Indiana § 12-15-30-7 - Statement requesting payment for fees for performance of administrative responsibilities; certification to state comptroller

§ 12-15-30-7. Statement requesting payment for fees for performance of administrative responsibilities; certification to state comptroller

Sec. 7. (a) A contractor under section 1 of this chapter shall submit a statement, at the times and in the form prescribed by the office, requesting payment for fees for performance of administrative responsibilities under contracts executed under this chapter.

(b) The office shall certify a statement under subsection (a) to the state comptroller, who shall pay the amount of the requested fees.

[Pre-1992 Revision Citation: 12-1-7-17. 1(g).]

As added by P.L.2-1992, SEC.9. Amended by P.L.9-2024, SEC.334.

IC 12-15-30.5Chapter 30.5. Nonemergency Medical Transportation

12-15-30.5-1"Broker" 12-15-30.5-2"Commission" 12-15-30.5-2Repealed 12-15-30.5-3"Nonemergency medical transportation" 12-15-30.5-4Reporting; duties when assignment for request not made within 48 hours 12-15-30.5-5Broker requirements; confidentiality; remediation plan 12-15-30.5-6Report on claims 12-15-30.5-6Repealed 12-15-30.5-7Commission; membership; term; staffing 12-15-30.5-7Repealed 12-15-30.5-8Commission member per diem and travel 12-15-30.5-8Repealed 12-15-30.5-9Meetings 12-15-30.5-9Repealed 12-15-30.5-10Reporting requirement 12-15-30.5-10Repealed

IC 12-15-30.5-1"Broker" Sec. 1. As used in this chapter, "broker" means a contractor of the office that administers the Medicaid fee-for-service nonemergency medical transportation program.

As added by P.L.116-2019, SEC.4.

IC 12-15-30.5-2"Commission" Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027.

Sec. 2. As used in this chapter, "commission" refers to the nonemergency medical transportation commission established by section 7 of this chapter.

As added by P.L.116-2019, SEC.4.

IC 12-15-30.5-2Repealed Note: This repeal of section effective 7-1-2027. See also preceding version of this section, effective until 7-1-2027.

As added by P.L.116-2019, SEC.4. Repealed by P.L.152-2026, SEC.187.

IC 12-15-30.5-3"Nonemergency medical transportation" Sec. 3. As used in this chapter, "nonemergency medical transportation" means medically necessary transportation to Medicaid covered services for an eligible Medicaid recipient who:

(1) participates in the Medicaid fee-for-service program; and

(2) does not have available transportation to:

(A) a Medicaid reimbursable service; or

(B) a pharmacy to obtain Medicaid reimbursable pharmacy services.

As added by P.L.116-2019, SEC.4.

IC 12-15-30.5-4Reporting; duties when assignment for request not made within 48 hours Sec. 4. (a) A broker must do the following:

(1) Submit monthly reports to the office of the secretary for the office of the secretary to post on the office of the secretary's website of the following:

(A) A list and map by county of the number of vehicles, by vehicle type, that are contracted, credentialed, and available to provide nonemergency medical transportation in that county.

(B) Based upon a comparison of trip-leg identification numbers issued by the broker to the corresponding claim submitted with that trip-leg identification number, the number of instances in which a requested nonemergency medical transportation for an eligible Medicaid recipient was not provided, including whether:

(i) the instance related to picking up the recipient to go to an appointment;

(ii) the instance related to picking up the recipient from an appointment;

(iii) the instance related to a Medicaid recipient or transportation provider not being available;

(iv) the recipient resides in the community, a health facility, an intermediate care facility for individuals with intellectual disabilities, a hospital, or another location; and

(v) the instance resulted from the transportation request being canceled by the transportation provider more than forty-eight (48) hours before the appointment or within forty-eight (48) hours of the appointment.

(C) A summary of the complaints received by the broker, whether or not the complaints have been substantiated. Information under this clause must include the total number of complaints and whether the complaint related to:

(i) a scheduled ride to go to an appointment;

(ii) a scheduled ride from an appointment; and

(iii) a recipient who resided in the community, a health facility, an intermediate care facility for individuals with intellectual disabilities, a hospital, or another location.

