Authority: IC 12-15-44.5

Affected: IC 12-15-44.5

Sec. 4. (a) This section outlines services available to a member enrolled in HIP State Plan. All covered services under HIP State Plan are subject to the coverage criteria, limitations, and procedures specified in this article as well as those services specified in the Centers for Medicare and Medicaid Services approved Medicaid State Plan.

(b) HIP State Plan shall include covered services in the following categories that are equivalent to the Medicaid State Plan:

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.

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

1. (1) Services that are not medically necessary.
2. (2) Any other services not covered by the Centers for Medicare and Medicaid Services approved Medicaid State Plan.

(Office of the Secretary of Family and Social Services; 405 IAC 10-7-4; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA; readopted filed Aug 18, 2021, 9:55 a.m.: 20210915-IR-405210197RFA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR-405230817RFA)