Section 405 IAC 1-14.6-1 - Policy; scopeAuthority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 6-8.1-10-1; IC 12-13-7-3; IC 12-15-13-4; IC 24-4.6-1-101
Sec. 1.
(a) This rule sets forth payment procedures for services rendered to members who are not in managed care and covered by the Indiana health coverage program (IHCP) by nursing facilities. All payments referred to within this rule are contingent upon the following:(1) Proper and current certification.(2) Compliance with applicable state and federal statutes and regulations.(b) The system of payment outlined in this rule is a prospective system. Cost limitations are contained in this rule that establish parameters regarding the allowability of ordinary patient-related costs and define reasonable allowable costs.(c) Retroactive payment or repayment will be required when an audit verifies an underpayment or overpayment due to intentional misrepresentation, billing or payment errors, or misstatement of historical financial or historical statistical data, or resident assessment data which caused a lower or higher rate than would have been allowed had the data been true and accurate. Upon discovery that a provider has received overpayment of a Medicaid claim from the office, the provider must complete the appropriate Medicaid billing adjustment form prescribed by the office and reimburse the office for the amount of the overpayment, or the office shall make a retroactive payment adjustment, as appropriate.(d) The office may implement Medicaid rates and recover overpayments from previous rate reimbursements, either through deductions of future payments or otherwise, without awaiting the outcome of the administrative appeal process, in accordance with IC 12-15-13-4(e).(e) Providers must pay interest on all overpayments, consistent with IC 12-15-13-4. The interest charge shall not exceed the percentage set out in IC 6-8.1-10-1(c). The interest shall: (1) accrue from the date of the overpayment to the provider; and(2) apply to the net outstanding overpayment during the periods in which such overpayment exists.Office ofthe Secretary of Family and Social Services; 405 IAC 1-14.6-1; filed Aug 12, 1998, 2:27p.m.: 22 IR 69, eff Oct 1, 1998; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; filed May 31, 2013, 8:52 a.m.: 20130626-IR-405120279FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR- 405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAFiled 10/13/2017, 12:09 p.m.: 20171108-IR-405160327FRAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA