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Medicaid/CHIP Data Requirements in Indiana

Indiana’s Medicaid program is subject to a number of state laws in addition to federal requirements.  Providers participating in Medicaid are required to maintain Medicaid patients’ records for a minimum of seven years.  The records must accurately reflect the care and scope of services provided to the patient.1  Providers are also required to fully disclose all records pertaining to Medicaid patients to the Office of Medicaid Policy and Planning upon request.2  The state has passed confidentiality laws with regard to Medicaid beneficiaries’ records and information.  However, the law provides an exception to the confidentiality requirement when the information is used is disclosed for the purpose of administering the Medicaid program.3  The law also requires the state to maintain publicly available records of the name and identification number of each Medicaid recipient and the amount of medical assistance received each month under the Medicaid program.4  The law grants providers access to eligibility information of patients, but prohibits providers from further disclosing this information.5

The state maintains strict confidentiality laws that pertain to the Children’s Health Insurance Program (CHIP).  Similar to its policy on Medicaid records, Indiana requires that records and information of CHIP beneficiaries be confidential, but that they may be disclosed for audits, investigations, or to administer CHIP.6  Providers who participate in CHIP are required to have access to specific CHIP eligibility information through phone or electronically.7  This information is confidential and cannot be further disclosed by the provider.8  The state CHIP office is also required to evaluate CHIP and conduct performance evaluation.9  Furthermore, in order to improve the quality of care provided under CHIP, Indiana has also instituted a Children’s Health Policy Board, which is charged with developing policies regarding delivery system reform, access, and outreach.10

 

 

Footnotes

  • 1. 405 Ind. Admin. Code 1-5-1
  • 2. 405 Ind. Admin. Code 1-5-2
  • 3. Ind. Code §12-15-27
  • 4. Ind. Code §12-15-27
  • 5. Ind. Code §12-15-27
  • 6. Ind. Code §12-17.6-9-2; Ind. Code §12-17.6-9-3
  • 7. Ind. Code §12-17.6-9-5; Ind. Code §12-17.6-9-6
  • 8. Ind. Code §12-17.6-9-7
  • 9. Ind. Code §12-17.6-2-6
  • 10. Ind. Code §4-23-27-7

 

Medicaid/CHIP Data Requirements in Indiana

Subtopic Statute/Regulation Description
Confidentiality of Medicaid data (including penalties for violating confidentiality) Confidentiality Requirements for CHIP Eligibility Information Obtained by Providers – Ind. Code Ann.§ 12-17.6-9-7 Any CHIP eligibility information obtained by a provider on an individual must remain confidential and cannot be disclosed. Related Laws: Ind. Code...
Confidentiality Requirements for General Information Under the CHIP Program – Ind. Code Ann.§ 12-17.6-9-2 The following information concerning CHIP applicants and recipients under the CHIP program are confidential: Applications Investigation...
Requirements for Disclosure of Information of General Nature Under the CHIP Program – Ind. Code Ann.§ 12-17.6-9-4 The release and use of information of a general nature will be provided as needed for adequate interpretation or development of the CHIP program....
Requirements for the Disclosure of Authorized Information Under the CHIP Program – Ind. Code Ann.§ 12-17.6-9-3 The disclosure and use of CHIP information is authorized for the following purposes: Financial audits; Legislative investigations; ...
Medicaid/CHIP Data Requirements Duties of the Children’s Health Policy Board – Ind. Code Ann.§ 4-23-27-7 The Children’s Health Policy Board is responsible for coordinating care by developing policies for delivery system reform, enhanced access to...
Punishment for Violations Under the Children's Health Insurance Program – Ind. Code Ann.§ 12-17.6-6-6 The law states that any person who provides services  under the Children’s Health Insurance Program (CHIP) for payment, and knowingly and...
Brief description of each state’s Medicaid program (Name and unique characteristics) Establishment of Performance Criteria and Evaluation Measures Under the CHIP Program – Ind. Code Ann.§ 12-17.6-2-6 Establishment of Performance Criteria and Evaluation Measures Under the CHIP Program The Office of the Children’s Health Insurance Program (...
Quality reporting by Medicaid providers (cross post to care coordination/care management (chronic disease management; sharing information across providers; enrollee participation) Establishment of Performance Criteria and Evaluation Measures Under the CHIP Program – Ind. Code Ann.§ 12-17.6-2-6 Establishment of Performance Criteria and Evaluation Measures Under the CHIP Program The Office of the Children’s Health Insurance Program (...
Mandatory reporting by Medicaid providers (cost/utilization information) Hospital Fiscal Reporting Requirements – Ind. Code Ann. § 16-21-6-3 Each hospital must file with the State Department of Health, a fiscal report containing the following information: Hospital’s balance sheet...
Access to Medicaid data (by patients, providers, and government agencies) Limits on Information Available to CHIP Participating Providers – Ind. Code Ann.§ 12-17.6-9-6 While the law grants CHIP participating providers access to participants’ eligibility information, the information that can be released to...
Required Contents of a Patient’s Written Consent for Release of Records – Ind. Code Ann.§ 16-39-1-4 When a patient’s written consent for release of the patient’s health record is required, the release must include the following: The...
Requirements for Availability of Information Through Telephone Hotlines or Electronic Databases to CHIP Participating Providers – Ind. Code Ann.§ 12-17.6-9-5 CHIP participating providers must have access to information to verify the eligibility of individuals through either a telephone hotline or an...
Requirements for Disclosure of Medicaid Patient Medical Records – 405 Ind. Admin. Code 1-5-2 Requirements for Disclosure of Medicaid Patient Medical Records All records maintained by Medicaid participating providers must be fully disclosed to...
Requirements for the Disclosure of Medical Records Under Medicaid – 405 Ind. Admin. Code 1-5-2 All records maintained by Medicaid participating providers must be fully disclosed to the state Office of Medicaid Policy and Planning upon request....
Medicaid medical records maintenance by providers (including retention period, storage, and other recordkeeping requirements) Requirements for the Establishment and Maintenance of Medical Records Under Medicaid – 405 Ind. Admin. Code 1-5-1 All Medicaid participating providers must maintain records of services provided under the Medicaid program for seven years.  The records must...