Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Indiana (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes				Fee for service, with surgical procedures grouped using Medicare methodology	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes				Fee for service or reasonable charge	CN
Federally Qualified Health Center Services
Yes				Prospective cost based rate/encounter	CN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes		Specified admissions, including to rehab and burn centers	Second opinions required for specified procedures, LOS less than 24 hours considered outpatient except for newborns, substance abuse treatment limited to detoxification	Prospective payment/discharge using DRG, prospective per diem for rehab and burn centers	CN
Outpatient Hospital Services
Yes	$3/non-emergency visit in ER			Fee for service, with surgical procedures grouped using Medicare methodology	CN
Rehabilitation Services: Mental Health and Substance Abuse
Yes		Yes	14 therapeutic leave days/year in psychiatric residential treatment facilities	Fee for service with services of specified mid-level practitioners paid 75% of physician fee, prospective cost based per diem for psych residential treatment facilities	CN
Rural Health Clinic Services
Yes				Prospective cost based rate/encounter	CN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes				Fee for service at 60% of physician fee	CN
Chiropractor Services
Yes			50 therapeutic physical medicine treatments/year including up to 5 office visits	Fee for service	CN
Dental Services
Yes		Specified services including non-emergency inpatient procedures and oral surgery	$600 maximum benefit/year included with denture services, exam and cleaning 1/year (2/year for nursing facility residents), frequency of x-rays limited by type, periodontia limited, second opinions required for specified procedures	Fee for service	CN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes		Specified services including non-emergency services provided on an inpatient hospital basis and oral surgery	Second opinions required for specified procedures, ambulatory services limited	Fee for service	CN
Nurse Midwife Services
Yes				Fee for service	CN
Nurse Practitioner Services
Yes				Fee for service at 75% of physician fee	CN
Optometrist Services
Yes			1 refractive exam/2 years	Fee for service	CN
Physician Services
Yes		Specified surgical procedures, procedures exceeding specified cost limits	30 visits/year	Fee for service, services performed with assistance of second surgeon or in outpatient setting rather than office paid reduced fee	CN
Podiatrist Services
Yes		Inpatient hospital services and specified services associated with orthopedic shoes and appliances	Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services	Fee for service	CN
Psychologist Services
Yes		Specified services including psychological testing	20 service/time units/year	Fee for service	CN
Prescription Drugs
Prescription Drugs
Yes	$3/Rx	Specified drugs		AWP-16% for brand Rx, AWP-20% for generic Rx, plus $4.90 dispensing fee for each	CN
Physical Therapy and Other Services
Occupational Therapy Services
Yes			30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge	Fee for service	CN
Physical Therapy Services
Yes		Therapy not following hospital discharge	12 hours/30 days or 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge	Fee for service	CN
Services for Speech, Hearing and Language Disorders
Yes		Specified services including therapy not following hospital discharge	1 audiological testing and evaluation/3 years, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge	Fee for service	CN
Products and Devices
Dentures
Yes		Yes	$600 maximum benefit/year included with dental services	Fee for service	CN
Eyeglasses
Yes			1 pair eyeglasses/2 years, age-specific minimum diopter correction required for initial and replacement eyeglasses	Fee for service	CN
Hearing Aids
Yes		Yes	1 hearing aid/5 years	Fee for service	CN
Medical Equipment and Supplies
Yes		Specified med equipment and med supply items	$1950 maximum benefit/year for incontinence products and products must be obtained from a contracted vendor	Fee for service using historical Medicare payment rates	CN
Prosthetic and Orthotic Devices
Yes		Yes		Fee for service	CN
Transportation Services
Ambulance Services
Yes	$.50-$2/non-emergency transport, depending on payment	Non-emergency transports or transports greater than 50 miles		Fee for service	CN
Non-Emergency Medical Transportation Services
Yes	$.50-$2/trip, depending on payment		20 one-way trips less than 50 miles/year	See service-specific FN	CN
Other Services
Diagnostic, Screening and Preventive Services
Yes				Dependent upon service and billing provider	CN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service	CN
Targeted Case Management
Yes			Quantity and frequency limits vary by group served	Fee for service	CN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes	Yes	Services for the following populations: 1, 2, 3, 4, 6, 7 & 8 - See service-specific FN	Dependent upon the services provided	CN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes		120 hours of care within 30 days of hospital discharge if ordered by physician, 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge	Prospective cost based rates	CN
Hospice Care
Yes	Yes		Prospective rates based on Medicare methodology	CN
Personal Care Services
No
Private Duty Nursing Services
Yes	Yes	Limited to ventilator dependent beneficiaries only	Fee for service	CN
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes		Services limited to hospital settings, 60 therapeutic leave days/year	Prospective cost based per diem, leave days paid at 50% of facility's rate	CN
Inpatient Psychiatric Services, under age 21
Yes	Yes	14 therapeutic leave days/year	Prospective cost based per diem, leave days paid at 50% of facility's rate	CN
Intermediate Care Facility Services for the Mentally Retarded
Yes	For LOC determination upon admission	15 hosp leave days/hospitalization, 60 therapeutic leave days/year	Prospective cost based per diem, leave days paid at 50% of facility's rate	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes	For LOC determination upon admission, therapies, specified prescription drugs	15 consecutive hosp leave days/hosp, 30 therapeutic leave days/year	Prospective per diem based on cost, leave days paid at 50% of facility's rate if 90% occupancy requirement met	CN
Religious Non-Medical Health Care Institution and Practitioner Services
Yes		Practitioner services not covered	Prospective cost based per diem	CN

Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA). These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 350 percent of the federal poverty level (FPL). Beneficiaries in this group with income above 150 percent of the FPL pay an income-based monthly premium. Any identified copayment requirements are applicable to beneficiaries age 18 and older.