Terms Used In Indiana Code > Title 12 > Article 15 - Medicaid

• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
• Allegation: something that someone says happened.
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
• Attorney: includes a counselor or other person authorized to appear and represent a party in an action or special proceeding. See Indiana Code 1-1-4-5
• Balanced budget: A budget in which receipts equal outlays.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• board: refers to the drug utilization review board created under this chapter. See Indiana Code 12-15-35-2
• broker: means a contractor of the office that administers the Medicaid fee-for-service nonemergency medical transportation program. See Indiana Code 12-15-30.5-1
• buy-in program: refers to the Medicaid buy-in program for working individuals with disabilities established by section 3 of this chapter. See Indiana Code 12-15-41-1
• clean claim: means a claim submitted by a provider for payment under the Medicaid program that can be processed without obtaining additional information from:

  Indiana Code 12-15-13-0.5

• Clerk: means the clerk of the court or a person authorized to perform the clerk's duties. See Indiana Code 1-1-4-5
• commission: refers to the nonemergency medical transportation commission established by section 7 of this chapter. See Indiana Code 12-15-30.5-2
• commission: refers to the Medicaid advisory commission created by this chapter. See Indiana Code 12-15-33-1
• committee: refers to the Medicaid clinical advisory committee established under this chapter. See Indiana Code 12-15-33.5-1
• compendia: means those resources widely accepted by the medical profession in the efficacious use of drugs, including the following sources:

  Indiana Code 12-15-35-3

• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Conviction: A judgement of guilt against a criminal defendant.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• counseling: means the activities conducted by a pharmacist to inform Medicaid recipients about the proper use of drugs as required by the board under this chapter. See Indiana Code 12-15-35-4
• countable resources: means all cash, other liquid assets, real property, and personal property owned by an applicant for or a recipient of Medicaid under this chapter, or the spouse of an applicant or a recipient, that could be converted to cash to be used for support or maintenance, except the following:

  Indiana Code 12-15-41-2

• covered entity: has the meaning set forth in Indiana Code 12-15-23.5-1
• covered outpatient drug: has the meaning set forth in Indiana Code 12-15-35-4.5
• criteria: means the predetermined and explicitly accepted elements that are used to measure drug use on an ongoing basis to determine if the use is appropriate, medically necessary, and not likely to result in adverse medical outcomes. See Indiana Code 12-15-35-5
• cross-indicated drug: means a drug that is used for a purpose generally held to be reasonable, appropriate, and within the community standards of practice even though the use is not included in the federal Food and Drug Administration's approved labeled indications for the drug. See Indiana Code 12-15-35.5-2
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Dependent: A person dependent for support upon another.
• Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• DUR: means the program designed to measure and assess on a retrospective and a prospective basis the proper use of outpatient drugs in the Medicaid program. See Indiana Code 12-15-35-8
• emergency medical condition: means a medical condition manifesting itself by acute symptoms, including severe pain, of sufficient severity that a prudent lay person with an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in:

  Indiana Code 12-15-12-0.3

• emergency services: means covered inpatient and outpatient services that are:

  Indiana Code 12-15-12-0.5

• Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• Escrow: Money given to a third party to be held for payment until certain conditions are met.
• estate: includes :

  Indiana Code 12-15-9-0.5

• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Ex officio: Literally, by virtue of one's office.
• Executive session: A portion of the Senate's daily session in which it considers executive business.
• facility: means a facility licensed under IC 12-28-5 and certified under Title XIX of the Social Security Act (Indiana Code 12-15-32-1
• federal income poverty level: means the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under Indiana Code 12-15-2-1
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. ^{Source: OCC}
• Fraud: Intentional deception resulting in injury to another.
• fund: refers to the Medicaid indigent care trust fund established by this chapter. See Indiana Code 12-15-20-1
• Garnishment: Generally, garnishment is a court proceeding in which a creditor asks a court to order a third party who owes money to the debtor or otherwise holds assets belonging to the debtor to turn over to the creditor any of the debtor
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• health maintenance organization: has the meaning set forth in IC 27-13-1-19. See Indiana Code 12-15-39.6-4
• home health agency: means a public or private organization, whether owned or operated by one (1) or more persons, that furnishes or offers to furnish home health services. See Indiana Code 12-15-34-1
• home health services: means any of the following items or services furnished to an individual by a home health agency or by others under arrangements with a home health agency on a visiting basis, and except as provided in subsection (b), in a place of temporary or permanent residence used as the individual's home:

