20161109-IR-405160493ACA Agency Correction LSA Document #16-493(AC)

TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES

Agency Correction LSA Document #16-493(AC)

Under IC 4-22-2-38, corrects the following typographical, clerical, or spelling errors in the Indiana Administrative Code:

(1) In 405 IAC 5-1-1(b)(5), delete "medical necessity" and insert "medically necessary services".

(2) In 405 IAC 5-1-5(d), delete "the medical necessity for" and insert "that"; and, after "the procedure or service", insert "is medically necessary".

(3) In 405 IAC 5-1-6(a), after "justifying", insert "how" and delete "the medical necessity of"; and, after "or technology", insert "is medically necessary".

(4) In 405 IAC 5-3-2(a), after "at the time the telephone call is made for the following", delete "services".

(5) In 405 IAC 5-3-2(b), after "is subsequently submitted for the following", delete "services".

(6) In 405 IAC 5-3-4, after "to determine", insert "whether"; delete "medical necessity of"; and, after "service", insert "was medically necessary".

(7) In 405 IAC 5-3-5(c)(13), delete "medical necessity" and insert "that the treatment was medically necessary".

(8) In 405 IAC 5-3-6(7), delete "medical necessity" and insert "that the service is medically necessary".

(9) In 405 IAC 5-3-9(5)(A), delete "or Medicaid".

(10) In 405 IAC 5-3-10, before "Prior authorization requests may be", insert "Except as otherwise provided in this title".

(11) In 405 IAC 5-3-11(4), delete "The medical necessity of the requested service" and insert "If the service is medically necessary".

(12) In 405 IAC 5-3-13(c), delete "for medical necessity" and insert "to determine if said procedure is medically necessary".

(13) In 405 IAC 5-3-14, after "If no decision is made by the office", insert "for a completed prior authorization request".

(14) In 405 IAC 5-5-2(c), delete "meets criteria for medical necessity" and insert "is medically necessary".

(15) In 405 IAC 5-7-2(a), delete "entitled" and insert "authorized".

(16) In 405 IAC 5-7-2(b), delete "must be forwarded" and insert "shall be submitted".

(17) In 405 IAC 5-8-3(e), before "If a recipient [member] is referred for management", insert "Reimbursement is not available"; and, delete "consultation codes cannot be billed to Medicaid".

(18) In 405 IAC 5-8-4(c), delete "medical necessity" and insert "that the service is medically necessary".

(19) In 405 IAC 5-10-1(3), delete "IC 25-22.5-1-2(a)(12)" and insert "IC 25-22.5-1-2(a)(13)".

(20) In 405 IAC 5-10-3(j), delete "medical necessity" and insert "medically necessary".

(21) In 405 IAC 5-10-5, delete "are noncovered services" and insert "services are not reimbursed separately".

(22) In 405 IAC 5-12-1(a), delete "846 IAC 1-1" and insert "846 IAC 1-3".

(23) In 405 IAC 5-12-1(b), delete "846 IAC 1-1" and insert "846 IAC 1-3".

(24) In 405 IAC 5-13-2(d), delete "should" and insert "shall".

(25) In 405 IAC 5-13-3(3), after "Habilitation services", insert "as defined by 405 IAC 5-21.6-2(g)".

(26) In 405 IAC 5-13-3(5), delete "registered, or certified".

(27) In 405 IAC 5-13-3(7), after "Durable medical equipment (DME)", insert "as defined in 405 IAC 5-19-2".

(28) In 405 IAC 5-13-7(d)(3), delete "Form 450B" and insert "a form approved by the office".

(29) In 405 IAC 5-13-7(d)(4), after "must have been eligible", insert "to participate in Medicaid".

(30) In 405 IAC 5-13-10(a), delete "A current Form 450B" and insert "A form as prescribed by 405 IAC 5-13-7(d)(3) [section 7(d)(3) of this rule]"; after "must be submitted", insert "to the office"; and, delete "year" and insert "twelve (12) months prior to the date of transfer".

(31) In 405 IAC 5-14-18, delete "The medical necessity for" and insert "The patient's record must document that"; and, delete "must be documented in the patient's record" and insert "is a medically necessary service".

(32) In 405 IAC 5-14-20(3)(A), delete "the medical necessity of"; and, after "the dental service", insert "is medically necessary".

(33) In 405 IAC 5-14-21, delete "medical necessity" and insert "medically necessary service".

(34) In 405 IAC 5-15-2, delete "will" and insert "shall".

(35) In 405 IAC 5-15-3(a), delete "will" and insert "shall".

(36) In 405 IAC 5-16-3(d)(2)(C), delete "affect" and insert "affects".

(37) In 405 IAC 5-16-3.1(b)(1), before "agency", insert "home health".

(38) In 405 IAC 5-16-3.1(c), after "which do not meet the definition of emergency services", insert "at 405 IAC 5-2-9".

(39) In 405 IAC 5-16-3.1(d)(2)(A), before "Emergency room", insert "An"; and, delete "visits" and insert "visit".

(40) In 405 IAC 5-16-3.1(d)(2)(B), before "Inpatient hospital", insert "An"; and, delete "stays" and insert "stay".

(41) In 405 IAC 5-16-6(1), after "or utilization parameters set out in", delete "the".

(42) In 405 IAC 5-16.5-4(a)(1), delete "as defined in 410 IAC 27-1-15.5".

(43) In 405 IAC 5-17-1(b), after "Reimbursement shall", delete "not"; after "be made", insert "only"; delete "any hospital" and insert "covered"; and, delete "not covered under the Medicaid program".

(44) In 405 IAC 5-17-2(c), delete "for medical necessity" and insert "to determine if the services were medically necessary".

(45) In 405 IAC 5-17-2(d), delete "the medical necessity for inpatient admission" and insert "that the inpatient admission is medically necessary".

(46) In 405 IAC 5-18-3(b), delete "Health Care Financing Administration" and insert "Centers for Medicare and Medicaid Services".

(47) In 405 IAC 5-19-1(e)(1), delete "of documented necessity" and insert "documented as medically necessary".

(48) In 405 IAC 5-19-7(1), delete "as defined at 405 IAC 5-2-17,".

(49) In 405 IAC 5-19-11(3), delete "purely" and insert "solely".

(50) In 405 IAC 5-19-15(3), delete "circumstances are documented justifying medical necessity" and insert "medically necessary and supported by documentation justifying the same".

(51) In 405 IAC 5-19-16(c)(2), delete "Medical necessity documentation" and insert "Documentation supporting that the device is medically necessary"; and, delete "the medical necessity for the communication device" and insert "the communication device is medically necessary".

(52) In 405 IAC 5-20-2(b), delete "psychiatric residential treatment facility" and insert "PRTF".

(53) In 405 IAC 5-20-2(b)(1), delete "psychiatric residential treatment facility" and insert "PRTF".

(54) In 405 IAC 5-20-2(b)(2), delete "psychiatric residential treatment facility" and insert "PRTF".

(55) In 405 IAC 5-20-2(b)(3), delete "psychiatric residential treatment facility" and insert "PRTF".

(56) In 405 IAC 5-20-2(b)(4), delete "psychiatric residential treatment facility" and insert "PRTF".

(57) In 405 IAC 5-20-2(d), delete "psychiatric residential treatment facility" and insert "PRTF".

(58) In 405 IAC 5-20-2(d)(3), in both places it appears, delete "psychiatric residential treatment facility" and insert "PRTF".

(59) In 405 IAC 5-20-2(d)(4), delete "psychiatric residential treatment facility" and insert "PRTF".

(60) In 405 IAC 5-20-3.1, delete "Psychiatric residential treatment facilities" and insert "PRTFs".

(61) In 405 IAC 5-20-3.1(1), delete "care institution" and insert "facility"; and, delete "470 IAC 3-13" and insert "465 IAC 2-11".

(62) In 405 IAC 5-20-4(a), delete "psychiatric residential treatment facility" and insert "PRTF".

(63) In 405 IAC 5-20-4(a)(2), delete "set forth treatment objectives and prescribe an integrated program of appropriate therapies, activities, and experiences designed to meet these objectives. It shall be formulated in consultation with the child and parents, legal guardians, or others to whose care or custody the individual will be released following discharge. The plan shall be based upon a diagnostic evaluation that includes examination of the medical, psychological, social, behavioral, and developmental aspects of the patient's situation. It shall include, at an appropriate time, a postdischarge treatment plan and plan for coordination of inpatient services with partial discharge plans and appropriate related services in the patient's community to ensure continuity of care when returned to the patient's family, school, and community upon discharge. Each plan of care must be reviewed and updated at least every thirty (30) days by the interdisciplinary team for determinations that the services provided were and are required on an inpatient basis and for recommendations as to any necessary adjustments in the plan as indicated by the patient's overall adjustment as an inpatient" and insert "comply with the requirements as set forth in 42 CFR 441.155"; and, before "The periodic update of the plan of care must be in writing", insert "Additionally,".

(64) In 405 IAC 5-20-7, delete "psychiatric residential treatment facility" and insert "PRTF"; and, delete "of medical necessity" and insert "substantiating that the service is medically necessary".

(65) In 405 IAC 5-20-8(3)(B), delete "medical necessity" and insert "the service is medically necessary".

(66) In 405 IAC 5-20-8(4)(C), after "who are not at imminent risk", delete "to" and insert "of"; and, after "harm", insert "to".

(67) In 405 IAC 5-21.7-2(b), delete "DMHA-certified" and insert "office-approved".

(68) In 405 IAC 5-21.7-2(h)(1), delete "certification" and insert "authorization".

(69) In 405 IAC 5-21.7-5(a)(2), delete "DSM-IV-TR" and insert "American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-IV-TR".

(70) In 405 IAC 5-21.7-10(c)(1)(B), delete "DMHA-authorized" and insert "office-approved".

(71) In 405 IAC 5-21.7-10(d)(3), delete "certification" and insert "authorization".

