Opioids and IN Pain Management Prescribing Final Rule, IN Hospital Code and Regulations

Indiana Opioid Prescribing Guidelines1. Background

• In 20#, ># million opioid prescriptions were dispensed in Indiana.

• Goal: Improve opioid prescribing to increase saX, reduce misX/abX, and ensure effective X management.

• Guidelines are clinical practice recommendations tailored to different healthcare settings.

2. Emergency Department (Acute Conditions)

Indiana Guidelines for Opioid Prescribing in the ED

• Focus: X pain in emergency department settings.

• Provides X approach to opioid prescribing.

• Includes a FacX AcX Checklist:

  • Allows hospitals to revX and compX X practices with X guidelines.

3. Chronic PainIndiana Pain Management Prescribing Final Rule (#)

• Adopted by Indiana X X Board, under 844 IAC 5-6.

• Applies to X practicing X management.

• Key components of safe/effective prescribing:

  1. Patient assX

  2. Non-X treatment options

  3. Patient information conX

  4. Patient X-ups

  5. IX reports (InX PrescX DrX MonitX ProgX)

  6. Drug monitoring tXs

  7. DaX X dose threshold

  8. X agreement

CDC Guidelines for Prescribing Opioids for Chronic Pain

• Focus: Primary care for adults with chronic pain ># months (excludes cancer, palliative, end-of-life care).

• Goals:

  1. Improve X between providers and patients.

  2. Increase X and X of long-term opioid therapy.

  3. Emphasize X-X to assess benefit vs harm.

• Physicians can apply X recommendations even if not mandated by Indiana law.

4. Acute Pain

Indiana Guidelines for the Management of Acute Pain

• Applies to Xpatient aX pain management.

• All X can apply, but not for X conditions causing acute pain.

Co-prescribing Naloxone

• Recommended for patients at risk of X.

• AMA guidance:

  • Determine clinical X

  • Discuss with patient before X 

5. Key Takeaways 

• Indiana rules are X binding for X physicians; X guidelines are recommendations.

• Acute vs chronic pain: Guidelines differ.

  • Acute pain = XX & Xpatient acute pain management.

  • Chronic pain = X-term management; requires X-ups, Xtoring, patient X.

Safety measures: INSPECT reports, drug monitoring, dose thresholds, naloxone co-prescribing.

The Indiana Pain Management Prescribing Final Rule is a set of X regulations adopted by the Indiana X X Board in # that govern how physicians prescribe X for X management. Its purpose is to ensure that opioid prescribing is saX, effeX, and monX, helping to prevent misX, abX, or overX.

Key Points of the Final Rule:

1. Patient AssessX – Doctors must evaluate the patient’s X, medical X, and X factors before prescribing opioids.

2. Non-X Treatment Options – Physicians should consider X to opioids when possible.

3. Patient X & X – Patients must be informed about the X and X of opioid treatment.

4. Patient X-X – Ongoing monitX is required to evaluate the effectiveness and safety of the therapy.

5. INSPECT Reports – Providers must check the Indiana Prescription Drug Monitoring Program to track X substance prescriptions.

6. Drug MonX Tests – X testing may be required to ensure compliance.

7. Daily X Dose Threshold – There are guidelines for safe X doses of opioids.

8. Treatment X – A X agreement between the doctor and patient outlining X and X.

In short: The Final Rule is a X framework in Indiana that guides how opioids should be prescribed for X pain to maximize patient X and minimize X risk.

Indiana Opioid Prescribing Guidelines1. Background

• In 2017, >6 million opioid prescriptions were dispensed in Indiana.

• Goal: Improve opioid prescribing to increase safety, reduce misuse/abuse, and ensure effective pain management.

• Guidelines are clinical practice recommendations tailored to different healthcare settings.

2. Emergency Department (Acute Conditions)

Indiana Guidelines for Opioid Prescribing in the ED

• Focus: Acute pain in emergency department settings.

• Provides general approach to opioid prescribing.

• Includes a Facility Action Checklist:

  • Allows hospitals to review and compare current practices with recommended guidelines.

3. Chronic PainIndiana Pain Management Prescribing Final Rule (2014)

• Adopted by Indiana Medical Licensing Board, under 844 IAC 5-6.

• Applies to physicians practicing pain management.

