Indiana Administrative Code
Title 470 - DIVISION OF FAMILY RESOURCES
Article 12 - PRIOR REVIEW OF OFF-SITE MEDICAL SERVICES; DEPARTMENT OF CORRECTION, STATE BOARD OF HEALTH, AND DEPARTMENT OF MENTAL HEALTH
Rule 1 - Prior Review and Authorization of Requests for Off-Site Medical Services
Section 1-2 - Criteria for authorization; procedural manual; private services not precluded

(a) Pursuant to IC 12-5-7[IC 12-5 was repealed by P.L. 2-1992, SECTION 897, effective February 14, 1992.], this rule [470 IAC 12] establishes procedures for prior review, and approval, conditional approval or denial, of requests for authorization of covered medical services.

(b) When acting upon requests, the department will consider the diagnosis and clinical summary of the individual, and the nature, duration and cost of the requested services, and will authorize only those that are requested by a physician or dentist and an official of an agency or institution, and are determined by licensed medical personnel of the department to be medically necessary and reasonable. For the purposes of this rule [470 IAC 12], medically necessary and reasonable services are those which medical staff personnel of the SDPW 590 element determine, under the circumstances of each case, to be essential to the restoration or maintenance of physical or mental health.

(c) Each affected agency will be responsible for developing and maintaining a procedures manual which prescribes their policies for processing the request for and delivery of medical services.

(d) This rule [470 IAC 12] does not preclude any medical service from being provided at the expense of persons or entities other than the state of Indiana.