405 Ind. Admin. Code 5-20-7

Current through January 8, 2025

Section 405 IAC 5-20-7 - Unnecessary services

Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-13-7-3; IC 12-15

Sec. 7.

Medicaid reimbursement will be denied for any days during which the inpatient psychiatric hospitalization or stay in a PRTF is found not to have been medically necessary. Telephone precertifications substantiating that the service is medically necessary will provide a basis for Medicaid reimbursement only if adequately supported by the written certification of need submitted in accordance with section 5 of this rule. If the required written documentation is not submitted within the specified time frame, Medicaid reimbursement will be denied.

405 IAC 5-20-7

Office of the Secretary of Family and Social Services; 405 IAC 5-20-7; filed Jul 25, 1997, 4:00p.m.: 20 IR 3335; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Mar 22, 2004, 3:15p.m.: 27 IR 2478; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA

Errata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACA

Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA

Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA