Section 405 IAC 5-24-14 - Skin protectants, sealants, moisturizers, and ointments for nursing facility residentsAuthority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 14.
(a) The cost of skin protectants, sealants, moisturizers, and ointments for nursing facility residents are to be reimbursed as follows:(1) Skin protectants, sealants, moisturizers, and ointments that are applied on an as needed basis, by the member, nursing facility care staff, or by prescriber's order, as a part of routine care, as defined in 405 IAC 1-14.6-2(ff), must be included in the per diem reimbursement and must not be reimbursed through the pharmacy benefit.(2) If all of the following conditions are met, skin protectants, sealants, moisturizers, and ointments must be reimbursed through the pharmacy benefit: (A) Legend or nonlegend (listed on the OTC drug formulary only).(B) Prescribed for regular application or applications, or both, as a single agent or compounded with other drug agents.(C) Used to treat or ameliorate a defect or physical or mental illness or condition.(b) Non-drug skin protectants, sealants, moisturizers, and ointments must be reimbursed through the pharmacy benefit only when they are compounded with other drug agents, otherwise they are to be included in the per diem reimbursement, as set forth in 405 IAC 5-31-4(8).Filed 4/29/2015, 3:38 p.m.: 20150527-IR-405150034FRAErrata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA