Section 405 IAC 1-11.5-1 - Policy; scopeAuthority: IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-15-13-2
Sec. 1.
(a) Reimbursement for physician services, limited license practitioner services, and nonphysician practitioner services as defined by 42 CFR 440.50 and 42 CFR 440.60(a) is available to providers licensed by the professional licensing agency and enrolled by the office as providers who are in good standing. Continued participation in Medicaid and payment for services is contingent upon maintenance of state licensure and conformance with the office's provider agreement.(b) As used in this rule, "physician and limited license practitioner" or "LLP" means any of the following: (1) A doctor of medicine.(2) A doctor of osteopathy.(3) A physician group practice.(4) A primary care group practice.(7) A dentist who is an oral surgeon.(9) A health service provider in psychology.(c) As used in this rule, "nonphysician practitioner" or "NPP" means any of the following: (1) A physical therapist.(2) An occupational therapist.(3) A respiratory therapist.(6) A licensed psychologist.(7) An independent laboratory or radiology provider.(8) A dentist who is not an oral surgeon.(9) A social worker certified through the American Academy of Certified Social Workers (ACSW) or who has a master of social work (MSW) degree, a psychologist with a basic certificate, or a licensed psychologist providing outpatient mental health services in a physician-directed outpatient mental health facility.(10) An advance practice nurse.(11) A physician's assistant.(12) A mental health professional listed in 405 IAC 5-21.5-1(c), or an individual who has documented education, training, or experience, comparable or equivalent to those listed in this subsection, as approved by the supervising physician or HSPP, under the supervision of a psychiatrist, a physician, or a licensed psychologist or a psychologist endorsed as a health service provider in psychology (HSPP).(13) An inpatient hospital facility as defined in 405 IAC 1-10.5-2.Office ofthe Secretary of Family and Social Services; 405 IAC 1-11.5-1; filed Sep 6, 1994, 3:25 p.m.: 18 IR 87; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; filed Sep 12, 2008, 12:34p.m.: 20081008-IR-405080186FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAErrata filed 10/6/2016, 2:59 p.m.: 20161019-IR-405160452ACAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA