§ 12-15-44.5-3.5 — Coverage; vision and dental; preventative care services

Indiana § 12-15-44.5-3.5

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 44.5: Healthy Indiana Plan 2.0

Text

5. (a) The plan must include the following
in a manner and to the extent determined by the office:
(1) Mental health care services.
(2) Inpatient hospital services.
(3) Prescription drug coverage, including coverage of a long
acting, nonaddictive medication assistance treatment drug if the
drug is being prescribed for the treatment of substance abuse.
(4) Emergency room services.
(5) Physician office services.
(6) Diagnostic services.
(7) Outpatient services, including therapy services.
(8) Comprehensive disease management.
(9) Home health services, including case management.
(10) Urgent care center services.
(11) Preventative care services.
(12) Family planning services:
(A) including contraceptives and sexually transmitted disease
testing, as described in federal Medicaid law (42 U.S.C. 1396
et seq.); and
(B) not including abortion or abortifacients.
(13) Hospice services.
(14) Substance abuse services.
(15) Donated breast milk that meets requirements developed by
the office of Medicaid policy and planning.
(16) A service determined by the secretary to be required by
federal law as a benchmark service under the federal Patient
Protection and Affordable Care Act.
(b) The plan may not permit treatment limitations or financial
requirements on the coverage of mental health care services or
substance abuse services if similar limitations or requirements are not
imposed on the coverage of services for other medical or surgical
conditions.
(c) The plan may provide vision services and dental services only
to individuals who regularly make the required monthly contributions
for the plan as set forth in section 4.7(c) of this chapter.
(d) The benefit package offered in the plan:
(1) must be benchmarked to a commercial health plan described
in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
(2) may not include a benefit that is not present in at least one (1)
of these commercial benchmark options.
(e) The office shall provide to an individual who participates in the
plan a list of health care services that qualify as preventative care
services for the age, gender, and preexisting conditions of the
individual. The office shall consult with the federal Centers for Disease
Control and Prevention for a list of recommended preventative care
services.
(f) The plan shall, at no cost to the individual, provide payment of
preventative care services described in 42 U.S.C. 300gg-13 for an
individual who participates in the plan.
(g) The plan shall, at no cost to the individual, provide payments of
not more than five hundred dollars ($500) per year for preventative
care services not described in subsection (f). Any additional
preventative care services covered under the plan and received by the
individual during the year are subject to the deductible and payment
requirements of the plan.
(h) The office shall apply to the United States Department of Health
and Human Services for any amendment to the waiver necessary to
implement the providing of the services or supplies described in
subsection (a)(15). This subsection expires July 1, 2024.

Legislative History

As added by P.L.30-2016, SEC.28. Amended by P.L.180-2022(ss), SEC.16.