CHAPTER 1. ADMINISTRATION
IC 12-15
ARTICLE 15. MEDICAID
IC 12-15-1
Chapter 1. Administration
IC 12-15-1-1
Office of Medicaid planning and policy
Sec. 1. The office of Medicaid policy and planning shalladminister the Medicaid program under 42 U.S.C. 1396 et seq.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-2
Agents of the division of family resources
Sec. 2. A county office shall serve as an agent of the division offamily resources.
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.106;P.L.5-1993, SEC.119; P.L.145-2006, SEC.82.
IC 12-15-1-3
Supervision of county offices
Sec. 3. The division of family resources shall supervise the countyoffices regarding services provided under this chapter.
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.107;P.L.5-1993, SEC.120; P.L.145-2006, SEC.83.
IC 12-15-1-4
Written protocols; contracts implementing state program
Sec. 4. (a) The office and the division of family resources shallformulate written protocols that specify the following:
(1) That the county offices are responsible for all eligibilitydeterminations made under the state Medicaid program.
(2) That the office is responsible for payment of a claim madeunder the state Medicaid plan.
(b) The office may enter into any contract to implement the stateprogram.
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.108;P.L.5-1993, SEC.121; P.L.145-2006, SEC.84.
IC 12-15-1-5
Agreement with Secretary of the Department of Health andHuman Services; eligibility determinations
Sec. 5. The office may enter into an agreement with the Secretaryof the United States Department of Health and Human Servicesunder which the Secretary shall accept applications and makedeterminations of eligibility for Medicaid for individuals who areaged, individuals who are blind, and individuals with a disability inaccordance with the standards and criteria established by the stateplan for Medicaid in effect January 1, 1972.
As added by P.L.2-1992, SEC.9. Amended by P.L.99-2007, SEC.93.
IC 12-15-1-6
Agreement with Secretary of United States Department of Healthand Human Services; division of administrative costs
Sec. 6. The office may pay to the Secretary of the United StatesDepartment of Health and Human Services one-half (1/2) of theadministrative cost of carrying out the agreement. However, withrespect to an individual eligible for benefits under the federalSupplemental Security Income program the costs must only includethose costs which are additional to the cost in carrying out theSupplemental Security Income program.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-7
Agreement with Secretary of United States Department of Healthand Human Services; eligibility determinations after January 1,1974
Sec. 7. The agreement under section 5 of this chapter must covereligibility determinations after January 1, 1974.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-8
Receipt of assistance in adult category before January 1, 1974;automatic coverage
Sec. 8. An individual who receives assistance in one (1) of theadult categories before January 1, 1974, is not required to make anew application and is automatically covered by the plan while theindividual remains eligible.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-9
Application to county offices
Sec. 9. (a) If the state does not enter into a contract with theSecretary of the United States Department of Health and HumanServices to administer the Medicaid program, a recipient must makean application for Medicaid to the county office of the county ordistrict in which the recipient resides.
(b) The application must be in the manner required by the office.
(c) However, an applicant who:
(1) was receiving assistance before January 1, 1974; and
(2) has been certified as eligible for Medicaid;
is not required to make an application while the recipient continuesto remain eligible under state laws.
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.109;P.L.5-1993, SEC.122.
IC 12-15-1-10
Administrative actions and directions; adoption of procedures andrules
Sec. 10. The secretary and office may:
(1) take actions; (2) give directions; and
(3) adopt procedures and rules under IC 4-22-2;
necessary to carry out the Medicaid program and the federal SocialSecurity Act to provide Medicaid and ensure uniform equitabletreatment of applicants for and recipients of Medicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-11
Money received from recipient or collected from estate; paymentinto Medicaid account; apportionment
Sec. 11. (a) Money received from a Medicaid recipient orcollected from the recipient's estate shall be:
(1) forwarded to the office; and
(2) paid into the Medicaid account of the state general fund.
(b) Money under subsection (a) must be distributed in proportionto the amounts in which the assistance payments represented moneycontributed by the federal government and the state.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-12
Attorney general; appearance and representation of state inproceedings affecting property or resources upon which state mayhave claim
Sec. 12. The attorney general may enter the appearance of thestate in a proceeding affecting property or resources upon which thestate may have a claim for Medicaid to do the following:
(1) Prosecute and defend in the proceeding.
(2) Institute probate proceedings as a creditor to deceasedpersons.
(3) Enter into a stipulation, a compromise, a settlement, anagreement, or an arrangement with respect to appropriateclaims, either in the course of or in the absence of and apartfrom any action or proceeding.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-13
Annual effectiveness evaluation
Sec. 13. The office shall conduct an annual evaluation of theeffectiveness of providing Medicaid under IC 12-15-2-12 andIC 12-15-2-14.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-14
Effectiveness evaluation; annual report to legislative council
Sec. 14. The office shall annually submit a report to the legislativecouncil that covers all aspects of the office's evaluation, including thefollowing:
(1) The number and demographic characteristics of theindividuals receiving Medicaid during the preceding fiscal year.
(2) The number of births during the preceding fiscal year. (3) The number of infant deaths during the preceding fiscalyear.
(4) The improvement in the number of low birth weight babiesfor the preceding fiscal year.
(5) The total cost of providing Medicaid during the precedingfiscal year.
(6) The total cost savings during the preceding fiscal year thatare realized in other state funded programs because of providingMedicaid.
The report must be in an electronic format under IC 5-14-6.
As added by P.L.2-1992, SEC.9. Amended by P.L.28-2004, SEC.103.
IC 12-15-1-15
Assignment, enforcement, and collection of rights of payment;contracts for administration of program; rules
Sec. 15. (a) The office shall administer the program ofassignment, enforcement, and collection of rights of payments formedical care that is provided for under 42 U.S.C. 1396k.
(b) The office may enter into contracts to administer the programdescribed in subsection (a).
(c) The administrator of the office shall adopt rules underIC 4-22-2 to implement this section.
As added by P.L.2-1992, SEC.9.
IC 12-15-1-16
School corporation or school corporation's provider; enrollmentin Medicaid program; sharing reimbursable costs
Sec. 16. (a) Each:
(1) school corporation; or
(2) school corporation's employed, licensed, or qualifiedprovider;
must enroll in a program to use federal funds under the Medicaidprogram (IC 12-15-1 et seq.) with the intent to share the costs ofservices that are reimbursable under the Medicaid program and thatare provided to eligible children by the school corporation. However,a school corporation or a school corporation's employed, licensed, orqualified provider is not required to file any claims or participate inthe program developed under this section.
(b) The office of Medicaid policy and planning and thedepartment of education may develop policies and adopt rules toadminister the program developed under this section.
(c) Three percent (3%) of the federal reimbursement for paidclaims that are submitted by the school corporation under theprogram required under this section must be:
(1) distributed to the state general fund for administration of theprogram; and
(2) used for consulting to encourage participation in theprogram.
The remainder of the federal reimbursement for services providedunder this section must be distributed to the school corporation. The
state shall retain the nonfederal share of the reimbursement forMedicaid services provided under this section.
(d) The office of Medicaid policy and planning, with the approvalof the budget agency and after consultation with the department ofeducation, shall establish procedures for the timely distribution offederal reimbursement due to the school corporations. Thedistribution procedures may provide for offsetting reductions todistributions of state tuition support or other state funds to schoolcorporations in the amount of the nonfederal reimbursementsrequired to be retained by the state under subsection (c).
As added by P.L.80-1994, SEC.1. Amended by P.L.224-2003,SEC.64.
