setting is not available or is determined by the division to
be an inappropriate option.
(d) The division shall report on a quarterly basis the following
information to the division of disability and rehabilitative services
advisory council established by IC 12-9-4-2 concerning each
Medicaid waiver for which the office has been approved under this
section to administer an emergency placement priority for individuals
described in this section:
(1) The number of applications for emergency placement
priority waivers.
(2) The number of individuals served on the waiver.
(3) The number of individuals on a wait list for the waiver.
(e) The office may adopt rules under IC 4-22-2 necessary to
implement this section.
(f) This section expires July 1, 2016.
As added by P.L.220-2011, SEC.264. Amended by P.L.229-2011,
SEC.122.
IC 12-15-1.3-16
Expired
(As added by P.L.220-2011, SEC.264. Expired 12-31-2013 by
P.L.220-2011, SEC.264.)
IC 12-15-1.3-17
Expired
(As added by P.L.220-2011, SEC.264. Expired 12-31-2013 by
P.L.220-2011, SEC.264.)
IC 12-15-1.3-17.5
Budget committee review of state plan amendments, waiver
requests, or revisions
Sec. 17.5. The office may not implement any Medicaid state plan
amendments, any Medicaid waiver requests, or any revisions to any
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Medicaid state plan amendments or Medicaid waiver requests unless
the office has submitted a written report to the budget committee
concerning the implementation of the amendment, waiver, or revision
and the budget committee has reviewed the amendment, waiver, or
revision.
As added by P.L.205-2013, SEC.188.
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