405 IAC 5-39-2 - Description of benefits

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

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

Sec. 2.

Individuals eligible for end stage renal disease (ESRD) services under this rule will be eligible for state plan benefits for monthly incurred medical costs that exceed the difference between the member's countable income and the monthly equivalent of one hundred percent (100%) FPL. This coverage is considered minimal essential coverage (MEC), pursuant to 42 CFR 156 Subpart G. Those eligible individuals may receive the following:

(1) Expenditures incurred for any services received while an ESRD enrollee is an inpatient in a long term care institutional setting will not be claimed under the demonstration. Any individual enrolled in the ESRD demonstration who is admitted to a nursing facility or other long term care setting, either temporarily (for less than thirty (30) days) or for a longer admission, will be assessed for eligibility under a Medicaid state plan covered category. Such individuals will be disenrolled from the demonstration upon admission to an institution or approval for HCBS waivers services, and will be assessed for reenrollment into the demonstration upon discharge from the institutional or other long term care setting.

(2) Individuals affected by this demonstration shall receive benefits in the form of a service to ensure nonemergency transportation to and from providers. The state must report in the quarterly reports any complaints or issues regarding nonemergency medical transportation (NEMT).

Notes

405 IAC 5-39-2

Office of the Secretary of Family and Social Services; 405 IAC 5-39-2; filed 6/11/2021, 2:35 p.m.: 20210707-IR-405190602FRA Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA