405 Ind. Admin. Code 1-4.2-4

Current through December 12, 2024

Section 405 IAC 1-4.2-4 - Home health care services; reimbursement methodology

Authority: IC 12-15

Affected: IC 12-15-13-2; IC 12-15-22-1

Sec. 4.

(a) HHAs will be reimbursed for covered services provided to Medicaid members through standard, statewide rates as:

(1) one (1) overhead rate per HHA visit, per member, per day; plus

(2) the staffing rate multiplied by the number of billing units spent in the performance of billable patient care activities; to equal the total reimbursement per visit.

(b) Retroactive repayment will be required when any of the following occur:

(1) A field audit identifies overpayment by Medicaid.

(2) The HHA knowingly receives overpayment of a Medicaid claim from the office. In this event, the HHA must:

(A) complete appropriate Medicaid billing adjustment forms; and

(B) reimburse the office for the amount of the overpayment.

405 IAC 1-4.2-4

Office of the Secretary of Family and Social Services; 405 IAC 1-4.2-4; filed Jul 18, 1996, 3:00 p.m.: 19 IR 3376; errata filed Sep 24, 1996, 3:20 p.m.: 20 IR 332; filed Jan 9, 1997, 4:00 p.m.: 20 IR 1117; filed Oct 8, 1998, 12:23 p.m.: 22 IR 434; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Jun 18, 2007, 11:38 a.m.: 20070718-IR-405070031FRA; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Nov 8, 2013, 2:56 p.m.: 20131204-IR-405130422FRA

Filed 4/29/2015, 3:38 p.m.: 20150527-IR-405150034FRA

Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA

Errata filed 10/6/2016, 2:59 p.m.: 20161019-IR-405160452ACA

Filed 5/23/2017, 1:43 p.m.: 20170621-IR-405170130FRA

Filed 12/21/2018, 3:11 p.m.: 20190116-IR-405180269FRA

Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA

405 IAC 1-4.2-4(l) was voided by P.L. 217-2017, SECTION 79, effective April 27, 2017.