Ind. Code ch. 12-15-5

Ind. Code ch. 12-15-5
in effect

Ind. Code § 12-15-5-1 Services and supplies provided; exceptions

Sec. 1. (a) Except as provided in IC 12-15-2-12, IC 12-15-6, and IC 12-15-21, the following services and supplies are provided under Medicaid: (1) Inpatient hospital services. (2) Nursing facility services. (3) Physician's services, including services provided under IC 25-10-1 and IC 25-22.5-1. (4) Outpatient hospital or clinic services. (5) Home health care services. (6) Private duty nursing services. (7) Physical therapy and related services. (8) Dental services. (9) Prescribed laboratory and x-ray services. (10) Prescribed drugs and pharmacist services. (11) Eyeglasses and prosthetic devices. (12) Optometric services. (13) Diagnostic, screening, preventive, and rehabilitative services. (14) Podiatric medicine services. (15) Hospice services. (16) Services or supplies recognized under Indiana law and specified under rules adopted by the office. (17) Family planning services except the performance of abortions. (18) Nonmedical nursing care given in accordance with the tenets and practices of a recognized church or religious denomination to an individual qualified for Medicaid who depends upon healing by prayer and spiritual means alone in accordance with the tenets and practices of the individual's church or religious denomination. (19) Services provided to individuals described in IC 12-15-2-8. (20) Services provided under IC 12-15-34 and IC 12-15-32. (21) Case management services provided to individuals described in IC 12-15-2-13. (22) Any other type of remedial care recognized under Indiana law and specified by the United States Secretary of Health and Human Services. (23) Examinations required under IC 16-41-17-2(a)(10). (24) Inpatient substance abuse detoxification services. (25) Chronic pain management. (26) Donated breast milk that meets requirements developed by the office of Medicaid policy and planning. (b) The office shall do the following: (1) Apply to the United States Department of Health and Human Services for any state plan amendment or waiver necessary to implement the services or supplies described in subsection (a)(26). (2) Develop requirements for donated breast milk as described in subsection (a)(26). (3) As soon as practicable, but not later than January 1, 2023, the office shall: (A) seek any necessary approval from the United States Department of Health and Human Services; and (B) adopt any written policies, procedures, or regulations determined necessary; to provide reimbursement for long-acting reversible contraception. This subdivision expires June 30, 2023. [Pre-1992 Revision Citation: 12-1-7-14.6 part.] As added by P.L.2-1992, SEC.9. Amended by P.L.24-1997, SEC.48; P.L.149-2001, SEC.1; P.L.274-2013, SEC.1; P.L.154-2015, SEC.2; P.L.210-2015, SEC.47; P.L.149-2019, SEC.4; P.L.117-2022, SEC.3; P.L.180-2022(ss), SEC.15.

Ind. Code § 12-15-5-2 Necessity of federal financial participation

Sec. 2. Medicaid does not include a service or supply for which federal financial participation is not available. [Pre-1992 Revision Citation: 12-1-7-14.6 part.] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-5-5 Office may provide drug coverage; requirements for drug coverage in managed care

Sec. 5. (a) The office may provide a prescription drug benefit to a Medicaid recipient in a Medicaid risk based managed care program. (b) If the office provides a prescription drug benefit to a Medicaid recipient in a Medicaid risk based managed care program: (1) the office shall develop a procedure and provide the recipient's risk based managed care provider with information concerning the recipient's prescription drug utilization for the risk based managed care provider's case management program; and (2) the provisions of IC 12-15-35.5 apply. (c) If the office does not provide a prescription drug benefit to a Medicaid recipient in a Medicaid risk based managed care program, a managed care organization shall provide coverage and reimbursement for outpatient single source legend drugs subject to IC 12-15-35-46, IC 12-15-35-47, and IC 12-15-35.5. As added by P.L.231-1999, SEC.1. Amended by P.L.101-2005, SEC.1; P.L.152-2017, SEC.5.

Ind. Code § 12-15-5-7 Reimbursement for doula services; rules

Sec. 7. (a) Pregnancy services provided under this article may include reimbursement for doula services. (b) The office may apply for any state plan amendment or waiver necessary to implement this section. (c) The office may adopt rules under IC 4-22-2 to implement this section. As added by P.L.35-2019, SEC.1.

Ind. Code § 12-15-5-8 Maintenance drugs; prescriptions; Internet based pharmacies

Sec. 8. (a) As used in this section, "maintenance drug" means a medication that is dispensed under a single prescription for a period of not less than one hundred eighty (180) days, excluding authorized refills, for the ongoing treatment of a chronic medical condition or disease or congenital condition or disorder. (b) The office may designate: (1) a mail order pharmacy; (2) an Internet based pharmacy (as defined in IC 25-26-18-1); (3) a pharmacy that agrees to sell a maintenance drug at the same price as a mail order or an Internet based pharmacy; or (4) all the pharmacies listed in subdivisions (1) through (3); through which a recipient may obtain a maintenance drug. (c) If the office makes a designation under subsection (b), a managed care organization that has a contract with the office under IC 12-15-12 is not required to use a pharmacy that is designated under subsection (b). (d) If a Medicaid recipient's physician prescribes a maintenance prescription drug, the Medicaid recipient may purchase the maintenance prescription drug from a pharmacy that is designated under subsection (b). (e) The office shall apply to amend the state Medicaid plan if the office determines that an amendment is necessary to carry out this section. (f) The office may require a recipient to pay the maximum copayment allowable under federal law if the recipient obtains a maintenance drug from a pharmacy other than a pharmacy described in subsection (b). As added by P.L.246-2005, SEC.105.

Ind. Code § 12-15-5-9 Provision of self-directed care options

Sec. 9. The office shall have self-directed care options and services available for an eligible individual who: (1) is a Medicaid waiver recipient; and (2) chooses self-directed care services. As added by P.L.47-2009, SEC.3.

Ind. Code § 12-15-5-9.2 Coverage for care related to cancer clinical trials

Sec. 9.2. (a) As used in this section, "care method" means the use of a particular drug or device in a particular manner. (b) As used in this section, "clinical trial" means a Phase I, II, III, or IV research study: (1) that is conducted: (A) using a particular care method to prevent, diagnose, or treat a cancer for which: (i) there is no clearly superior, noninvestigational alternative care method; and (ii) available clinical or preclinical data provides a reasonable basis from which to believe that the care method used in the research study is at least as effective as any noninvestigational alternative care method; (B) in a facility where personnel providing the care method to be followed in the research study have: (i) received training in providing the care method; (ii) expertise in providing the type of care required for the research study; and (iii) experience providing the type of care required for the research study to a sufficient volume of patients to maintain expertise; and (C) to scientifically determine the best care method to prevent, diagnose, or treat the cancer; and (2) that is approved or funded by one (1) of the following: (A) A National Institutes of Health institute. (B) A cooperative group of research facilities that has an established peer review program that is approved by a National Institutes of Health institute or center. (C) The federal Food and Drug Administration. (D) The United States Department of Veterans Affairs. (E) The United States Department of Defense. (F) The institutional review board of an institution located in Indiana that has a multiple project assurance contract approved by the National Institutes of Health Office for Protection from Research Risks as provided in 45 CFR 46.103. (G) A research entity that meets eligibility criteria for a support grant from a National Institutes of Health center. (c) As used in this section, "routine care cost" means the cost of medically necessary services related to the care method that is under evaluation in a clinical trial. The term does not include the following: (1) The drug or device that is under evaluation in a clinical trial. (2) Items or services that are: (A) provided solely for data collection and analysis and not in the direct clinical management of an individual enrolled in a clinical trial; (B) customarily provided at no cost by a research sponsor to an individual enrolled in a clinical trial; or (C) provided solely to determine eligibility of an individual for participation in a clinical trial. (d) The Medicaid program must provide coverage for routine care costs that are incurred in the course of a clinical trial if the Medicaid program would provide coverage for the same routine care costs not incurred in a clinical trial. (e) The coverage that must be provided under this section is subject to the terms, conditions, restrictions, exclusions, and limitations that apply generally under the Medicaid program, including terms, conditions, restrictions, exclusions, or limitations that apply to health care services rendered by participating providers and nonparticipating providers. (f) This section does not do any of the following: (1) Require the Medicaid program to provide coverage for clinical trial services rendered by a participating provider. (2) Prohibit the Medicaid program from providing coverage for clinical trial services rendered by a participating provider. (3) Require reimbursement for services that are rendered in a clinical trial by a nonparticipating provider at the same rate of reimbursement that would apply to the same services rendered by a participating provider. As added by P.L.109-2009, SEC.2.

