Authority: 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 covered by the Indiana health coverage program by nursing facilities. Payments referred to in this rule are contingent on the following:

1. (1) Proper and current certification.
2. (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 and the IMPRM that establish parameters regarding the allowability of ordinary patient related costs and define reasonable nursing facility allowable costs.

(c) An action that results in recoupment, rate reduction, or retrospective payment may be addressed through a prospective rate calculation, retroactive reprocessing of claims, or settlement process.

(Office of the Secretary of Family and Social Services; 405 IAC 1-14.7-1; filed Aug 20, 2024, 9:11 a.m.: 20240918-IR-405240088FRA)