Indiana Medicaid State Plan Complete Plan  (NOTE: Document is over 50MB and will take a few moments to open completely.) Table of Contents Section 1 - Single State Agency Organization 1.1 - Designation and Authority 1.2 - Organization for Administration 1.3 - Statewide Operation 1.4 - State Medical Care Advisory Committee 1.5 - Pediatric Immunization Program Section 2 - Coverage and Eligibility 2.1 - Application, Determination of Eligibility and Furnishing Medicaid 2.2 - Coverage and Conditions of Eligibility 2.3 - Residence 2.4 - Blindness 2.5 - Disability 2.6 - Financial Eligibility 2.7 - Medicaid Furnished Out of State Section 3 - Services: General Provisions 3.1 - Page 19(a1) - Amount, Duration, and Scope of Services 3.1 - Page 20(a2) - Amount, Duration, and Scope of Services 3.1 - Page 21(a3-a5) - Amount, Duration, and Scope of Services 3.1 - Pages 21-22(a6-a10) - Amount, Duration, and Scope of Services 3.1 - Page 23(b) - Amount, Duration, and Scope of Services 3.1 - Pages 24-26(c-e) - Amount, Duration, and Scope of Services 3.1 - Page 27(f-h) - Amount, Duration, and Scope of Services 3.2 - Coordination of Medicaid with Medicare Part B 3.3 - Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases 3.4 - Special Requirements Applicable to Sterilization Procedures 3.5 - Families Receiving Extended Medicaid Benefits Section 4 - General Program Administration 4.1 - Methods of Administration 4.2 - Hearings for Applicants and Recipients 4.3 - Safeguarding Information on Applicants and Recipients 4.4 - Medicaid Quality Control 4.5 - Medicaid Agency Fraud Detection and Investigation Program 4.6 - Reports 4.7 - Maintenance of Records 4.8 - Availability of Agency Program Manuals 4.9 - Reporting Provider Payments to the Internal Revenue Service 4.10 - Free Choice of Providers 4.11 - Relations with Standard-Setting and Survey Agencies 4.12 - Consultation to Medical Facilities 4.13 - Required Provider Agreement 4.14 - Utilization Control 4.15 - Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases 4.16 - Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees 4.17 - Liens and Recoveries 4.18 - Cost Sharing and Similar Charges 4.19 - Payment for Services 4.20 - Direct Payments to certain Recipients for Physicians' or Dentists' Services 4.21 - Prohibition Against Reassignment of Provider Claims 4.22 - Third Party Liability 4.23 - Use of Contracts 4.24 - Standards for Payments for Skilled Nursing and Intermediate Care Facility Services 4.25 - Program for Licensing Administrators of Nursing Homes 4.26 - Drug Utilization Review Program 4.27 - Disclosure of Survey information and Provider or Contractor Evaluation 4.28 - Appeals Process for Skilled Nursing and Intermediate Care Facilities 4.29 - Conflict of Interest Provisions 4.30 - Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals 4.31 - Disclosure of Information by Providers and Fiscal Agents 4.32 - Income and Eligibility Verification System 4.33 - Medicaid Eligibility Cards for Homeless Individuals 4.34 - Systematic Alien Verification for Entitlements 4.35 - Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation 4.36 - Required Coordination Between the Medicaid and WIC Programs 4.38 - Nurse Aide Training and Competency Evaluation for Nursing Facilities 4.39 - Preadmission Screening and Annual Resident Review in Nursing Facilities 4.40 - Survey and Certification Process 4.41 - Resident Assessment for Nursing Facilities 4.42 - Employee Education About False Claim Recoveries 4.43 - Cooperation with Medicaid Integrity Program Efforts 4.44 - Prohibition on Payments to Institutions or Entities Located Outside of the US 4.46 - Provider Screening and Enrollment Section 5 - Personnel Administration 5.1 - Standards of Personnel Administration 5.2 - For Future Use 5.3 - Training Programs; Subprofessional and Volunteer Programs Section 6 - Financial Administration 6.1 - Fiscal Policies and Accountability 6.2 - Cost Allocation 6.3 - State Financial Participation Section 7 - General Provisions 7.1 - Plan Amendments 7.2 - Nondiscrimination 7.3 - Maintenance of AFDC Effort 7.4 - State Governor's Review 7.7 - Compliance with American Rescue Plan Act Attachments 1.1-A - Attorney General's Certification 1.2-A - Organization and Function of State Agency 1.2-B - Organization and Function of Medical Assistance Unit 1.2-C - Professional Medical and Supporting Staff 1.2-D - Description of Staff Making Eligibility Determination 2.2-A, Pages 1-5 - Groups Covered and Agencies Responsible for Eligibility 2.2-A, Pages 6-8 - Groups Covered and Agencies Responsible for Eligibility 2.2-A, Pages 9-11a - Groups Covered and Agencies Responsible for Eligibility 2.2-A, Pages 12-17 - Groups Covered and Agencies Responsible for Eligibility 2.2-A, Pages 18-23h - Groups Covered and Agencies