Ind. Code § 12-15-5-10 Care available for individuals receiving Medicaid waiver services; eligibility not affected by receipt of services

Sec. 10. (a) An individual who receives Medicaid services through a Medicaid waiver shall receive the following: (1) The development of a care plan addressing the individual's needs. (2) Advocacy on behalf of the individual's interests. (3) The monitoring of the quality of community and home care services provided to the individual. (4) Information and referral services concerning community and home care services if the individual is eligible for these services. (b) The use by or on behalf of an individual receiving Medicaid waiver services of any of the following services or devices does not make the individual ineligible for services under a Medicaid waiver: (1) Skilled nursing assistance. (2) Supervised community and home care services, including skilled nursing supervision. (3) Adaptive medical equipment and devices. (4) Adaptive nonmedical equipment and devices. As added by P.L.47-2009, SEC.4.

Ind. Code § 12-15-5-11 "Telehealth services"; reimbursement; prohibition on distance restrictions and location requirements; waiver of confidentiality; community mental health centers; rules

Sec. 11. (a) As used in this section, "telehealth services" has the meaning set forth for "telehealth" in IC 25-1-9.5-6. (b) The office shall reimburse the following Medicaid providers for medically necessary telehealth services: (1) A federally qualified health center (as defined in 42 U.S.C. 1396d(l)(2)(B)). (2) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)). (3) A community mental health center certified under IC 12-21-2-3(5)(C). (4) A critical access hospital that meets the criteria under 42 CFR 485.601 et seq. (5) A home health agency licensed under IC 16-27-1. (6) A provider, as determined by the office to be eligible, providing a covered telehealth service. (c) The office may not impose any distance restrictions on providers of telehealth services. (d) Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient. (e) A Medicaid recipient waives confidentiality of any medical information discussed with the health care provider that is: (1) provided during a telehealth visit; and (2) heard by another individual in the vicinity of the Medicaid recipient during a health care service or consultation. (f) For purposes of a community mental health center, telehealth services satisfy any face to face meeting requirement between a clinician and consumer. (g) The office shall implement any part of this section that is approved by the United States Department of Health and Human Services. (h) The office may adopt rules under IC 4-22-2 necessary to implement and administer this section. As added by P.L.204-2013, SEC.3. Amended by P.L.150-2017, SEC.1; P.L.85-2021, SEC.3; P.L.207-2021, SEC.8; P.L.109-2022, SEC.2.

Ind. Code § 12-15-5-12 "Child"; reimbursement for specialized or nonstandard wheelchairs; prior authorization

Sec. 12. (a) As used in this section, "child" includes any of the following: (1) An individual who is less than eighteen (18) years of age. (2) An individual who is at least eighteen (18) years of age and either: (A) continues to be enrolled in a kindergarten through grade 12 school; or (B) has a developmental disability. (b) The office shall reimburse a nursing facility for a specialized or nonstandard wheelchair for a child recipient who resides in a nursing facility at a rate outside the nursing facility's per diem payment for nursing facility services, regardless of whether the child recipient is determined by the office to be rehabilitative. (c) The office may require prior authorization for reimbursement under this section. As added by P.L.108-2014, SEC.1.

Ind. Code § 12-15-5-13 Coverage for treatment of opioid or alcohol dependence; office requirements; report use of medications to committee

Sec. 13. (a) The office shall provide coverage for treatment of opioid or alcohol dependence that includes the following: (1) Counseling services that address the psychological and behavioral aspects of addiction. (2) When medically indicated, drug treatment involving agents approved by the federal Food and Drug Administration for the: (A) treatment of opioid or alcohol dependence; or (B) prevention of relapse to opioids or alcohol after detoxification. (3) When determined by the treatment plan to be medically necessary, inpatient detoxification in accordance with the most current edition of the American Society of Addiction Medicine Patient Placement Criteria. (b) The office shall: (1) develop quality measures to ensure; and (2) require a managed care organization to report; compliance with the coverage required under subsection (a). (c) The office may implement quality capitation withholding of reimbursement to ensure that a managed care organization has provided the coverage required under subsection (a). (d) The office shall report the clinical use of the medications covered under this section to the mental health Medicaid quality advisory committee established by IC 12-15-35-51. The mental health Medicaid quality advisory committee may make recommendations to the office concerning this section. As added by P.L.209-2015, SEC.11. Amended by P.L.8-2016, SEC.1; P.L.152-2017, SEC.6; P.L.179-2019, SEC.1.