• Key components of safe/effective prescribing:

  1. Patient assessment

  2. Non-opioid treatment options

  3. Patient information consent

  4. Patient follow-ups

  5. INSPECT reports (Indiana Prescription Drug Monitoring Program)

  6. Drug monitoring tests

  7. Daily high dose threshold

  8. Treatment agreement

CDC Guidelines for Prescribing Opioids for Chronic Pain

• Focus: Primary care for adults with chronic pain >3 months (excludes cancer, palliative, end-of-life care).

• Goals:

  1. Improve communication between providers and patients.

  2. Increase safety and effectiveness of long-term opioid therapy.

  3. Emphasize follow-ups to assess benefit vs harm.

• Physicians can apply CDC recommendations even if not mandated by Indiana law.

4. Acute Pain

Indiana Guidelines for the Management of Acute Pain

• Applies to outpatient acute pain management.

• All ages can apply, but not for chronic conditions causing acute pain.

Co-prescribing Naloxone

• Recommended for patients at risk of overdose.

• AMA guidance:

  • Determine clinical appropriateness

  • Discuss with patient before prescribing 

5. Key Takeaways 

• Indiana rules are legally binding for state physicians; CDC guidelines are recommendations.

• Acute vs chronic pain: Guidelines differ.

  • Acute pain = ED & outpatient acute pain management.

  • Chronic pain = long-term management; requires follow-ups, monitoring, patient agreements.

Safety measures: INSPECT reports, drug monitoring, dose thresholds, naloxone co-prescribing.The Indiana Pain Management Prescribing Final Rule is a set of state regulations adopted by the Indiana Medical Licensing Board in 2014 that govern how physicians prescribe opioids for pain management. Its purpose is to ensure that opioid prescribing is safe, effective, and monitored, helping to prevent misuse, abuse, or overdose.

Key Points of the Final Rule:

1. Patient Assessment – Doctors must evaluate the patient’s pain, medical history, and risk factors before prescribing opioids.

2. Non-Opioid Treatment Options – Physicians should consider alternatives to opioids when possible.

3. Patient Information & Consent – Patients must be informed about the risks and benefits of opioid treatment.

4. Patient Follow-Ups – Ongoing monitoring is required to evaluate the effectiveness and safety of the therapy.

5. INSPECT Reports – Providers must check the Indiana Prescription Drug Monitoring Program to track controlled substance prescriptions.

6. Drug Monitoring Tests – Regular testing may be required to ensure compliance.

7. Daily High Dose Threshold – There are guidelines for safe maximum doses of opioids.

8. Treatment Agreement – A formal agreement between the doctor and patient outlining responsibilities and expectations.

In short: The Final Rule is a legal framework in Indiana that guides how opioids should be prescribed for chronic pain to maximize patient safety and minimize abuse risk.

Federal Opioid Treatment Program (OTP) Standards1. General Requirements

• OTPs must provide treatment according to X standards to maintain X.

• Programs must comply with all applicable X, X, and X laws.
  2. Administrative & Organizational Structure

• OTPs must have:

  1. Program X – formX agrees to comply with regulations.

  2. Medical X – responsible for all medical and behavioral health services and compliance.

3. Quality Assurance

• Maintain X assurance/control plans:

  • X review of policies and procedures.

  • Ongoing assX of patient outcomes.

• Maintain a DivX CX Plan (DCP):

  • Measures to prevent diversion of X Medications for Opioid Use Disorder.

  • Staff assigned specific X.

4. Staff Credentials

• All personnel must have sufficient X, X, or X for their role.

• Licensed/certified staff must maintain X.

5. Patient Admission

• Admission requires:

  1. DiaX of moderate to severe OUD or high risk for recurrence/overdose.

  2. VolX treatment with X consent.

• Patients under # require X consent from X/X (unless state law allows self-consent).

• Withdrawal management: Patients can taper from MOUD safely with X X.

6. Required Services

• OTPs must provide:

  • MedX, counX, vocX, eduX, and other support services.

  • Services must be indiviX based on patient X and X plan.

Initial Medical Examination

• Two parts:

  1. ScX exam – eligibility & contraindications.

  2. Full hX & eX – broader health status, labs as needed.

• Xhealth allowed for evaluation with certain rules.

Special Services

• Pregnant patients: prioritize adX, provide X-based treatment (e.g., split dosing), preXcare, reproductive health services.

Periodic Assessment

• Physical & behavioral health assessment within # days of admission and periodically.

• Care plan includes: gXs, X reduction, eduX, vocX, X support.

Counseling & Education

• Substance use disorder X, X reduction, X support.

• Counseling on HX, hX, SX, and rX to treatment if needed.

• Provide or refer to vocX, educX, and emplX services.

Drug Testing

• X drug testing usingX-approved tests.

At least # random tests per year per patient.

Federal Opioid Treatment Program (OTP) Standards1. General Requirements

• OTPs must provide treatment according to federal standards to maintain certification.

• Programs must comply with all applicable federal, state, and local laws.
  2. Administrative & Organizational Structure

• OTPs must have:

  1. Program Sponsor – formally agrees to comply with regulations.

  2. Medical Director – responsible for all medical and behavioral health services and compliance.

3. Quality Assurance

• Maintain quality assurance/control plans:

  • Annual review of policies and procedures.

  • Ongoing assessment of patient outcomes.

• Maintain a Diversion Control Plan (DCP):

  • Measures to prevent diversion of MOUD.

  • Staff assigned specific responsibilities.

4. Staff Credentials

• All personnel must have sufficient education, training, or experience for their role.

• Licensed/certified staff must maintain credentials.

5. Patient Admission

• Admission requires:

  1. Diagnosis of moderate to severe OUD or high risk for recurrence/overdose.

  2. Voluntary treatment with informed consent.

• Patients under 18 require written consent from parent/guardian (unless state law allows self-consent).

• Withdrawal management: Patients can taper from MOUD safely with informed consent.

6. Required Services

• OTPs must provide:

  • Medical, counseling, vocational, educational, and other support services.

  • Services must be individualized based on patient assessment and care plan.

Initial Medical Examination

• Two parts:

  1. Screening exam – eligibility & contraindications.

  2. Full history & exam – broader health status, labs as needed.

• Telehealth allowed for evaluation with certain rules.

Special Services

• Pregnant patients: prioritize admission, provide evidence-based treatment (e.g., split dosing), prenatal care, reproductive health services.

Periodic Assessment

• Physical & behavioral health assessment within 14 days of admission and periodically.

• Care plan includes: goals, harm reduction, education, vocational, social support.

Counseling & Education

• Substance use disorder counseling, harm reduction, recovery support.

• Counseling on HIV, hepatitis, STIs, and referral to treatment if needed.

• Provide or refer to vocational, educational, and employment services.

Drug Testing

• Random drug testing using FDA-approved tests.

At least 8 random tests per year per patient.

7. Recordkeeping & Confidentiality

• DocXt & monX patient care.

• Verify patients aren’t enrolled in multiple X unless for valid reasons.

• Maintain confXy per federal/state laws.

8. Medication Administration & MOUD

• Only X practitioners may administer or dispense MOUD.

• Approved medications: MX, BupXe, NalX.

• Methadone dosing rules:

  • Initial dose ≤# mg/day unless clinically justified.

  • X form only; reduce potential for misuse.

• MOUD must follow X-approved labeling; deviations must be X.

Take-Home Doses

• Initially limited; increase based on stability, absence of risk factors, and clinician discretion.

  • First 14 days: up to # days

  • Day 15–30: up to # days

  • Day 31+: up to # days

• X on safe tranX and storX required.

9. Interim Treatment

• Temporary treatment when comprehensive services aren’t immediately available (max # days).

• At least # drug tests during interim treatment.

• Interim treatment exceptions:

  • No primary X required

  • Some X/X services optional

  • PregX patients prioritized

• Must transition to X treatment once available.

✅ Key Takeaways

• Federal OTP standards focus on qX, sX, and iX care.

• Includes adX, tX services, MOUD use, cX, X testing, rXkeeping, take-X dosing, and inX care.

Goal: maximize X effectiveness, reduce diX, and support patient X.

7. Recordkeeping & Confidentiality

• Document & monitor patient care.

• Verify patients aren’t enrolled in multiple OTPs unless for valid reasons.

• Maintain confidentiality per federal/state laws.

8. Medication Administration & MOUD

• Only licensed practitioners may administer or dispense MOUD.

• Approved medications: Methadone, Buprenorphine, Naltrexone.

