Authority: IC 12-8-6.5-5; IC 12-15

Affected: IC 12-13-7-3; IC 12-29; IC 25-23-1-1; IC 25-23.6-10.5; IC 25-27.5-5

Sec. 16. (a) The services reimbursable as medication training and support services include the following:

1. (1) Services provided to the member in an individual or in a group setting.
2. (2) Services provided to family members or other nonprofessional caregivers in an individual or a group setting with or without the member present.

(b) The following services are reimbursable and must be provided face-to-face in either an individual or a group setting:

1. (1) Monitoring medication compliance.
2. (2) Medication training and support.
3. (3) Monitoring medication side effects.
4. (4) Providing other nursing or medical assessments.

(c) A provider agency may receive reimbursement for training family members or nonprofessional caregivers to perform the activities identified in this section.

(d) When provided to family members or other nonprofessional caregivers, the service:

1. (1) must focus on and be on behalf of the member; and

2. (2) may include the training of family members or nonprofessional caregivers to:

   1. (A) monitor the member's medication compliance;
   2. (B) assist with the administration of prescribed medications; and

   3. (C) monitor side effects, including:

      1. (i) weight;
      2. (ii) blood glucose level; and
      3. (iii) blood pressure.

(e) Medication training and support may also include the following services that are not required to be provided face-to-face with the member:

1. (1) Transcribing medication orders of the following:

   1. (A) A physician.
   2. (B) An AHCP.
2. (2) Setting or filling medication boxes.
3. (3) Consulting with the attending provider or AHCP regarding medication-related issues.
4. (4) Ensuring linkage that lab and other prescribed clinical orders are sent.
5. (5) Ensuring that the member follows through and receives lab work and services pursuant to other clinical orders.
6. (6) Follow-up reporting of lab and clinical test results to the member and physician.

(f) Services provided that are not face-to-face with the member must meet the following standards:

1. (1) The member must be the focus of the service.
2. (2) Documentation must support how the service benefits the member.

(g) When provided in a clinic setting, medication training and support may compliment, but not duplicate, activities associated with medication management activities available under the Medicaid clinic option.

(h) When provided in a residential treatment setting, medication training and support may include components of medication management services as defined under the Medicaid clinic option.

(i) Provider staff delivering services under this section must meet one (1) of the following qualifications:

1. (1) A licensed physician.
2. (2) An AHCP.
3. (3) A licensed registered nurse (RN).
4. (4) A licensed practical nurse (LPN).
5. (5) A medical assistant (MA) who has graduated from a two-year clinical program.

(j) The services under this section must be provided within the practitioner's scope of practice as defined by federal and state law.

(k) The following services are not reimbursable under this section:

1. (1) Medication management, counseling, or psychotherapy when medication management is a component of the service.
2. (2) Medication training and support that is billed separately for the same visit by the same provider.
3. (3) Coaching and instruction regarding a member's self-administration of medications.
4. (4) Services provided to paid, professional caregivers.

(Office of the Secretary of Family and Social Services; 405 IAC 5-21.6-16; filed Dec 16, 2013, 9:11 a.m.: 20140115-IR-405130183FRA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; readopted filed Jul 28, 2022, 2:21 p.m.: 20220824-IR-405220205RFA; readopted filed May 30, 2023, 11:54 a.m.: 20230628-IR-405230292RFA)