Ind. Code § 12-15-5-13.5 Expired

As added by P.L.205-2023, SEC.4. Amended by P.L.147-2024, SEC.1. Expired 6-30-2025 by P.L.147-2024, SEC.1.

Ind. Code § 12-15-5-14 Reimbursement for services provided by advanced practice registered nurse; eligible provider

Sec. 14. (a) As used in this section, "advanced practice registered nurse" means: (1) a nurse practitioner; or (2) a clinical nurse specialist; who is a registered nurse licensed under IC 25-23 and qualified to practice nursing in a specialty role based upon the additional knowledge and skill gained through a formal organized program of study and clinical experience, or the equivalent as determined by the Indiana state board of nursing. (b) As used in this section, "office" includes the following: (1) The office of the secretary of family and social services. (2) A managed care organization that has contracted with the office of Medicaid policy and planning under this article. (3) A person that has contracted with a managed care organization described in subdivision (2). (c) The office shall reimburse eligible Medicaid claims for the following services provided by an advanced practice registered nurse employed by a community mental health center if the services are part of the advanced practice registered nurse's scope of practice: (1) Mental health services. (2) Behavioral health services. (3) Substance abuse treatment. (4) Primary care services. (5) Evaluation and management services for inpatient or outpatient psychiatric treatment. (6) Prescription drugs. (d) The office shall include an advanced practice registered nurse as an eligible provider for the supervision of a plan of treatment for a patient's outpatient mental health or substance abuse treatment services, if the supervision is in the advanced practice registered nurse's scope of practice, education, and training. (e) This section: (1) may not be construed to expand an advanced practice registered nurse's scope of practice; and (2) is subject to IC 25-23-1-19.4(c) and applies only if the service is included in the advanced practice registered nurse's practice agreement with a collaborating physician. As added by P.L.87-2016, SEC.4. Amended by P.L.85-2017, SEC.58; P.L.129-2018, SEC.5.

Ind. Code § 12-15-5-14.5 Eligible providers for supervising treatment plan

Sec. 14.5. (a) The office shall include a: (1) licensed clinical social worker; (2) licensed mental health counselor; (3) licensed clinical addiction counselor; and (4) licensed marriage and family therapist; as eligible providers for the supervision of a plan of treatment for a patient's outpatient mental health or substance abuse treatment services, if the individual holds at least a master's degree and the supervision is in the scope of practice, education, and training of the clinical social worker, mental health counselor, clinical addiction counselor, or marriage and family therapist. (b) Before July 1, 2020, the office shall apply to the United States Department of Health and Human Services to amend the state Medicaid plan to implement subsection (a). As added by P.L.128-2019, SEC.1. Amended by P.L.103-2020, SEC.1.

Ind. Code § 12-15-5-15 Reimbursement for students; conditions; policies

Sec. 15. (a) This section is effective upon approval by the federal government of the office's Medicaid state plan amendment to implement the requirements of this section. The office shall submit the Medicaid state plan amendment not later than December 1, 2016. (b) As used in this section, "office" includes the following: (1) The office of the secretary of family and social services. (2) A managed care organization that has contracted with the office of Medicaid policy and planning under this article. (3) A person that has contracted with a managed care organization described in subdivision (2). (c) The office shall authorize Medicaid reimbursement for eligible Medicaid services provided by a student if: (1) the student is currently enrolled in a graduate or postgraduate degree level: (A) medical; (B) nursing; (C) mental health; (D) behavioral health; or (E) addiction treatment; accredited college or university program; (2) the student has been approved by the college or university to work as an intern or practicum student at a community mental health center under the direct supervision of a licensed professional who holds a master's degree or doctoral level degree related to the area of study; and (3) the services being provided by the student are within the scope of practice of the supervising practitioner. (d) Medicaid claims for eligible Medicaid services provided under this section must be submitted by the supervising practitioner. Only one (1) Medicaid claim may be submitted per episode of care. (e) A community mental health center that allows intern and practicum students to provide services under this section shall have a policy and procedure for the intern and practicum students to receive supervision and a method for documenting the supervision provided. As added by P.L.87-2016, SEC.5. Amended by P.L.85-2017, SEC.59.

