Section 405 IAC 5-34-4.2 - AuditAuthority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-40-8
Affected: IC 12-15
Sec. 4.2.
(a) The office may conduct audits of hospice services, including services for which hospice authorization has been granted. Audit of hospice services shall include review of the medical record to determine the services are medically necessary based upon applicable current professional guidelines, including the local Medicare medical review policies for hospice services.(b) If the office determines that hospice services for a member are not medically necessary, hospice authorization will be revoked for the dates during which hospice services did not meet medically necessary criteria for hospice care. Medicaid payment for hospice services is not available for services that the office determines are not medically necessary.Office of the Secretary of Family and Social Services; 405 IAC 5-34-4.2; filed Jun 5, 2003, 8:30 a.m.: 26 IR 3638; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAErrata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA