§ 12-21-2-8 — Development of comprehensive system of monitoring, evaluation, and quality assurance; contract determination; reimbursement; submission of contract to attorney general; contract requirements

Indiana § 12-21-2-8

• Jurisdiction: Indiana
• Art. 21: DIVISION OF MENTAL HEALTH AND
• Ch. 2: Director of Division

Text

(a) The secretary or the secretary's designee
shall develop a comprehensive system of monitoring, evaluation, and
quality assurance for the services required by this chapter.
(b) The secretary shall determine to whom contracts are awarded,
based on the following factors:
(1) The continuity of services a contractor provides for patients.
(2) The accessibility of a contractor's services to patients.
(3) The acceptability of a contractor's services to patients.
(4) A contractor's ability to focus services on building the
self-sufficiency of the patient.
(c) This subsection applies to the reimbursement of contract
payments to providers. Payments must be determined prospectively in
accordance with generally accepted accounting principles and actuarial
principles recognizing costs incurred by efficiently and economically
operated programs that:
(1) serve individuals with a mental illness or substance abuse
patients; and
(2) are subject to quality and safety standards and laws.
(d) Before entering into a contract under this section, the secretary
or the secretary's designee shall submit the contract to the attorney
general for approval as to form and legality.
(e) A contract under this section must do the following:
(1) Specify:
(A) the work to be performed; and
(B) the patient populations to whom services must be provided.
(2) Provide for a reduction in funding or termination of the
contract for failure to comply with terms of the contract.
(3) Require that the contractor meet the standards set forth in
rules adopted by the division of mental health and addiction under
IC 4-22-2.
(4) Require that the contractor participate in the division's
evaluation process.
(5) For any service for which the division chooses to contract on
a per diem basis, the per diem reimbursement shall be determined
under subsection (c) for the contractor's reasonable cost of
providing services.
(6) In contracts with capitated payment provisions, provide that
the contractor's cost of purchasing stop-loss insurance for the
patient populations to be served in amounts and with limits
customarily purchased by prepaid health care plans must be:
(A) included in the actuarial determination of the capitated
payment amounts; or
(B) separately paid to the contractor by the division.
(7) Provide that a contract for enumerated services granted by the
division under this section to an approved provider may not create
or confer upon the provider liability or responsibility for care or
services beyond those services supported by the contract.

Legislative History

As added by P.L.40-1994, SEC.30. Amended by P.L.215-2001, SEC.57; P.L.99-2007, SEC.102; P.L.143-2011, SEC.15; P.L.35-2016, SEC.58.