Ind. Code § 12-15-5-16 Reimbursement for clinical addiction counselors; clinical supervision requirement

Sec. 16. (a) This section is effective upon approval by the federal government of the office's Medicaid state plan amendment to implement the requirements of this section. The office shall submit the Medicaid state plan amendment not later than December 1, 2016. (b) As used in this section, "office" includes the following: (1) The office of the secretary of family and social services. (2) A managed care organization that has contracted with the office of Medicaid policy and planning under this article. (3) A person that has contracted with a managed care organization described in subdivision (2). (c) The office shall reimburse a clinical addiction counselor licensed under IC 25-23.6 for an eligible Medicaid behavioral health or addictions service that is within the counselor's scope of practice if the clinical addiction counselor is under the clinical supervision of a physician or health service provider in psychology. As added by P.L.87-2016, SEC.6.

Ind. Code § 12-15-5-17 Expired

As added by P.L.224-2017, SEC.3. Amended by P.L.108-2019, SEC.194; P.L.103-2020, SEC.2. Expired 6-30-2021 by P.L.103-2020, SEC.2.

Ind. Code § 12-15-5-17.5 Report on implementation of risk based managed care program; request for proposal; budget committee review

Sec. 17.5. (a) The office shall report on its progress on the development of a risk based managed care program or capitated managed care program for Medicaid recipients who are eligible to participate in the Medicare program (42 U.S.C. 1395 et seq.) and receive nursing facility services to the interim study committee on public health, behavioral health, and human services before November 1, 2021. (b) Not later than February 1, 2022, the office shall report the following information and analysis to the legislative council and budget committee (in an electronic format under IC 5-14-6) regarding the implementation of a risk based managed care program or capitated managed care program for Medicaid recipients who are eligible to participate in the Medicare program (42 U.S.C. 1395 et seq.) and receive nursing facility services, as follows: (1) The projected utilization of home and community based services and institutional services for the four (4) years following implementation, and including, but not limited to, information on: (A) provider network adequacy; (B) family caregiver programming; and (C) costs and funding sources associated with creating and maintaining adequate provider networks and family caregiving programming. (2) How administrative processes, including service approval and billing processes, between managed care entities and providers of services will be addressed or streamlined in a risk based managed care program or capitated managed care program, with specific discussion of uniform provider credentialing, the potential of a single claims processing portal, and prior authorization processes. (3) Projected total spending for a risk based managed care program or capitated managed care program for the four (4) years following implementation. Such information shall include the identification of and impact on each source of state matching funds and overall impact on the state general fund. (4) The expected financial impacts of a risk based managed care program or capitated managed care program on the available amounts and use of the nursing facility quality assessment fee and supplemental payments to nursing facilities that are owned and operated by a governmental entity. Such information shall include an analysis on whether either of these funding streams will be diverted for uses other than the uses prior to implementation of a risk based managed care program or capitated managed care program and the effects on access to acute and post-acute care services due to the expected financial impacts. (c) A request for proposal for the procurement of a Medicaid program to enroll a Medicaid recipient who is eligible to participate in the Medicare program (42 U.S.C. 1395 et seq.) and receives nursing facility services in a risk based managed care program or capitated managed care program: (1) must comply with IC 12-15-13-1.8(e) and any other applicable statute; and (2) may not be issued until the request for proposal has been reviewed by the budget committee. As added by P.L.165-2021, SEC.138. Amended by P.L.138-2022, SEC.18; P.L.160-2026, SEC.9.

Ind. Code § 12-15-5-18 Emergency medical service provider agencies; reimbursement; federal approval

Sec. 18. (a) This section applies to an emergency medical services provider agency that meets the following requirements: (1) Is requesting reimbursement for services provided as part of a mobile integrated healthcare program that has been approved by the emergency medical services commission under IC 16-31-12. (2) Is a Medicaid provider. (b) The office of the secretary may reimburse an emergency medical services provider agency that is a Medicaid provider under this article for Medicaid covered services provided to a Medicaid recipient. (c) The office of the secretary may apply to the United States Department of Health and Human Services for any amendment to the state Medicaid plan or for any Medicaid waiver necessary to implement this section. As added by P.L.100-2019, SEC.1.

