405 IAC 5-17-5 - Inpatient detoxification, rehabilitation, and aftercare for chemical dependency

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

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

Sec. 5.

(a) Medicaid reimbursement is available for inpatient detoxification, rehabilitation, and aftercare for chemical dependency when such services are prior authorized subject to this section.

(b) Admission to a general hospital floor is not indicated unless the medical services are required for life support and cannot be rendered in a substance abuse treatment unit or facility.

(c) Prior authorization for inpatient detoxification, rehabilitation, and aftercare for chemical dependency shall include consideration of the following:

(1) All requests for prior authorization will be reviewed on a case-by-case basis.

(2) The treatment, evaluation, and detoxification are based on the stated medical condition.

(3) The need for safe withdrawal from alcohol or other drugs.

(4) A history of recent convulsions or poorly controlled convulsive disorder.

(5) Reasonable evidence that detoxification and aftercare cannot be accomplished in an outpatient setting.

Notes

405 IAC 5-17-5

Office ofthe Secretary of Family and Social Services; 405 IAC 5-17-5; filed Jul 25, 1997, 4:00p.m.: 20 IR 3327; 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