Ind. Code § 12-15-12.7-1 "Program"
Sec. 1. As used in this chapter, "program" refers to the pathways for aging risk based managed care program established under IC 12-15-13-1.8 for a covered population.
As added by P.L.174-2025, SEC.41.
Ind. Code ch. 12-15-12.7
Ind. Code ch. 12-15-12.7
in effectInd. Code § 12-15-12.7-2 Determination of reimbursement rates; prohibition
Sec. 2. (a) The office of the secretary shall determine the base reimbursement rate structure, methodology, and reimbursement rates that may be paid to a provider for the services rendered under the program.
(b) A managed care organization may not pay a provider less than the reimbursement rates established by the office of the secretary under this section.
As added by P.L.174-2025, SEC.41.
Ind. Code § 12-15-12.7-3 Contract with nursing facilities
Sec. 3. (a) A managed care organization shall contract with any nursing facility that is:
(1) licensed under IC 16-28;
(2) certified by:
(A) the United States Department of Health and Human Services to provide services under the Medicare program; or
(B) the office of the secretary to provide services under the Medicaid program; and
(3) willing to contract with the managed care organization to provide the services under the same terms and conditions that are offered by the managed care organization to any other participating provider that has contracted with the managed care organization to provide that service for the program through June 30, 2029.
(b) A contract between a managed care organization and a provider to provide services under the program must include the reimbursement rates established by the office of the secretary under section 2 of this chapter.
As added by P.L.174-2025, SEC.41.
Ind. Code § 12-15-12.7-4 Report concerning denial of claims
Sec. 4. (a) On a monthly basis, a managed care organization shall provide a report to the office of the secretary concerning the denial of claims. The report must specify denials by claim type for the previous month if the denials for the claim type total at least five percent (5%).
(b) The office of the secretary shall post the reports submitted under subsection (a) to the office of the secretary's website.
As added by P.L.174-2025, SEC.41.
Ind. Code § 12-15-12.7-5 Claims review permitted
Sec. 5. The office of the secretary may conduct a claims review of claims submitted to a managed care organization for the covered population under the program.
As added by P.L.174-2025, SEC.41.
Ind. Code § 12-15-12.7-6 External review of claim denials required
Sec. 6. The office of the secretary shall at least annually conduct external reviews of claim denials in the program by a managed care organization.
As added by P.L.174-2025, SEC.41.
Ind. Code § 12-15-12.7-7 Payment, denial, or suspension of claims submitted by nursing facilities; time; interest
Sec. 7. (a) This section applies to claims submitted for payment under the program by a nursing facility participating in the program.
(b) The managed care organization shall pay, deny, or suspend each claim submitted by a nursing facility provider for payment under the program not later than:
(1) twenty-one (21) days after the claim was electronically filed; or
(2) thirty (30) days after a claim has been filed on paper;
from receipt by the managed care organization.
(c) If the managed care organization:
(1) fails to pay a clean claim in the time required under this section; or
(2) denies or suspends a claim that is subsequently determined to have been a clean claim when the claim was filed;
the managed care organization shall pay the provider interest on the Medicaid allowable amount of the claim as set forth in this section.
(d) Interest paid under subsection (c):
(1) accrues beginning:
(A) twenty-two (22) days from the date the claim is filed under subsection (b)(1); or
(B) thirty-one (31) days from the date the claim is filed under subsection (b)(2); and
(2) stops accruing on the date the managed care organization pays the claim.
(e) A managed care organization shall pay interest under subsection (c) to a provider at the rate established for Medicare overpayments and underpayments, as set forth in 42 CFR 405.378.
As added by P.L.174-2025, SEC.41.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026