405 IAC 5-30-4 - Prior authorization

Authority: IC 12-15-1-10; IC 12-15-6-5; IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-13-7-3; IC 12-15-6

Sec. 4.

Prior authorization is required for the following transportation services:

(1) Train or bus services.

(2) Family member services.

(3) Airline or air ambulance and transportation services rendered by a provider located out-of-state in a nondesignated area.

(4) Transportation rendered by any provider to or from an out-of-state nondesignated area.

(5) Trips exceeding twenty (20) one-way trips per member, per rolling twelve (12) month period of time, except as specified in section 1 of this rule.

(6) Trips of fifty (50) miles or more one (1) way.

Notes

405 IAC 5-30-4

Office ofthe Secretary of Family and Social Services; 405 IAC 5-30-4; filed Jul 25, 1997, 4:00p.m.: 20 IR 3359; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA