§ 12-15-13.5-6 — Recovery audits; development, review, and certification of plans of treatment

Indiana § 12-15-13.5-6

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 13.5: Medicaid Recovery Audits

Text

(a) Subject to subsection (b), a recovery
audit shall not require documentation, at the time of service, for
services provided by a community mental health center (as defined in
IC 12-7-2-38) when the documentation is part of an ongoing plan of
treatment or a documentation of specific treatment methods.
(b) The direct service provider shall complete documentation
described in subsection (a) within a reasonable time frame, but not later
than thirty (30) days from the date of service, prior to Medicaid billing.
(c) Any supervising provider in a community mental health center
is eligible to review documentation in order to certify a plan of
treatment or review specific treatment methods at intervals not greater
than ninety (90) days.
(d) A supervising provider described in subsection (c) may review
the documentation described in subsection (c) regardless of:
(1) whether the supervising provider is providing direct
supervision; and
(2) the location where the service was provided.
A review described under this subsection must be documented by the
signature of the supervising provider.
(e) In developing a plan of treatment, the following must be
completed to demonstrate active treatment with a client:
(1) A signed client consent form.
(2) The completion of a list of requirements concerning audit
compliance, as determined by the division in collaboration with
community mental health centers, that verifies active participation
in the development of the client's plan of treatment.
(3) Either:
(A) the signature of the client on the client's plan of treatment;
or
(B) if the direct care provider, after a good faith effort, is unable
to obtain the client's signature on the client's plan of treatment:
(i) the provision of documentation by the provider of the
reasons the provider was unable to obtain the signature;
(ii) the continuation of attempting to obtain the client's
signature on the client's plan of treatment; and
(iii) a determination by the division, based on the
documentation in item (i), that the direct care provider has
made a good faith effort to obtain the signature.

Legislative History

As added by P.L.127-2020, SEC.3.