Responsible for Eligibility 2.2-A, Pages 24-27 - Groups Covered and Agencies Responsible for Eligibility Supplement 1 - Reasonable Classifications of Individuals under the Age of 21, 20, 19 and 18 Supplement 3 - Method of Determining Cost Effectiveness of Caring for Certain Disabled Children at Home 2.6-A, Pages 1-4c - Eligibility Conditions and Requirements 2.6-A, Pages 5-10 - Eligibility Conditions and Requirements 2.6-A, Pages 11-15a - Eligibility Conditions and Requirements 2.6-A, Pages 16-20a - Eligibility Conditions and Requirements 2.6-A, Pages 21-26a - Eligibility Conditions and Requirements Supplement 1 - Income Eligibility Levels Supplement 2 - Resource Levels Supplement 3 - Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered Under Medicaid Supplement 4 - Section_1902(f) Methodologies for Treatment of Income that Differ from those of the SSI Program Supplement 5 - More Restrictive Methods of Treatment Resources than those of the SSI Program Supplement 5a - Methods for Treatment of Resources for Individuals with Incomes Related to the Federal Poverty Level Supplement 6 - Standards for Optional State Supplementary Payments Supplement 7 - Income Levels for 1902(f) States - Categorically Needy Who Are Covered Under Requirements More Restrictive than SSI Supplement 8 - Resource Standards for 1902(f) States - Categorically Needy Supplement 8a - More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act Supplement 8b - More Liberal Methods of Treating Resources Under Section 1902(r)(2) of the Act Supplement 9 - Transfer of Assets Supplement 9a - Transfer of Assets Supplement 9b - Transfer of Assets Supplement 10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship Supplement 11 - Cost-Effective Methods for COBRA Groups (States and Territories) Supplement 12 - Variations from the Basic Personal Needs Allowance; Section 1931 Eligibility Supplement 13 - Section_1924 Provisions Supplement 14 - Income and Resource Requirements for TB-infected Individuals Supplement 15 - Eligibility Under Section 1931 of the Act Supplement 16 - Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity Supplement 17 - Asset Verification System Supplement 18 - Methodology for Identification of Applicable FMAP Rates 3.1-A, Pages 1-13 - Amount, Duration and Scope of Medical Services Provided to the Categorically Needy 3.1-A, Addendum Pages 1-14 - Description of Limitations Supplement 1 - Case Management Services Supplement 3 - Program of All-Inclusive Care for the Elderly (PACE) Supplement 4 - Medication Assisted Treatment 3.1-A.1 - Requirements Relating to Covered Outpatient Drugs 3.1-B - Program of All-Inclusive Care for the Elderly (PACE) 3.1-C - Standards and Methods of Assuring High Quality Care 3.1-D - Methods of Providing Transportation 3.1-E - Standards for the Coverage of Organ Transplant Procedures 3.1-F - 1932a of the Act 3.1-I - 1915(i) Home and Community-Based Services 3.1-i-B - 1915(i) Home and Community-Based Services 3.1-i-C - 1915(i) Home and Community-Based Services 4.11-A - Standards for Institutions 4.16-A, Pages 1a-7a - Cooperative Arrangement: Indiana State Department of Health 4.16-A, Pages 1b-4b - Cooperative Arrangement: Division of Disability, Aging and Rehabilitation 4.16-A, Pages 1c-7c - Cooperative Arrangement: Indiana State Department of Health 4.16-A, Pages 1d-1e - Cooperative Arrangement: Reserved for Future Use 4.16-A, Pages 1f-7f - Cooperative Arrangement: Division of Mental Health and Addiction, and Division of Disabilty, Aging and Rehabilitation 4.16-A, Pages 1g-6g - Cooperative Arrangement: Head Start Program 4.16-A, Pages 1h-4h - Cooperative Arrangement: Office of Attorney General 4.16-A, Pages 1i-4i - Cooperative Arrangement: Division of Mental Health and Addiction 4.17-A - Liens and Adjustments or Recoveries 4.18-A - Charges Imposed on Categorically Needy 4.18-C - Charges Imposed on Medically Needy and Other Optional Groups 4.18-D - Premiums Imposed on Low-Income Pregnant Women and Infants 4.18-E - Premiums Imposed on Qualified Disabled and Working Individuals 4.19-A, Pages i-1H.3 - Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care 4.19-A, Pages 1I-1M - Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care 4.19-A, Pages 1N.1-1N.10 - Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care 4.19-A, Pages 2-21 - Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care 4.19-B, Pages 1-1h - Methods and Standards for Establishing Payment Rates - Other Types of Care 4.19-B, Pages 2-2.12 - Methods and Standards for Establishing Payment Rates - Other Types of Care 4.19-B, Pages 2a-2f - Methods and Standards for Establishing Payment Rates - Other Types of Care 4.19-B, Pages 3-3e - Methods and Standards for Establishing Payment Rates - Other Types of Care 4.19-B, Pages 4-8 - Methods and Standards for Establishing Payment Rates - Other Types of Care 4.19-B, Pages 9-15 - Methods and Standards for Establishing Payment Rates - 1915(i) Home and Community-Based Services Supplement 1 - Methods and Standards for Establishing Payment Rates for Title XVIII Deductible/Coinsurance 4.19-C - Payments for Reserved Beds 4.19-D, Pages i-44 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 45-54 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 55-64 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 65-68D - Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care 4.19-D, Pages 69-77 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 78-86 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 87-95 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 96-105 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 106-112 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 113-123 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-D, Pages 124-137 - Methods and Standards for Establishing Payment Rates - Skilled Nursing and Intermediate Care Facility Services 4.19-E - Timely Claims Payment 4.22-A - Requirements for Third Party Liability - Identifying Liable Resources 4.22-B - Requirements for Third Party Liability - Payment of Claims 4.22-C - State Methodology on Cost Effectiveness of Employer-Based Group Health Plans 4.30 - Sanctions for Psychiatric Hospitals 4.32-A - Income and Eligibility Verification System Procedures: Requests to Other State Agencies 4.33-A - Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals 4.34-A - Advanced Directives 4.35-A - Enforcement of Compliance for Nursing Facilities 4.35-B - Enforcement of Compliance for Nursing Facilities 4.35-C - Enforcement of Compliance for Nursing Facilities 4.35- D - Enforcement of Compliance for Nursing Facilities 4.35- E - Enforcement of Compliance for Nursing Facilities 4.35-F - Enforcement of Compliance for Nursing Facilities 4.35-G - Enforcement of Compliance for Nursing Facilities 4.35-H - Enforcement of Compliance for Nursing Facilities 4.38 - Disclosure of Additional Registry Information 4.38-A - Collection of Additional Registry Information 4.39 - Definition of Specialized Services 4.39-A - Categorical Determinations 4.40-A - Survey and Certification Education Program 4.40-B - Process for Investigation of Allegations of Resident Neglect, Abuse and Misappropriation of Resident Property 4.40-C - Procedures for Scheduling and Conduct of Standard Surveys 4.40-D - Programs to Measure and Reduce Inconsistency 4.40-E - Process for Investigations of Complaints and Monitoring 4.42 - Employee Education About False Claim Recoveries 7.2-A - Methods of Administration - Civil Rights Act (Title VI) Medicaid State Plan Eligibility A1 - State Plan Administration S10- MAGI-based Income Methodologies S14- AFDC Income Standards S25- Parents and Other Caretaker Relatives S28- Pregnant Women S30- Infants and Children Under age 19 S32- Adult Groups S33- Former Foster Care Children S50- Individuals above 133% FPL S51- Optional Coverage of Parents and Other Caretaker Relatives S52- Reasonable Classification of Individuals Under Age 21 S53- Children with Non IV-E Adoption Assistance S54- Optional Targeted Income Children S55- Individuals with Tuberculosis S57- Independent Foster Care Adolescents S59- Individuals Eligible for Family Planning Services S88- State Residency S89- Citizenship and Non-Citizenship Eligibility S94- General Eligibility Requirements - Eligibility Process Eligibility and Enrollment Processes - Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage Medicaid Premiums and Cost Sharing G1 - Cost Sharing Requirements G2a - Cost Sharing Amounts - Categorically Needy Individuals G2b - Cost Sharing Amounts - Medically Needy Individuals G2c - Cost Sharing Amounts - Targeting G3 - Cost Sharing Limitations Alternative Benefit Plan HIP Basic H1.1 - Alternative Benefit Plan Populations H1.2a- Voluntary Benefit Package Selection Assurances H1.2c- Enrollment Assurances - Mandatory Participants H1.3 - Benchmark-Equivalent Benefit Package H1.4 - Alternative Benefit Plan Cost-Sharing H1.5 - Benefits Description H1.7 - Benefits Assurances H1.8 - Service Delivery Systems H1.9 - Employer Sponsored Insurance and Payment of Premiums H1.10- General Assurances H1.11- Payment Methodologies HIP Plus H2.1 - Alternative Benefit Plan Populations H2.2a- Voluntary Benefit Package Selection Assurances H2.2c- Enrollment Assurances - Mandatory Participants H2.3 - Benchmark-Equivalent Benefit Package H2.4 - Alternative Benefit Plan Cost-Sharing H2.5 - Benefits Description H2.7 - Benefits Assurances H2.8 - Service Delivery Systems H2.9 - Employer Sponsored Insurance and Payment of Premiums H2.10- General Assurances H2.11- Payment Methodologies