• Methadone dosing rules:

  • Initial dose ≤50 mg/day unless clinically justified.

  • Oral form only; reduce potential for misuse.

• MOUD must follow FDA-approved labeling; deviations must be documented.

Take-Home Doses

• Initially limited; increase based on stability, absence of risk factors, and clinician discretion.

  • First 14 days: up to 7 days

  • Day 15–30: up to 14 days

  • Day 31+: up to 28 days

• Education on safe transport and storage required.

9. Interim Treatment

• Temporary treatment when comprehensive services aren’t immediately available (max 180 days).

• At least 2 drug tests during interim treatment.

• Interim treatment exceptions:

  • No primary counselor required

  • Some counseling/support services optional

  • Pregnant patients prioritized

• Must transition to comprehensive treatment once available.

✅ Key Takeaways

• Federal OTP standards focus on quality, safety, and individualized care.

• Includes admissions, treatment services, MOUD use, counseling, drug testing, recordkeeping, take-home dosing, and interim care.

Goal: maximize treatment effectiveness, reduce diversion, and support patient recovery.

Prescription Drug Time and Dosage Limit Laws1. Purpose

• PresX drug overdose is a major X; prescription opioids (like oxyX, hydrX, methXe) are a major contributor.

• States regulate prescribing to reduce overdose risk.

• X limits = how long a X lasts (hours/days).

• X limits = X number of pills or units prescribed.

2. Time Limits

A. By Drug Type

• Some states limit all prescriptions; others limit specific sX.

• Examples:

  • Florida: ≤#-day supply for most prescriptions.

  • Missouri: Schedule II ≤# days, Schedule III–V ≤# days.

  • California: Schedule II ≤3 hours if dispensed directly by prescriber.

  • Mississippi: Emergency oral Schedule II ≤# hours.

B. Multiple Prescriptions

• Some states allow X prescriptions up to a total X supply, with conditions.

• Examples: IXa & NX JX: Multiple Schedule II prescriptions may total ≤# days.

• Utah: No more than # prescriptions at once; each ≤# days.

C. Benefit Plans (Medicare/Medicaid)

• Many states limit prescriptions to #–#-day supply for plan members.

• Examples: OX, IX, WX.

D. Emergency Situations

• Most states allow limited X dispensing (usually ≤# hours) if prescriber is unavailable.

• Some states exclude Schedule II drugs from X refills.

• Examples: KX, NX, OX.

E. Pain Management Clinics

• Louisiana: max #-day supply, non-X.

West Virginia: ≤#-hour supply.

3. Dosage Limits

A. By Drug Type

• Limits on X of dosage units (capsules, tablets, or oral liquid).

• Examples:

  • Rhode Island: Schedule III ≤# units; Schedule IV–V ≤# units.

  • Arkansas: Schedule V ≤# units (opium-containing) in # hours.

B. Benefit Plans

• Some states limit prescription by dosing X or X’ supply for plan members.

• Examples:

  • Delaware: ≤# units or # days.

  • New Jersey: ≤# days or # units for chronic maintenance drugs.

4. Key Takeaways

• Time limits = prevent excessive sX and reduce overdose X.

• Dosage limits = prevent X-prescribing or accumulation of controlled substances.

• X laws vary widely, but most target X substances (Schedule II–V).

• EX provisions and X plan-specific rules exist.

Providers must follow X law and consult X guidance for compliance

Prescription Drug Time and Dosage Limit Laws – Key Points1. Purpose

• Prescription drug overdose is a major epidemic; prescription opioids (like oxycodone, hydrocodone, methadone) are a major contributor.

• States regulate prescribing to reduce overdose risk.

• Time limits = how long a prescription lasts (hours/days).

• Dosage limits = maximum number of pills or units prescribed.

2. Time Limits

A. By Drug Type

• Some states limit all prescriptions; others limit specific schedules.

• Examples:

  • Florida: ≤34-day supply for most prescriptions.

  • Missouri: Schedule II ≤30 days, Schedule III–V ≤90 days.

  • California: Schedule II ≤72 hours if dispensed directly by prescriber.

  • Mississippi: Emergency oral Schedule II ≤48 hours.

B. Multiple Prescriptions

• Some states allow multiple prescriptions up to a total maximum supply, with conditions.

• Examples: Iowa & New Jersey: Multiple Schedule II prescriptions may total ≤90 days.

• Utah: No more than 3 prescriptions at once; each ≤30 days.

C. Benefit Plans (Medicare/Medicaid)

• Many states limit prescriptions to 30–34-day supply for plan members.

• Examples: Oklahoma, Illinois, Wyoming.

D. Emergency Situations

• Most states allow limited emergency dispensing (usually ≤72 hours) if prescriber is unavailable.

• Some states exclude Schedule II drugs from emergency refills.

• Examples: Kentucky, Nebraska, Oregon.

E. Pain Management Clinics

• Louisiana: max 30-day supply, non-refillable.

• West Virginia: ≤72-hour supply.

3. Dosage Limits

A. By Drug Type

• Limits on number of dosage units (capsules, tablets, or oral liquid).

• Examples:

  • Rhode Island: Schedule III ≤100 units; Schedule IV–V ≤360 units.

  • Arkansas: Schedule V ≤48 units (opium-containing) in 48 hours.

B. Benefit Plans

• Some states limit prescription by dosing units or days’ supply for plan members.

• Examples:

  • Delaware: ≤100 units or 34 days.

  • New Jersey: ≤60 days or 100 units for chronic maintenance drugs.

4. Key Takeaways

• Time limits = prevent excessive supply and reduce overdose risk.

• Dosage limits = prevent over-prescribing or accumulation of controlled substances.

• State laws vary widely, but most target controlled substances (Schedule II–V).

• Emergency provisions and benefit plan-specific rules exist.

Providers must follow state law and consult legal guidance for compliance

US Attorney's Office, Eastern District of Pennsylvania: Federal Law Enforcement Efforts to Combat the Opioid Crisis

1. Criminal Prosecutions

• Focus on stopping illegal prXn, disX, and X of opioids.

• Target eX in the sX chain: doctors, pharmacies, street dealers, distributors.

• Examples:

  • PX mX: doctors and staff prescribing opioids without medical need (e.g., oxycodone).

  • StX traffX: prosecuted for distributing fentanyl and heroin causing overdose deaths.

2. Civil Enforcement

• Filed a first-of-its-kind lawsuit against SX in X.

• Goal: prevent “supervised iX sites” (illegal under X law, X X Act §856(a)(2)).

• Legal stance: managing or controlling a pX for illegal drug use is a X crX.

3. Multi-Agency Collaboration

• Partnerships with FX, DX, HX, X and X police, and other federal offices.

• Coordinated efforts increase effectiveness in identifying X activity.

4. Focus on Prevention and Recovery

• Programs like RX PX Court help non-X drug users with supervised recovery.

• OutX and eduX are part of the strategy alongside enforcement.

5. Key Takeaways

• Enforce the law sX: X prosecution for illegal prescribing and trafficking.

• PX mXand fraudulent prXs are major targets.

• Supervised injection sites are X and X in court.

• Multi-pronged approach: crX, cX, prX, rX, and edX.

"Community benefits" defined

   "community benefits" means the unX cost to a hospital of providing chX care, X sponsored indigent health care, donX, educX, X sponsored program services, reseX, and X health services. The term does not include the X to the hospital of paying any taxes or other governmental assessments.

As added by P.L.94-1994, SEC.17.

US Attorney's Office, Eastern District of Pennsylvania: Federal Law Enforcement Efforts to Combat the Opioid Crisis

1. Criminal Prosecutions

• Focus on stopping illegal production, distribution, and use of opioids.

• Target everyone in the supply chain: doctors, pharmacies, street dealers, distributors.

• Examples:

  • Pill mills: doctors and staff prescribing opioids without medical need (e.g., oxycodone).

  • Street traffickers: prosecuted for distributing fentanyl and heroin causing overdose deaths.

2. Civil Enforcement

• Filed a first-of-its-kind lawsuit against Safehouse in Philadelphia.

• Goal: prevent “supervised injection sites” (illegal under federal law, Controlled Substances Act §856(a)(2)).

• Legal stance: managing or controlling a place for illegal drug use is a federal crime.

3. Multi-Agency Collaboration

• Partnerships with FBI, DEA, HHS, state and local police, and other federal offices.

• Coordinated efforts increase effectiveness in identifying illegal activity.

4. Focus on Prevention and Recovery

• Programs like Relapse Prevention Court help non-violent drug users with supervised recovery.

• Outreach and education are part of the strategy alongside enforcement.

5. Key Takeaways

• Enforce the law strictly: federal prosecution for illegal prescribing and trafficking.

• Pill mills and fraudulent prescriptions are major targets.

• Supervised injection sites are illegal and challenged in court.

• Multi-pronged approach: criminal, civil, prevention, recovery, and education.

"Community benefits" defined

     Sec. 1. As used in this chapter, "community benefits" means the unreimbursed cost to a hospital of providing charity care, government sponsored indigent health care, donations, education, government sponsored program services, research, and subsidized health services. The term does not include the cost to the hospital of paying any taxes or other governmental assessments.

As added by P.L.94-1994, SEC.17.

Elements of a Community Benefits Plan (Sec. 6)

Every nonprofit hospital’s plan must include:

1. EX mechanisms – a way to check if the plan is wXncluding asking the X for feedback.

2. Measurable obX – specific X that the hospital wants to achieve, with a timeline.

3. BX– a clear outline of how much X will be spent on the plan.

Annual Community Benefit Plan Report Requirements (Sec. 7)

Nonprofit hospitals must prepare a report every X including:

• Hospital X statement

• X health needs considered when making the plan

• Actual X benefits provided, including X care (X care must be listed separately)

Filing rules:

• Filed with the X department

• Timeline depends on fiscal X:

Public notice:

• Hospitals must notify the public that the report is:

  1. X information

  2. Filed with the X

  3. Available on X

• Post notices in prominent areas (ER, admissions, patient guides)

Charity care notice:

• X instructions on how to X

• Post in X areas: waiting areas, business office, ER, etc.

• Provide in appropriate X when possible

Failure to File Report (Sec. 8)

• State can assess a X penalty for X reports: up to $# per day

Hospital gets # business days’ notice before penalties start

Elements of a Community Benefits Plan (Sec. 6)

Every nonprofit hospital’s plan must include:

1. Evaluation mechanisms – a way to check if the plan is working, including asking the community for feedback.

2. Measurable objectives – specific goals that the hospital wants to achieve, with a timeline.

3. Budget – a clear outline of how much money will be spent on the plan.

Annual Community Benefit Plan Report Requirements (Sec. 7)

Nonprofit hospitals must prepare a report every year including:

• Hospital mission statement

• Community health needs considered when making the plan

• Actual community benefits provided, including charity care (charity care must be listed separately)

Filing rules:

• Filed with the state department

• Timeline depends on fiscal year:

  • Before July 1, 2011 → 120 days after fiscal year end

  • After June 30, 2011 → same time as annual IRS return (Form 990)

Public notice:

• Hospitals must notify the public that the report is:

  1. Public information

  2. Filed with the state

  3. Available on request

• Post notices in prominent areas (ER, admissions, patient guides)

Charity care notice:

• Written instructions on how to apply

• Post in key areas: waiting areas, business office, ER, etc.

• Provide in appropriate languages when possible

Failure to File Report (Sec. 8)

• State can assess a civil penalty for late reports: up to $1,000 per day

Hospital gets 30 business days’ notice before penalties start

IN Hospital Laws: Review the Indiana Code "Hospital" definition 

     Sec. 4. (a) As used in this chapter, "hospital" means either of the following:

(1) A hX (as defined in IC 16-18-2-179(b)) licensed under this article.

(2) A X pXhospital licensed under IC 12-25.

     (b) The term does not include the following:

(1) A X mX health institution operated under IC 12-24-1-3.

(2) A hospital:

(A) designated by the MXprogram as a X term care hX;

(B) that has an average iXpatient length of stay that is greater than X-X (#) days, as determined by the office of MXpolicy and planning under the Medicaid program;

(C) that is a MX certified, freestanding rX hospital; or

(D) that is a hospital operated by the X government.

Included as a hospital:

1. A standard hospital licensed under the X hospital regulations (IC 16-18-2-179(b)).

2. A X psychiatric hospital licensed under IC 12-25.

Not included as a hospital:

1. X-run mental health institutions (IC 12-24-1-3).

2. Hospitals that meet any of these conditions:

   • Designated by X as a X-term care hospital.

