Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 1 - MEDICAID PROVIDERS AND SERVICES
Rule 4.2 - Home Health Services
Section 4.2-4 - Home health care services; reimbursement methodology
Universal Citation: 405 IN Admin Code 4.2-4
Current through March 20, 2024
Authority: IC 12-15
Affected: IC 12-15-13-2; IC 12-15-22-1
Sec. 4.
(a) HHAs will be reimbursed for covered services provided to Medicaid members through standard, statewide rates as:
(1) one (1)
overhead rate per HHA visit, per member, per day; plus
(2) the staffing rate multiplied by the
number of billing units spent in the performance of billable patient care
activities; to equal the total reimbursement per visit.
(b) Retroactive repayment will be required when any of the following occur:
(1) A field
audit identifies overpayment by Medicaid.
(2) The HHA knowingly receives overpayment of
a Medicaid claim from the office. In this event, the HHA must:
(A) complete appropriate Medicaid billing
adjustment forms; and
(B) reimburse
the office for the amount of the overpayment.
405 IAC 1-4.2-4(l) was voided by P.L. 217-2017, SECTION 79, effective April 27, 2017.
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