Authority: IC 12-15-44.5

Affected: IC 12-15-44.5

Sec. 3. (a) This section outlines the services available to an individual enrolled in HIP Plus. The covered services provided under HIP Plus are in accordance with the essential health benefit requirements under 42 CFR 440.347 for alternative benefit plans.

(b) HIP Plus shall include covered services in each of the following categories:

1. (1) Ambulatory patient services.
2. (2) Emergency services.
3. (3) Hospitalization.
4. (4) Maternity services.
5. (5) Mental health and substance abuse services.
6. (6) Prescription drugs.
7. (7) Rehabilitative and habilitative services and devices.
8. (8) Laboratory services.
9. (9) Preventive care services.
10. (10) Vision services.
11. (11) Dental services.
12. (12) Early and periodic screening, diagnostic, and treatment services for members nineteen (19) and twenty (20) years of age.
13. (13) Any other services approved by the Centers for Medicare and Medicaid Services in the HIP Plus alternative benefit plan.

(c) The following services shall not be covered under HIP Plus:

1. (1) Services that are not medically necessary.
2. (2) Nonemergency transportation services.
3. (3) Any other services not approved by the Centers for Medicare and Medicaid Services in the HIP Plus alternative benefit plan.

(Office of the Secretary of Family and Social Services; 405 IAC 10-7-3; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA; filed Jan 19, 2018, 8:42 a.m.: 20180214-IR-405170484FRA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR-405230817RFA)