   • Have an average inpatient stay longer than # days.

   • Are X-certified freestanding X hospitals.

   • Are operated by the X government.

✅ Bottom line: Only certain types of licensed hospitals (general or private psychiatric) are subject to these X benefits and X care rules. Hospitals like federal, long-term, rehab, or state mental institutions are excluded.

Failure to File Report (Sec. 8)

• State can assess a civil penalty for late reports: up to $1,000 per day

• Hospital gets 30 business days’ notice before penalties start

IN Hospital Laws: Review the Indiana Code "Hospital" definition 

     Sec. 4. (a) As used in this chapter, "hospital" means either of the following:

(1) A hospital (as defined in IC 16-18-2-179(b)) licensed under this article.

(2) A private psychiatric hospital licensed under IC 12-25.

     (b) The term does not include the following:

(1) A state mental health institution operated under IC 12-24-1-3.

(2) A hospital:

(A) designated by the Medicaid program as a long term care hospital;

(B) that has an average inpatient length of stay that is greater than twenty-five (25) days, as determined by the office of Medicaid policy and planning under the Medicaid program;

(C) that is a Medicare certified, freestanding rehabilitation hospital; or

(D) that is a hospital operated by the federal government.

Included as a hospital:

1. A standard hospital licensed under the state hospital regulations (IC 16-18-2-179(b)).

2. A private psychiatric hospital licensed under IC 12-25.

Not included as a hospital:

1. State-run mental health institutions (IC 12-24-1-3).

2. Hospitals that meet any of these conditions:

   • Designated by Medicaid as a long-term care hospital.

   • Have an average inpatient stay longer than 25 days.

   • Are Medicare-certified freestanding rehabilitation hospitals.

   • Are operated by the federal government.

✅ Bottom line: Only certain types of licensed hospitals (general or private psychiatric) are subject to these community benefits and charity care rules. Hospitals like federal, long-term, rehab, or state mental institutions are excluded.

Healthcare Associated Infections (HAIs) from the Indiana Department of Health (IDOH):

• Definition: HAIs are X that patients get while receiving X care for something else in a healthcare setting.

• Prevalence: About # in # hospital patients has at least # HAI on any given day.

• Importance of Prevention: Reducing HAIs requires:

  • SurX – tracking infections in hospitals.

  • OutX investX – figuring out how infections spread.

  • LabX resX – studying pathogens and treatment.

  • PrevX activities – following safety and hygiene protocols.

• Resources: X provides tools, guidance, and state quality improvement initiatives to help hospitals prevent and treat HAIs.

✅ Bottom line: HAIs are X but largely prevX with proper monitX, resX, and infection X practices.

Healthcare Associated Infections (HAIs) from the Indiana Department of Health (IDOH):

• Definition: HAIs are infections that patients get while receiving medical care for something else in a healthcare setting.

• Prevalence: About 1 in 25 hospital patients has at least one HAI on any given day.

• Importance of Prevention: Reducing HAIs requires:

  • Surveillance – tracking infections in hospitals.

  • Outbreak investigations – figuring out how infections spread.

  • Laboratory research – studying pathogens and treatment.

  • Prevention activities – following safety and hygiene protocols.

• Resources: IDOH provides tools, guidance, and state quality improvement initiatives to help hospitals prevent and treat HAIs.

✅ Bottom line: HAIs are common but largely preventable with proper monitoring, research, and infection control practices.

 CAH stands for Critical Access Hospital.

These are sX, X hospitals that meet specific X requirements to improve access to healthcare in X areas. The CAH designation allows them certain benefits like X-based MX reiX, sX flexibility, and access to X programs aimed at supporting X healthcare.

Key Benefits of CAH Status

1. Financial ReX

   • Cost-based reimbursement from MX (allowable cost + 1%).

   • Subject to a #% redXn due to sequestration (since 2013).

   • Some states provide similar cost-based reimbursement through MX.

   • CaX improvement costs are included in allowable costs for Medicare reimbursement.

2. Staffing & Service Flexibility

   • CAHs have more flX than regular hospitals in medical and nursing staff requirements.

   • Advanced practice providers (PAs, NPs, clinical nurse specialists) can provide dXcare, including emergency care, sometimes without a physician onsite.

   • Emergency services must be #, but X services are not required.