IC 12-15-1-17
Reimbursement from parent for health services provided to child
Sec. 17. (a) The office shall, under procedures established by thedepartment of state revenue, file an application for the offset of statetax refunds due to a parent who:
(1) is required by a court or an administrative order to providecoverage of the costs of health services to a child who iseligible for medical assistance;
(2) has received payment from a third party for the costs of theservices to the child; and
(3) has not used the payments to reimburse, as appropriate,either the:
(A) other parent or guardian of the child; or
(B) provider of the health services;
to the extent necessary to reimburse the office, or, where the otherparent has paid the provider or the office, the other parent, for thecosts of the services provided to the child under the Medicaidprogram.
(b) The office may institute garnishment proceedings against thewages, salary, or other employment income of the parent describedin subsection (a) to the extent necessary to reimburse the office forthe costs of health services provided to a child who has received theservices under the Medicaid program.
(c) Claims for current or past due child support take priority overany claims authorized by this section.
As added by P.L.46-1995, SEC.30.
IC 12-15-1-18
Use of funds to encourage application and enrollment of minors
Sec. 18. The office shall use all funds that are appropriated to theoffice under 42 U.S.C. 1397ee to conduct activities allowed under 42U.S.C. 1397bb(c)(1) in order to encourage children who are:
(1) less than nineteen (19) years of age;
(2) eligible for Medicaid; and
(3) not enrolled in the Medicaid program;
to apply for and enroll in the Medicaid program.
As added by P.L.58-1998, SEC.5.
IC 12-15-1-19
Contracts with community entities
Sec. 19. The office may, in administering managed care programs,contract with community entities, including private entities, for thefollowing:
(1) Outreach for and enrollment in the managed care programs.
(2) Provision of services.
(3) Consumer education and public health education.
As added by P.L.273-1999, SEC.170.
IC 12-15-1-20
Implementation of policy of funds following an individualtransferring to community based care
Sec. 20. (a) The office shall implement a policy that allows theamount of Medicaid funds necessary to provide services to follow anindividual who is transferring from institutional care to Medicaidhome and community based care.
(b) The amount may not exceed the amount that would have beenspent on the individual if the individual had stayed in institutionalcare.
As added by P.L.47-2009, SEC.2.
IC 12-15-1-20.2
Computer system for disproportionate share hospital paymentprogram; HCI; UPL
Sec. 20.2. The office shall develop, maintain, and use a computersystem to store documents concerning the disproportionate sharehospital payment program, the hospital care for the indigent program,and the hospital care for the indigent upper payment level program.The system must include the following documents related to theprograms:
(1) Federal and state laws.
(2) Federal and state rules and regulations.
(3) Policies and guidance statements.
(4) Medicaid waivers.
(5) Medicaid state plan amendments.
(6) Funding allotments to health care facilities.
(7) Funding formulas and any other explanatory informationdetailing how an individual allotment is calculated.
As added by P.L.140-2009, SEC.1.
IC 12-15-1-20.4
Suspension of Medicaid for a delinquent child; participation inMedicaid upon release
Sec. 20.4. (a) If a Medicaid recipient is:
(1) less than eighteen (18) years of age;
(2) adjudicated to be a delinquent child and placed in:
(A) a community based correctional facility for children;
(B) a juvenile detention facility; or
(C) a secure facility, not including a facility licensed as a
child caring institution under IC 31-27; and
(3) ineligible to participate in the Medicaid program during theplacement described in subdivision (2) because of federalMedicaid law;
the division of family resources, upon notice that a child has beenadjudicated to be a delinquent child and placed in a facility describedin subdivision (2) shall suspend the child's participation in theMedicaid program for up to six (6) months before terminating thechild's eligibility.
(b) If the division of family resources receives:
(1) a dispositional decree under IC 31-37-19-28; or
(2) a modified disposition order under IC 31-37-22-9;
and the department of correction gives the division at least forty (40)days notice that a child will be released from a facility described insubsection (a)(2)(C), the division of family resources shall takeaction necessary to ensure that a child described in subsection (a) iseligible to participate in the Medicaid program upon the child'srelease, if the child is eligible to participate.
As added by P.L.114-2009, SEC.1. Amended by P.L.1-2010, SEC.57.