Indiana Administrative Code Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Here’s an updated and organized overview of Title 405 – Office of the Secretary of Family and Social Services (405 IAC) in the Indiana Administrative Code:
📘 Overview of Title 405 – Key Articles & Status
Article 1 – Medicaid Providers and Services (Rules 1‑1 to 1‑21)
Covers provider qualifications, reimbursement, long‑term care inspections, nursing facility rate‑setting, hospice services, and ownership disclosures
Includes sub‑articles on provider appeals (Rules 1.4, 1.6) and some repealed rules dealing with audits and home health.
Article 1.1 – Appeal Procedures for Applicants and Recipients (Rules 1.1‑1 to 1.1‑3)
Sets standards for appeals related to Medicaid eligibility decisions
Article 2 – Medicaid Members; Eligibility (Rules 2‑1 to 2‑10)
Defines eligibility requirements, procedures, and estate‑recovery provisions (e.g., Rule 2‑8 on claims against estates and hardship exemptions)
Article 3 – Local Step Ahead Councils
Expired; no current active rules
Article 4 – Purchase of Products/Services by Persons with Disabilities (Rule 4‑1)
Governs procurement and related policies (exact scope in Rule 4‑1) .
Article 5 – Medicaid Services (Rules 5‑1 to 5‑39)
Includes definitions, coverage policies, fees for physician services (e.g., Rule 5‑25), prescription services, and more—some may be repealed or updated
Article 6 – Indiana Prescription Drug Program (Rules 6‑1 to 6‑10)
Provides regulations for the state’s prescription drug assistance.
Article 7 – State Supplemental Assistance for Personal Needs (Rules 7‑1 to 7‑2)
Covers supplemental aid for personal needs of eligible individuals.
Article 8 – Prescription Drug Program Medicare Part D Assistance Benefit (Rules 8‑1 to 8‑10)
Details assistance for Medicare Part D enrollees via Indiana’s program.
Article 9 – Indiana Check‑Up Plan
Repealed (no longer in effect)
Article 10 – Healthy Indiana Plan (Rules 10‑1 to 10‑13)
Regulates HIP, Indiana’s health coverage initiative.
Article 11 – Children’s Health Insurance Program (CHIP) (Rules 11‑1 to 11‑6)
Covers CHIP provisions on eligibility and provider participation.
Article 12 – Applicants & Members; Eligibility, Enrollment, Appeals (Rules 12‑1 to 12‑4)
Offers standards for member enrollment and appeals for both Medicaid and CHIP programs.
Article 13 – Benefits and Medical Policy (Rules 13‑1 to 13‑12)
Sets medical policy guidelines and benefit limitations.
Article 14 – Medicaid and CHIP Managed Care (Rules 14‑1 to 14‑6)
Addresses managed care requirements and oversight.
📝 Summary Table
| Article | Topic | Status |
|---|---|---|
| 1 | Medicaid providers & services | Active |
| 1.1 | Appeals for applicants & recipients | Active |
| 2 | Medicaid members & eligibility (incl. estate recovery) | Active |
| 3 | Local Step Ahead Councils | Expired |
| 4 | Program for purchase of products/services by persons with disabilities | Active |
| 5 | Broad Medicaid service definitions and policies | Active |
| 6 | Prescription Drug Program | Active |
| 7 | Supplemental personal needs assistance | Active |
| 8 | Medicare Part D assistance | Active |
| 9 | Indiana Check-Up Plan | Repealed |
| 10 | Healthy Indiana Plan | Active |
| 11 | Children’s Health Insurance Program | Active |
| 12 | Enrollment & appeal procedures | Active |
| 13 | Benefits & medical policy | Active |
| 14 | Medicaid/CHIP managed care | Active |
✅ What This Means for You
Core active rules focus on Medicaid eligibility, provider services, appeals, medical benefits, and managed care under the Secretary’s oversight.
Some programs are expired or repealed, e.g., Article 3 (Step Ahead), Article 9 (Check‑Up).
Detailed policy rules include estate recovery (Article 2), appeals (Articles 1.1 & 12), and service definitions (Articles 5 & 13).
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