3. Quality Improvement Support

   • Access to the Medicare Beneficiary Quality Improvement Project (MBQIP).

   • Must maintain qX assurance arrangements with hospitals, CAHs, or quality improvement organizations.

4. Access to Grants and Technical Assistance

   • Federal and state programs such as the FX Program provide edX, techX assistance, and grX.

   • Capital funding opportunities through UX, HX, and other programs.

5. Service and Community Benefits

   • CAHs are designed to meet the specific healthcare needs of their X communities.

   • Can operate sX beX (for acute or post-acute care) and manage other facilities like rural health clinics or skilled nursing care.

   • Can participate in the #XB program to purchase X at reduced cost.

6. Location & Distance Advantages

   • Must be located in X areas and meet distance requirements (# miles from nearest hospital, # in mountainous/secondary road areas).

   • Some CAHs designated as “NeX ProX” before 2006 are exempt from distance requirements.

7. Size & Patient Limits

   • Maximum of # acute care beds.

   • Average patient length of stay ≤ # hours.

Network & Referral Agreements

Must have agreements with at least one other aX care hospital for patient reX, transfer, and quality assurance.

Can collaborate with X health departments and community organizations to expand services.

Legislative Support

CAH program created by X X Act of 1# and modified by later laws to improve reimbursement, staffing flexibility, HIT adoption, and rural healthcare support.

Important Notes

CAH status does not guarantee finX X; hospitals must assess their own situation.

Services are tailored to X needs; one CAH may offer X services than another.

• Not all benefits apply in every X; state licensure laws may impose X requirements.

CAHs can own or collaborate with other healthcare facilities, but X-campus clinics must meet X requirements.

CAH stands for Critical Access Hospital.These are small, rural hospitals that meet specific federal requirements to improve access to healthcare in rural areas. The CAH designation allows them certain benefits like cost-based Medicare reimbursement, staffing flexibility, and access to federal programs aimed at supporting rural healthcare. Key Benefits of CAH Status

1. Financial Reimbursement

   • Cost-based reimbursement from Medicare (allowable cost + 1%).

   • Subject to a 2% reduction due to sequestration (since 2013).

   • Some states provide similar cost-based reimbursement through Medicaid.

   • Capital improvement costs are included in allowable costs for Medicare reimbursement.

2. Staffing & Service Flexibility

   • CAHs have more flexibility than regular hospitals in medical and nursing staff requirements.

   • Advanced practice providers (PAs, NPs, clinical nurse specialists) can provide direct care, including emergency care, sometimes without a physician onsite.

   • Emergency services must be 24/7, but EMS services are not required.

3. Quality Improvement Support

   • Access to the Medicare Beneficiary Quality Improvement Project (MBQIP).

   • Must maintain quality assurance arrangements with hospitals, CAHs, or quality improvement organizations.

4. Access to Grants and Technical Assistance

   • Federal and state programs such as the Flex Program provide education, technical assistance, and grants.

   • Capital funding opportunities through USDA, HUD, and other programs.

5. Service and Community Benefits

   • CAHs are designed to meet the specific healthcare needs of their rural communities.

   • Can operate swing beds (for acute or post-acute care) and manage other facilities like rural health clinics or skilled nursing care.

   • Can participate in the 340B program to purchase medications at reduced cost.

6. Location & Distance Advantages

   • Must be located in rural areas and meet distance requirements (35 miles from nearest hospital, 15 in mountainous/secondary road areas).

   • Some CAHs designated as “Necessary Providers” before 2006 are exempt from distance requirements.

7. Size & Patient Limits

   • Maximum of 25 acute care beds.

   • Average patient length of stay ≤ 96 hours.

Network & Referral Agreements

Must have agreements with at least one other acute care hospital for patient referral, transfer, and quality assurance.

Can collaborate with local health departments and community organizations to expand services.

Legislative Support

CAH program created by Balanced Budget Act of 1997 and modified by later laws to improve reimbursement, staffing flexibility, HIT adoption, and rural healthcare support.

Important Notes

CAH status does not guarantee financial success; hospitals must assess their own situation.

Services are tailored to community needs; one CAH may offer different services than another.

• Not all benefits apply in every state; state licensure laws may impose stricter requirements.

• CAHs can own or collaborate with other healthcare facilities, but off-campus clinics must meet distance requirements.