Ind. Code § 12-15-5-18.2 Mobile integrated healthcare program; authority to apply for a waiver and for federal funding

Sec. 18.2. The office of the secretary may apply to the United States Department of Health and Human Services for the following concerning the mobile integrated healthcare program: (1) A waiver to implement the program. (2) Federal funding through Section 9813 of the American Rescue Plan Act of 2021 (P.L. 117-2) for the programs set forth in IC 16-31-12. However, if federal funding ceases to be available, then no additional state funding for the mobile integrated healthcare program shall be allocated to the program after that date. As added by P.L.165-2021, SEC.139.

Ind. Code § 12-15-5-18.5 Reimbursement for emergency medical services

Sec. 18.5. (a) This section applies to an emergency medical services provider organization that meets the following requirements: (1) Is certified by the Indiana emergency medical services commission as an advanced life support provider organization under rules adopted under IC 16-31-3. (2) Is a Medicaid provider. (b) The office of the secretary shall provide reimbursement for Medicaid covered services provided to a Medicaid recipient that are: (1) rendered by an emergency medical services provider organization that is a Medicaid provider; (2) within the emergency medical services provider organization's scope of practice; (3) performed or provided as advanced life support services; and (4) performed or provided during a response initiated through the 911 system, regardless of whether the patient is transported. (c) If multiple emergency medical services provider organizations qualify and submit a claim for reimbursement under this section, the office of the secretary: (1) may reimburse under this section only for one (1) claim per patient encounter; and (2) shall reimburse the claim submitted by the emergency medical services provider organization that performed or provided the majority of advanced life support services. (d) The office of the secretary may apply to the United States Department of Health and Human Services for any amendment to the state Medicaid plan or for any Medicaid waiver necessary to implement this section. As added by P.L.115-2020, SEC.3.

Ind. Code § 12-15-5-18.7 Reimbursement for emergency medical services provider organizations; waiver or state plan amendment

Sec. 18.7. (a) This section applies to an emergency medical services provider organization that meets the following requirements: (1) Is certified by the Indiana emergency medical services commission to provide emergency medical services. (2) Is a Medicaid provider. (b) Beginning July 1, 2023, the office of the secretary shall reimburse an emergency medical services provider organization for Medicaid covered services to a Medicaid recipient, including: (1) advanced life support services; (2) basic life support services; and (3) nonemergency medical transportation services; that are within the emergency medical services provider organization's scope of practice at a rate that is comparable to the federal Medicare reimbursement rate for the service provided by the emergency medical services provider organization. However, the reimbursement rate specified in this subsection may not be implemented by the office of the secretary before July 1, 2023. (c) Before September 1, 2022, the office of the secretary shall apply to the United States Department of Health and Human Services for any state plan amendment or waiver necessary to implement this section and IC 12-15-12-18.5. As added by P.L.142-2022, SEC.1.

Ind. Code § 12-15-5-19 Medicaid rehabilitation option service; review; determination on services; report; notification; contract with community mental health center

Sec. 19. (a) Not later than one (1) year from the date the office receives approval for the state plan amendment described in IC 12-15-1.3-21 concerning Medicaid rehabilitation option services, the office shall do the following: (1) Review the current services included in the Medicaid rehabilitation option services program in the school setting. (2) Determine whether additional appropriate services, including: (A) family engagement services; and (B) additional comprehensive behavioral health services, including addiction services; should be included as part of the program. (3) Report the office's findings under this subsection to the general assembly in an electronic format under IC 5-14-6. (b) Not later than three (3) months from the date the office receives approval for the state plan amendment described in IC 12-15-1.3-21 concerning Medicaid rehabilitation option services, the office shall notify each school corporation that the United States Department of Health and Human Services has approved the state plan amendment applied for under IC 12-15-1.3-21. (c) Each school corporation shall, not later than one (1) year from the date the office receives approval for the state plan amendment described in IC 12-15-1.3-21 concerning Medicaid rehabilitation option services, contract with a community mental health center to provide Medicaid rehabilitation option services for: (1) a student of the school corporation who is a Medicaid recipient; and (2) the student's family. As added by P.L.246-2019, SEC.3.

