Indiana Code 12-15-44.5-3. Plan established; eligibility; oversight of marketing; promotion of plan; ensure enrollment distribution; consumer protection; provider participation; exemptions
(b) The office shall administer the plan.
Terms Used In Indiana Code 12-15-44.5-3
- Oversight: Committee review of the activities of a Federal agency or program.
- plan: refers to the healthy Indiana plan established by section 3 of this chapter. See Indiana Code 12-15-44.5-2
(1) The adult group described in 42 C.F.R. § 435.119.
(2) Parents and caretaker relatives eligible under 42 C.F.R. § 435.110.
(3) Low income individuals who are:
(A) at least nineteen (19) years of age; and
(B) less than twenty-one (21) years of age;
and eligible under 42 C.F.R. § 435.222.
(4) Individuals, for purposes of receiving transitional medical assistance.
An individual must meet the Medicaid residency requirements under IC 12-15-4-4 and this article to be eligible for the plan.
(d) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare program (42 U.S.C. § 1395 et seq.).
(2) An individual who is otherwise eligible and enrolled for medical assistance.
(e) The department of insurance and the office of the secretary shall provide oversight of the marketing practices of the plan.
(f) The office shall promote the plan and provide information to potential eligible individuals who live in medically underserved rural areas of Indiana.
(g) The office shall, to the extent possible, ensure that enrollment in the plan is distributed throughout Indiana in proportion to the number of individuals throughout Indiana who are eligible for participation in the plan.
(h) The office shall establish standards for consumer protection, including the following:
(1) Quality of care standards.
(2) A uniform process for participant grievances and appeals.
(3) Standardized reporting concerning provider performance, consumer experience, and cost.
(i) A health care provider that provides care to an individual who receives health coverage under the plan shall also participate in the Medicaid program under this article.
(j) The following do not apply to the plan:
(1) IC 12-15-12.
(2) IC 12-15-13.
(3) IC 12-15-14.
(4) IC 12-15-15.
(5) IC 12-15-21.
(6) IC 12-15-26.
(7) IC 12-15-31.1.
(8) IC 12-15-34.
(9) IC 12-15-35.
(10) IC 16-42-22-10.
As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.27; P.L.152-2017, SEC.32; P.L.241-2023, SEC.16.