(72) In 405 IAC 5-21.7-10(f), delete "certification" and insert "authorization".

(73) In 405 IAC 5-21.7-11(d)(3), delete "certification" and insert "authorization".

(74) In 405 IAC 5-21.7-13(a), delete "office-certified" and insert "office-approved"; delete "certification" and insert "authorization"; and, delete "recertification" and insert "reauthorization".

(75) In 405 IAC 5-21.7-13(a)(1), delete "recertification" and insert "reauthorization".

(76) In 405 IAC 5-21.7-13(a)(1)(A), delete "DMHA certification" and insert "office authorization".

(77) In 405 IAC 5-21.7-13(a)(3), delete "DMHA certification" and insert "office authorization".

(78) In 405 IAC 5-21.7-13(c)(1), delete "recertification" and insert "reauthorization".

(79) In 405 IAC 5-22-3, [in both places it appears] delete "nurse-midwife" and insert "nurse midwife".

(80) In 405 IAC 5-22-7(c)(2), delete "based on only the medical necessity of such" and insert "only for such medically necessary".

(81) In 405 IAC 5-23-2(a), delete "medical necessity dictates"; after "examination or care", insert "is medically necessary"; and, delete "of such medical necessity" and insert "supporting such medically necessary determinations".

(82) In 405 IAC 5-23-2(b), delete "Medical necessity will determine which" and insert "The"; and, delete "will be given" and insert "given must be medically necessary".

(83) In 405 IAC 5-23-4(1), delete "medical necessity requires"; after "a more expensive frame", insert "is medically necessary"; delete "medical necessity for"; after "a more expensive frame may be indicated", insert "as medically necessary"; and, delete "medical necessity documentation" and insert "documentation supporting a determination that said frames are medically necessary".

(84) In 405 IAC 5-23-4(3), delete "medical necessity is documented" and insert "documented as medically necessary".

(85) In 405 IAC 5-23-5, delete "medical necessity is documented" and insert "documented as medically necessary"; and, delete "Documentation of such medical necessity" and insert "Medically necessary documentation".

(86) In 405 IAC 5-24-2, after "nonlegend", insert "(over-the-counter or "OTC")".

(87) In 405 IAC 5-24-3(a)(2), delete "Health Care Financing Administration" and insert "Centers for Medicare and Medicaid Services (CMS)".

(88) In 405 IAC 5-24-3(a)(3), delete "the HCFA" and insert "CMS".

(89) In 405 IAC 5-24-4(e), delete "Pharmacies and providers that are enrolled in Medicaid" and insert "Pharmacy providers".

(90) In 405 IAC 5-24-5(a), after "over-the-counter", insert "or "OTC"".

(91) In 405 IAC 5-24-8(b)(2), delete "the medical necessity of"; and, after "the brand name drug", insert "is medically necessary".

(92) In 405 IAC 5-24-14(a)(1), delete "405 IAC 1-14.6-2(gg)" and insert "405 IAC 1-14.6-2(ff)".

(93) In 405 IAC 5-26-2(1), before "In an emergency situation", insert "Except as set forth in 405 IAC 5-3-12(1),".

(94) In 405 IAC 5-26-2(2), delete "405 IAC 5-21" and insert "405 IAC 5-17".

(95) In 405 IAC 5-26-8, delete "providing" and insert "provided".

(96) In 405 IAC 5-26-8(5), between "evaluation" and "limited", insert "is".

(97) In 405 IAC 5-26-10(a), delete "medical necessity" and insert "medically necessary service".

(98) In 405 IAC 5-27-1(b)(3)(B), delete "angeoplasty" and insert "angioplasty".

(99) In 405 IAC 5-28-10(a), delete "catherization" and insert "catheterization".

(100) In 405 IAC 5-30-1(1), delete "medical necessity for"; and, after "additional trips", insert "are medically necessary and the same".

(101) In 405 IAC 5-30-3(1), delete "medical necessity for"; and, after "additional trips", insert "are medically necessary and the same".

(102) In 405 IAC 5-31-9(c), delete "the medical necessity of the service" and insert "that the service is medically necessary".

(103) In 405 IAC 5-31-9(d)(1)(A), delete "Medical necessity of the service" and insert "The service is medically necessary".

(104) In 405 IAC 5-34-4.2(a), delete "medical necessity of services" and insert "services are medically necessary".

(105) In 405 IAC 5-34-4.2(b), delete "medical necessity" and insert "medically necessary".

(106) In 405 IAC 5-36-3(a), after "via the prior authorization process", insert "as set forth in 405 IAC 5-3".

(107) In 405 IAC 5-37-2(c), delete "invidivual's" and insert "individual's".

(108) In 405 IAC 5-38-4(4), after "is available only when the", insert "distance between the".

Filed with Publisher: November 1, 2016, 9:36 a.m.

Under IC 4-22-2-38(g)(2), this correction takes effect 45 days from the date and time filed with the Publisher.

Posted: 11/09/2016 by Legislative Services Agency

DIN: 20161109-IR-405160493ACA

Composed: Nov 11,2016 8:19:20PM EST

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