Ind. Code § 12-15-44.5-5
Managed care organization responsibilities; reimbursement; cultural competency standards
Redline — January 1, 2018 → current.View current text →
Current — January 1, 2023
As of January 1, 2018
Sec. 5. (a) A managed care organization that contracts with the office to provide health coverage, dental coverage, or vision coverage to an individual who participates in the plan:
Sec. 5. (a) A managed care organization that contracts with the office to provide health coverage, dental coverage, or vision coverage to an individual who participates in the plan:
(1) is responsible for the claim processing for the coverage;
(1) is responsible for the claim processing for the coverage;
(2) shall reimburse providers at a rate that is not less than the rate established by the secretary. The rate set by the secretary must be based on a reimbursement formula that is: (A) comparable to the federal Medicare reimbursement rate for the service provided by the provider; or (B) one hundred thirty percent (130%) of the Medicaid reimbursement rate for a service that does not have a Medicare reimbursement rate; and
(2) shall reimburse providers at a rate that is not less than the rate established by the secretary; and
(3) may not deny coverage to an eligible individual who has been approved by the office to participate in the plan.
(3) may not deny coverage to an eligible individual who has been approved by the office to participate in the plan.
(b) A managed care organization that contracts with the office to provide health coverage under the plan must incorporate cultural competency standards established by the office. The standards must include standards for non-English speaking, minority, and disabled populations.
(b) A managed care organization that contracts with the office to provide health coverage under the plan must incorporate cultural competency standards established by the office. The standards must include standards for non-English speaking, minority, and disabled populations.
Official source: Indiana General Assembly. Reproduced from public-domain Indiana statutes; confirm against the official source for the current text. Not legal advice.