§ 12-15-1.3-6 — Waiver application for prescription drug program for low income senior citizens; conditions; changes to program approved by prescription drug advisory committee; limitation of state expenditures; implementation of waiver

Indiana § 12-15-1.3-6

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 1.3: Medicaid Waivers and Plan Amendments

Text

(a) The office shall develop a federal
Medicaid waiver application under which a prescription drug program
may be established or implemented to provide access to prescription
drugs for low income senior citizens.
(b) Before the office may submit an application for a federal
Medicaid waiver that will affect the Indiana prescription drug program
established under IC 12-10-16, the following must occur:
(1) The office shall submit the proposed Medicaid waiver to the
prescription drug advisory committee.
(2) The prescription drug advisory committee must review, allow
public comment on, and approve the proposed Medicaid waiver.
(c) A prescription drug program established or implemented by the
office or a contractor of the office under this section may not limit
access to prescription drugs for prescription drug program recipients,
except under the following circumstances:
(1) Access may be limited to the extent that restrictions were in
place in the Medicaid program on March 26, 2002.
(2) Access may be limited to:
(A) prevent:
(i) fraud;
(ii) abuse;
(iii) waste;
(iv) overutilization of prescription drugs; and
(v) inappropriate utilization of prescription drugs; or
(B) implement a disease management program.
IC 12-15-35.5-7 applies to a limit implemented under this
subdivision.
(d) Changes to a prescription drug program that:
(1) is established or implemented by the office or a contractor of
the office under this section; and
(2) uses money from the Indiana prescription drug account
established under IC 4-12-8-2;
must be approved by the prescription drug advisory committee.
(e) 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 to provide access to prescription drugs for
low income senior citizens.
(f) A Medicaid waiver developed under this section must limit a
prescription drug program's state expenditures to funding appropriated
to the Indiana prescription drug account established under IC 4-12-8-2
from the Indiana tobacco master settlement agreement fund.
(g) 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.

Legislative History

As added by P.L.220-2011, SEC.264. Amended by P.L.213-2025, SEC.111.