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