(2) Submit monthly to the office of the secretary for the office of the secretary to post on the office of the secretary's website a report comparing:

(A) the number of eligible Medicaid recipients; to

(B) the number of contracted and credentialed transportation vehicles, by type and by county, that are available to provide nonemergency medical transportation in a county;

and including the calculation of the ratio of eligible Medicaid recipients to vehicle type.

(3) Submit a monthly report to the office of the secretary that includes the following information for the previous month:

(A) The number of ride requests received and scheduled trip-leg identification numbers issued.

(B) Call center statistics.

(C) Information on claims payments, including claim denial reason codes.

(D) Program integrity referrals.

(E) Information concerning grievances and appeals, including the status of any grievance or appeal that is either open or closed in the month of the report.

(b) If the broker has not assigned a transportation provider to a request for nonemergency medical transportation within forty-eight (48) hours of the time in which the transportation is to be provided, the broker shall do the following:

(1) Take steps to notify the:

(A) Medicaid recipient for which the request was made; and

(B) health facility, if the Medicaid recipient resides in a health facility;

that a transportation provider has not yet been assigned.

(2) Continue to make every effort in securing transportation for the Medicaid recipient and immediately notify the recipient described in subdivision (1)(A) and, if applicable, the health facility described in subdivision (1)(B), when transportation has been assigned.

(3) Document whether the notice required under subdivision (1) was communicated to the Medicaid recipient or a person on behalf of the Medicaid recipient, and the method of communication.

As added by P.L.116-2019, SEC.4. Amended by P.L.156-2020, SEC.56; P.L.1-2025, SEC.168.

IC 12-15-30.5-5Broker requirements; confidentiality; remediation plan Sec. 5. (a) A broker shall establish, implement, and maintain the following:

(1) One (1) toll free telephone number clearly identified for the handling of complaints concerning the nonemergency medical transportation services.

(2) A link on the home page of the broker's website titled "File a Complaint Here" that is accessible by the public and that allows for the submission of a complaint concerning the nonemergency medical transportation services.

(3) Instructions on the broker's website on how to file a complaint concerning nonemergency medical transportation services.

(4) A process to notify a person who files a complaint about:

(A) the steps the broker will take to investigate the complaint; and

(B) the results of the investigation.

(b) Except for disclosure to the office of the secretary, the broker shall keep confidential the identity of any individual who submits a complaint with the broker concerning nonemergency medical transportation services.

(c) If a complaint concerning nonemergency medical transportation services made to the broker is substantiated, the broker shall develop a remediation plan concerning the complaint and submit the remediation plan to the office of the secretary for the office of the secretary to post the remediation plan on the office of the secretary's website.

As added by P.L.116-2019, SEC.4. Amended by P.L.1-2025, SEC.169.

IC 12-15-30.5-6Report on claims Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027.

Sec. 6. (a) Before October 1, 2019, the office of the secretary shall prepare a report containing the number of Medicaid fee-for-service nonemergency medical transportation claims paid by:

(1) vehicle type;

(2) Medicaid recipient category; and

(3) whether the recipient for which the claim was paid resided in:

(A) the community;

(B) a health facility;

(C) an intermediate care facility for individuals with intellectual disabilities;

(D) a hospital; or

(E) another location.

(b) Beginning June 1, 2016, through May 31, 2019, the claims data reported in subsection (a) must be organized by month.

(c) The office of the secretary shall submit the report prepared under subsection (a) to the commission.

As added by P.L.116-2019, SEC.4.

IC 12-15-30.5-6Repealed Note: This repeal of section effective 7-1-2027. See also preceding version of this section, effective until 7-1-2027.

As added by P.L.116-2019, SEC.4. Repealed by P.L.152-2026, SEC.188.

IC 12-15-30.5-7Commission; membership; term; staffing Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027.

Sec. 7. (a) The nonemergency medical transportation commission is established for the purpose of overseeing the provision of nonemergency medical transportation services to ensure that Medicaid fee-for-service recipients are receiving satisfactory service and to ensure that brokers pay the claims of transportation providers in a timely manner.

(b) The commission consists of the following members:

(1) Two (2) members of the senate, who may not be members of the same political party, appointed by the president pro tempore of the senate with the advice of the minority leader of the senate.

(2) Two (2) members of the house of representatives, who may not be members of the same political party, appointed by the speaker of the house of representatives with the advice of the minority leader of the house of representatives.

(3) One (1) representative of the office of the secretary.

(4) One (1) individual representing a broker.

(5) One (1) individual representing a transportation provider that has contracted with a broker.

(6) One (1) individual representing the Indiana Hospital Association.

(7) One (1) individual representing the Indiana Health Care Association.

(8) One (1) individual representing the Indiana Association of Rehabilitation Facilities.

(9) One (1) individual representing the Arc of Indiana.

(10) One (1) physician licensed under IC 25-22.5.

(11) One (1) individual representing dialysis providers.

(12) One (1) Medicaid fee-for-service recipient.

(13) One (1) individual representing the Indiana Association of Area Agencies on Aging.

(14) One (1) individual representing the Indiana Emergency Medical Services Association.

(c) The members of the commission described in subsection (b)(1) and (b)(2) shall serve:

(1) as nonvoting advisory members; and

(2) for a four (4) year term.

(d) The members of the commission described in subsection (b)(3) through (b)(14) shall be appointed by the governor for terms of four (4) years. The term of a member of the commission expires July 1. However, a member may continue to serve until a successor is appointed. In case of a vacancy, the governor shall appoint an individual to serve for the remainder of the unexpired term. The governor shall designate one (1) member described in this subsection as chairperson of the commission.

(e) The office shall provide staff support and technical assistance to the commission, including the collection of and dissemination of data and reports required by this chapter, in order for the commission to carry out its duties under this chapter.

As added by P.L.116-2019, SEC.4. Amended by P.L.23-2026, SEC.85.

IC 12-15-30.5-7Repealed Note: This repeal of section effective 7-1-2027. See also preceding version of this section, effective until 7-1-2027.

As added by P.L.116-2019, SEC.4. Amended by P.L.23-2026, SEC.85. Repealed by P.L.152-2026, SEC.189.

IC 12-15-30.5-8Commission member per diem and travel Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027.

Sec. 8. (a) Each member of the commission who is not a state employee is entitled to the minimum salary per diem provided by IC 4-10-11-2.1(b). Such a member is also entitled to reimbursement for traveling expenses and other expenses actually incurred in connection with the member's duties, as provided in the state travel policies and procedures established by the Indiana department of administration and approved by the budget agency.

(b) Each member of the commission who is a state employee but who is not a member of the general assembly is entitled to reimbursement for traveling expenses and other expenses actually incurred in connection with the member's duties, as provided in the state travel policies and procedures established by the Indiana department of administration and approved by the budget agency.

(c) Each member of the commission who is a member of the general assembly is entitled to receive the same per diem, mileage, and travel allowances paid to legislative members of interim study committees established by the legislative council. Per diem, mileage, and travel allowances paid under this subsection shall be paid from appropriations made to the legislative council or the legislative services agency.

As added by P.L.116-2019, SEC.4.

IC 12-15-30.5-8Repealed Note: This repeal of section effective 7-1-2027. See also preceding version of this section, effective until 7-1-2027.

As added by P.L.116-2019, SEC.4. Repealed by P.L.152-2026, SEC.190.

IC 12-15-30.5-9Meetings Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027.

Sec. 9. The commission shall meet at least two (2) times per year at a public meeting to do the following:

(1) Review a report submitted under this chapter.

(2) Provide feedback and make recommendations to the office of the secretary concerning the provision of nonemergency medical transportation services.

(3) Approve any monies to be awarded to a broker as part of a withhold provision outlined in the contract between the office of the secretary and the broker.

As added by P.L.116-2019, SEC.4.

IC 12-15-30.5-9Repealed Note: This repeal of section effective 7-1-2027. See also preceding version of this section, effective until 7-1-2027.

As added by P.L.116-2019, SEC.4. Repealed by P.L.152-2026, SEC.191.

IC 12-15-30.5-10Reporting requirement Note: This version of section effective until 7-1-2027. See also following repeal of this section, effective 7-1-2027.

Sec. 10. On or before July 1, 2027, and July 1 biennially thereafter, the commission shall submit a report to the executive director of the legislative services agency, in an electronic format under IC 5-14-6, for review by the interim committee on government in accordance with IC 1-1-15.5-4 and IC 2-5-1.3-13(g). The report shall describe:

(1) official action taken; and

(2) actionable items considered;

by the commission during the preceding two (2) years.

As added by P.L.161-2025, SEC.19.

IC 12-15-30.5-10Repealed Note: This repeal of section effective 7-1-2027. See also preceding version of this section, effective until 7-1-2027.

As added by P.L.161-2025, SEC.19. Repealed by P.L.152-2026, SEC.192.

IC 12-15-31Chapter 31. Repealed[Pre-1992 Revision Citations:

12-15-31-1formerly 12-1-7-16.3(a) part12-15-31-2formerly 12-1-7-16.3(a) part12-15-31-3formerly 12-1-7-16.3(a) part12-15-31-4formerly 12-1-7-16.3(b).]Repealed by P.L.291-2001, SEC.211.

IC 12-15-31.1Chapter 31.1. Adjustment of Pharmacy Dispensing Fees

12-15-31.1-1Dispensing fee surveys 12-15-31.1-2Evaluation of other dispensing fees 12-15-31.1-3Dispensing fee criteria 12-15-31.1-4Adjustment of dispensing fees

IC 12-15-31.1-1Dispensing fee surveys Sec. 1. At least once every two (2) years, the office shall conduct a survey of pharmacy providers to assess the appropriate level of dispensing fees to be paid to providers for prescribed drugs.

As added by P.L.15-2002, SEC.1.

IC 12-15-31.1-2Evaluation of other dispensing fees Sec. 2. A survey under section 1 of this chapter must include an evaluation of dispensing fees in other states and the policies of the federal Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration).

As added by P.L.15-2002, SEC.1.

IC 12-15-31.1-3Dispensing fee criteria Sec. 3. A dispensing fee shall be evaluated based upon the following information concerning the costs of pharmacy operation:

(1) Operational data.

(2) Professional services data.

(3) Overhead data.

(4) Profit data.

As added by P.L.15-2002, SEC.1.

IC 12-15-31.1-4Adjustment of dispensing fees Sec. 4. If an adjustment in dispensing fees is made following a survey conducted under section 1 of this chapter, the secretary shall commence the rulemaking process under IC 4-22-2 to make the adjustment not later than November 1 of the year in which the survey was conducted.

As added by P.L.15-2002, SEC.1.

IC 12-15-32Chapter 32. Community Residential Facilities for the Developmentally Disabled

12-15-32-1"Facility" 12-15-32-2Reimbursement; voiding of administrative rule 12-15-32-3Repealed 12-15-32-4Reimbursement rate criteria; necessary factors 12-15-32-4.5Reimbursement for staff hours of employees 12-15-32-5Special interim rates 12-15-32-6Facility residents; personal allowance; range of amounts 12-15-32-6.5Payment calculation for federal SSI recipient; exemption from income eligibility consideration 12-15-32-7Rules; functioning level of resident; personal allowance 12-15-32-8Personal allowance; income eligibility consideration; exemption 12-15-32-9Personal allowance; individuals employed as part of habilitation plan or working in sheltered workshop or day activity center 12-15-32-10Placement in facility; diagnostic evaluations 12-15-32-11Assessment upon total annual revenue of certain nonstate facilities; Medicaid assessment account; unavailability of federal matching funds