Ind. Code § 12-15-5-20 "Intensive outpatient treatment program"

Sec. 20. (a) As used in this section, "intensive outpatient treatment program" means an organized treatment program that uses behavioral health professionals and clinicians in a group setting to provide multiple treatment service components for rehabilitation of alcohol and other substance use or dependency. The term includes services determined by the office and approved in the Medicaid state plan. (b) If the office requires a supervisor for addiction based intensive outpatient treatment under this article, the following supervisors who either have at least two (2) years of experience in addiction treatment or hold an addiction credential, as determined by the division, are eligible supervisors: (1) Licensed clinical social workers. (2) Licensed mental health counselors. (3) Licensed marriage and family therapists. (4) Licensed clinical addiction counselors. (c) The office may not require a direct service provider in an intensive outpatient treatment program to be a licensed addiction counselor or a licensed clinical addiction counselor. However, the direct service provider must, under the supervision of a clinician described in subsection (b), either: (1) hold an addiction credential, as determined by the division; or (2) have training and experience in addiction treatment, as determined by the division. As added by P.L.127-2020, SEC.1.

Ind. Code § 12-15-5-21 Community mental health centers; governmental units

Sec. 21. For purposes of required nonfederal share medical assistance payments under Title XIX of the Social Security Act, a community mental health center is defined as a governmental unit. As added by P.L.127-2020, SEC.2.

Ind. Code § 12-15-5-21.5 Biomarker testing; federal approval; report

Sec. 21.5. (a) As used in this section, "biomarker" means a characteristic that is objectively measured and evaluated as an indicator of: (1) normal biological processes; (2) pathogenic processes; or (3) pharmacologic responses to a specific therapeutic intervention, including known gene-drug interactions for medications being considered for use or already being administered. The term includes gene mutations, characteristics of genes, and protein expression. (b) As used in this section, "biomarker testing" means the analysis of a patient's tissue, blood, or other biospecimen for the presence of a biomarker. The term includes: (1) single-analyte tests; (2) multiplex panel tests; (3) protein expression; and (4) whole exome, whole genome, and whole transcriptome sequencing. (c) As used in this section, "consensus statement" means a statement that is: (1) issued by an independent, multidisciplinary panel of experts that: (A) uses a transparent methodology and reporting structure; and (B) has a conflict of interest policy; (2) aimed at specific clinical circumstances; (3) based on the best available evidence; and (4) developed for the purpose of optimizing the outcomes of clinical care. (d) As used in this section, "nationally recognized clinical practice guidelines" means evidence based clinical practice guidelines that: (1) are developed by an independent organization or medical professional society that: (A) uses a transparent methodology and reporting structure; and (B) has a conflict of interest policy; (2) establish standards of care informed by: (A) a systematic review of evidence; and (B) an assessment of the benefits and risks of alternative care options; and (3) include recommendations intended to optimize patient care. (e) The office shall provide, as a Medicaid program service, biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when biomarker testing is supported by medical and scientific evidence, including: (1) labeled indications for a test approved or cleared by the United States Food and Drug Administration; (2) indicated tests for a drug approved by the United States Food and Drug Administration; (3) a warning or precaution on the label of a drug approved by the United States Food and Drug Administration; (4) a national coverage determination of the Centers for Medicare and Medicaid Services (CMS); (5) a local coverage determination of a Medicare administrative contractor; or (6) nationally recognized clinical practice guidelines or consensus statements. The service required by this section must be provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples. (f) Nothing in this section shall be construed to require coverage of biomarker testing for screening purposes. (g) 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 for the purpose of providing biomarker testing. 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. (i) Before November 1, 2025, and before November 1 of each year thereafter, the office of the secretary shall report to the budget committee on the Medicaid reimbursement rates provided for biomarker testing. The report shall include the following statewide aggregate information for the state fiscal year 2023 and the state fiscal year most recently ended: (1) The total number of patients who received biomarker testing. (2) The total number of patients who received biomarker testing for each biomarker test type. (3) The total amount of state funding expended for biomarker testing. (4) The ten (10) most common conditions or treatments for which biomarker testing was ordered. (5) As a result of the biomarker testing, how many patients: (A) were placed on particular therapies; (B) avoided certain treatments; and (C) were subject to any other treatment impacts. (6) Any other information requested by the budget committee. Each provider that receives state Medicaid funding under this section shall provide the information described in subdivisions (1) through (6) to the office of the secretary not later than August 1 of each year. As added by P.L.37-2024, SEC.1.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026