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Legislation Signed into Law

2020

Primary Focus: Medicaid; Compliance; Reporting
Title/Description: An act to amend the Indiana Code concerning human services
Citation: 2020 – Public Law 103
Summary: This law requires state authorities to amend state Medicaid plans to include reimbursement for the treatment of outpatient mental health and substance abuse treatment services. It also requires health maintenance organizations and insurers to submit annual reports demonstrating compliance with the 2008 Mental Health Parity and Addiction Equity Act, including an analysis for each non-quantitative treatment limitation in each classification of care consistent with the six-step process.
Effective Date: 3/30/2020
Notes: N/A

2016

Primary Focus: Reimbursement
Title/Description: Mental Health
Citation: Burns Ind. Code Ann. § 12-15-5-14
Summary: Section 12-15-5-14 was added to the Indiana Code to require the Medicaid office to reimburse eligible Medicaid claims for services provided by an advanced practice nurse employed by a community mental health center if the services are part of the advance practice nurse’s scope of practice, including mental health services, behavioral health services, substance use treatment and evaluation and management services for inpatient or outpatient psychiatric treatment.
Effective Date: July 1, 2016
Notes: Amended by In. H. 1347.

SB 297
Introduced: 1/2016
Sponsor: Sen. Miller and Sen. Becker
Status: Signed into law 3/2016
Summary: This bill amends the state Medicaid law in several ways that impact access to substance use disorder treatment. Among many other things, the bill defines the following requirements for suboxone reimbursement eligibility –
  • Provider has a waiver from the federal Substance Abuse and Mental Health Services Administration and meet the qualifying standards to treat opioid addicted patients in an office based setting
  • Provider has a valid federal drug enforcement administration registration number and a drug enforcement administration identification number that specifically authorizes treatment in an office based setting

The bill also defines the following requirements for an opioid treatment program. The program must provide treatment for opioid addiction using a drug approved by the federal Food an Drug Administration for opioid addiction. The program must also be an enrolled Medicaid Provider under Indiana state law, an enrolled Health Indiana Plan Provider, or a provider credentialed to accept insurance from a health plan.

2015

SB 165
Introduced: 12/2015
Sponsor: Sens. Miller, Becker, and Charbonneau
Status: Signed into law 3/2016
Summary: This bill amends the state Medicaid law about the Healthy Indiana Plan (HIP). The bill requires that HIP cover mental health and substance use disorder services. It also states that the plan can not use treatment limitations or financial requirements for mental health or substance use disorders if there are no similar limitations or requirements for medical or surgical conditions.

Primary Focus: Telemedicine
Title/Description: Mental Health
Citation: Burns Ind. Code Ann §§ 16-18-2-348.5, 27-8-34, 27-13-1-34
Summary: Section 16-18-2-348.5 was added to the Indiana Code to provide a definition for telemedicine, which, for the purposes of IC 16-36-1, means a specific method of delivery of services, including medical exams and consultations and behavioral health evaluations and treatment, including those for substance use, using videoconferencing equipment to allow a provider to render an examination of other services to a patient at a distant location. Sections IC 27-8-34 and IC 27-13-1-34 were also added to the Indiana Code to provide coverage for telemedicine services, which includes behavioral health, including substance abuse evaluations and treatment.
Effective Date: July 1, 2015
Notes: Amended by IN H. 1269.

Primary Focus: Treatment; Reimbursement
Title/Description: Mental Health Drugs
Citation: Burns Ind. Code Ann. §§ 11-12-3.8-1.5, 12-15-5-13, 12-15-35.5-7.5, 27-8-32.4, 27-13-7-20.4
Summary: Section 11-12-3.8-1.5 was added to the Indiana Code to allow for substance abuse treatment to include addiction counseling, inpatient detoxification and medication assisted treatment, including federal FDA approved long acting, nonaddictive medication for the treatment of opioid or alcohol dependence. Section 12-15-5-13 was also added to the Indiana Code to require the Medicaid office to provide for treatment of opioid or alcohol dependence that includes counseling services that address the psychological and behavioral aspects of addiction; when medically indicated, drug treatment involving agents proved by the federal FDA for the treatment of opioid or alcohol dependence or prevention of relapse to opioids or alcohol after detoxification. The Medicaid office shall also develop quality measures to ensure and requires a Medicaid managed care organization to report compliance with the coverage required. Section 12-15-35.5-7.5 was added to the Indiana Code to allow the office or a managed care organization to reimburse under Medicaid for methadone if the drug was prescribed for the treatment of pain or pain management only as follows: (1) If the daily dosage is not more than sixty (60) milligrams. (2) If the daily dosage is more than sixty (60) milligrams, only if: (A) prior authorization is obtained; and (B) a determination of medical necessity has been shown. Lastly, Section 27-8-32.4 and Section 27-13-7-20.4 were also added regarding the coverage of methadone by policies of accident and sickness insurance policies and individual contractor group contract policies that are issued, amended or renewed after June 30, 2015, provided that it prescribed for the treatment of pain or pain management (1) If the daily dosage is not more than sixty (60) milligrams. (2) If the daily dosage is more than sixty (60) milligrams, only if: (A) prior authorization is obtained; and (B) a determination of medical necessity has been shown by the provider.
Effective Date: July 1, 2015
Notes: Amended by In. S. 464.

2009

SB 102
Introduced: 1/2009
Sponsor: Sen. Simpson
Status: Signed into law 5/2009
Summary: This bill changed the state’s children’s services law so that the Children’s Health Insurance Program (CHIP) must cover the following behavioral health services:

Indiana Parity Law

Behavioral Health

The sections of state law relevant to parity requires that if plans offer behavioral health coverage, they cannot use treatment limitations and financial requirements if similar treatment limitations and financial requirements are not used for other medical coverage.

These sections of the law apply to large employer fully-insured plans, individual plans, and state employee plans.

Here are the relevant sections of the law: It is not possible to provide direct links to the specific subsections. You must scroll manually to the proper subsection once the link takes you to the appropriate title, article, and chapter. The specific subsections are listed next to each link.

Section for HMOs (scroll to 27-13-7-14.8)

Section for other commercial plans (scroll to 27-8-5-15.6)

Section for state employee plans (scroll to 5-10-8-9)

Autism

The sections of state law about autism coverage require large employer fully-insured plans, small employer fully-insured plans, and state employee plans to cover autism services. Individual plans must offer optional coverage for autism that can be rejected by the individual.

All plans that provide autism coverage cannot have annual maximums, lifetime maximums, deductibles, or coinsurance for autism services that are less favorable than those used with for other medical services.

Here are the relevant sections of the law:

Except for the section about commercial plans, It is not possible to provide direct links to the specific subsections. You must scroll manually to the proper subsection once the link takes you to the appropriate title, article, and chapter. The specific subsections are listed next to each link.

Section for commercial plans (this link goes directly to the proper location)

Section for HMOs (scroll to 27-13-7-14.7)

Section for state employee plans (scroll to 5-10-8-7.1)

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Indiana Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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