  Indiana Code 12-15-34-2

• hospice: means a person or health care provider who owns or operates a hospice program or facility, or both, that uses an interdisciplinary team directed by a licensed physician to provide a program of planned and continuous care for hospice program patients and their families. See Indiana Code 12-15-40-2
• hospice program: means a specialized form of interdisciplinary health care that is designed to alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phase of a terminal illness or disease. See Indiana Code 12-15-40-3
• hospice program patient: means a terminally ill patient who:

  Indiana Code 12-15-40-4

• hospice services: means :

  Indiana Code 12-15-40-5

• hospital: refers to an acute care hospital provider that:

  Indiana Code 12-15-11.5-1

• hospital: has the meaning set forth in IC 16-18-2-179(b). See Indiana Code 12-15-18-2
• in writing: include printing, lithographing, or other mode of representing words and letters. See Indiana Code 1-1-4-5
• insurer: includes a pharmacy benefit manager. See Indiana Code 12-15-29-0.5
• Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. ^{Source: OCC}
• intervention: means an action taken by the board with a prescriber or pharmacist to inform about or to influence prescribing or dispensing practices or utilization of drugs. See Indiana Code 12-15-35-9
• Irrevocable trust: A trust arrangement that cannot be revoked, rescinded, or repealed by the grantor.
• Joint tenancy: A form of property ownership in which two or more parties hold an undivided interest in the same property that was conveyed under the same instrument at the same time. A joint tenant can sell his (her) interest but not dispose of it by will. Upon the death of a joint tenant, his (her) undivided interest is distributed among the surviving joint tenants.
• Judgment: means all final orders, decrees, and determinations in an action and all orders upon which executions may issue. See Indiana Code 1-1-4-5
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Lien: A claim against real or personal property in satisfaction of a debt.
• long acting reversible contraceptive: includes intrauterine devices and birth control implants. See Indiana Code 12-15-47-1
• long term care: means the provision of the following services in a setting other than an acute care wing of a hospital to enable individuals whose functional capacities are chronically impaired to be maintained at their maximum level of health and well-being:

  Indiana Code 12-15-39.6-1

• long term care facility: means a facility licensed under IC 16-28. See Indiana Code 12-15-39.6-2
• long term care insurance: means insurance coverage for at least twelve (12) consecutive months for each covered person on an expense incurred, indemnity, or prepaid basis for one (1) or more necessary long term care services provided in a setting other than an acute care wing of a hospital. See Indiana Code 12-15-39.6-3
• Medicaid inpatient payments for safety-net hospitals: means the payments provided for in the Medicaid state plan for inpatient services provided by hospitals that satisfy the definition of a safety-net hospital under the Medicaid state plan; and

  Indiana Code 12-15-20.7-1

• Medicaid outpatient payments for safety-net hospitals: means the payments provided for in the Medicaid state plan for outpatient services provided by hospitals that satisfy the definition of a safety-net hospital under the Medicaid state plan. See Indiana Code 12-15-20.7-1
• medical institution: means any of the following:

  Indiana Code 12-15-8.5-1

• medical record: means written or printed information possessed by a provider (as defined in IC 16-18-2-295) concerning any diagnosis, treatment, or prognosis of the patient, unless otherwise defined. See Indiana Code 1-1-4-5
• minor: means a person less than eighteen (18) years of age. See Indiana Code 1-1-4-5
• Minority leader: See Floor Leaders
• Month: means a calendar month, unless otherwise expressed. See Indiana Code 1-1-4-5
• Mortgagee: The person to whom property is mortgaged and who has loaned the money.
• nonemergency medical transportation: means medically necessary transportation to Medicaid covered services for an eligible Medicaid recipient who:

  Indiana Code 12-15-30.5-3

• nonprobate transfer: has the meaning set forth in IC 32-17-13-1. See Indiana Code 12-15-9-0.5
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• office: includes the following:

  Indiana Code 12-15-13-0.4

• office: refers to the office of the secretary of family and social services. See Indiana Code 12-15-13.5-1
• Oversight: Committee review of the activities of a Federal agency or program.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Personal property: All property that is not real property.
• Personal property: includes goods, chattels, evidences of debt, and things in action. See Indiana Code 1-1-4-5
• pharmacist: means an individual who is licensed as a pharmacist in Indiana under IC 25-26. See Indiana Code 12-15-35-11
• phase out period: refers to the following periods:

  Indiana Code 12-15-44.5-1

• physician: means an individual who is licensed to practice medicine in Indiana under Indiana Code 12-15-35-12
• physician services: means services provided by an individual licensed under Indiana Code 12-15-11-1
• plan: refers to the healthy Indiana plan established by section 3 of this chapter. See Indiana Code 12-15-44.5-2
• Population: has the meaning set forth in Indiana Code 1-1-4-5
• post-stabilization care services: means covered services related to an emergency medical condition that are provided after an enrollee is stabilized in order to maintain the stabilized condition or, under the circumstances described in IC 12-15-12-17(b)(3), to improve or resolve the enrollee's condition. See Indiana Code 12-15-12-0.7
• Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
• President pro tempore: A constitutionally recognized officer of the Senate who presides over the chamber in the absence of the Vice President. The President Pro Tempore (or, "president for a time") is elected by the Senate and is, by custom, the Senator of the majority party with the longest record of continuous service.
• preventative care services: means care that is provided to an individual to prevent disease, diagnose disease, or promote good health. See Indiana Code 12-15-44.5-2.3
• private psychiatric institution: means an acute care inpatient facility licensed under IC 12-25, for the treatment of individuals with mental illness. See Indiana Code 12-15-18-3
• Probate: Proving a will
• program: means the Indiana long term care insurance partnership program established by section 4(a) of this chapter. See Indiana Code 12-15-39.8-2
• Property: includes personal and real property. See Indiana Code 1-1-4-5
• Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
• prospective DUR: means the part of the drug utilization review program that:

  Indiana Code 12-15-35-13

• qualified entity: means an entity that:

  Indiana Code 12-15-2.3-2

• qualified long term care insurance policy: means an insurance policy that meets the following requirements:

  Indiana Code 12-15-39.8-3

• qualified long term care policy: means an insurance policy that:

  Indiana Code 12-15-39.6-5

• Quorum: The number of legislators that must be present to do business.
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• real property: include lands, tenements, and hereditaments. See Indiana Code 1-1-4-5
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• retrospective DUR: means the part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards that are developed on an ongoing basis with professional input. See Indiana Code 12-15-35-14
• Right of survivorship: The ownership rights that result in the acquisition of title to property by reason of having survived other co-owners.
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Sheriff: means the sheriff of the county or another person authorized to perform sheriff's duties. See Indiana Code 1-1-4-5
• special skilled services: refers to medical and health services that are provided to a patient who is:

  Indiana Code 12-15-36-3

• standards: means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the Medicaid recipient database. See Indiana Code 12-15-35-15
• Statute: A law passed by a legislature.
• Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
• SURS: refers to the surveillance utilization review system of the Medicaid program. See Indiana Code 12-15-35-16
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• therapeutic category: means a group of pharmacologic agents primarily characterized by a significant similarity of the biochemical or physiological mechanism by which these agents result in the intended clinical outcome. See Indiana Code 12-15-35-17.5
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• trustees: refers to the trustees of Indiana University. See Indiana Code 12-15-18-3.5
• United States: includes the District of Columbia and the commonwealths, possessions, states in free association with the United States, and the territories. See Indiana Code 1-1-4-5
• unrestricted access: means the ability of a recipient to obtain a prescribed drug without being subject to limits or preferences imposed by the office or the board for the purpose of cost savings except as provided under section 7 of this chapter. See Indiana Code 12-15-35.5-2.5
• Verified: when applied to pleadings, means supported by oath or affirmation in writing. See Indiana Code 1-1-4-5
• veteran: includes "Hoosier veteran" and applies to the construction of all Indiana statutes, unless the construction is expressly excluded by the terms of the statute, is plainly repugnant to the intent of the general assembly or of the context of the statute, or is inconsistent with federal law. See Indiana Code 1-1-4-5
• waste: means inappropriate:

  Indiana Code 12-15-35.5-2.6

• Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5