Medicaid 101: Managed care in Indiana 2017 First quarter Indiana Health Coverage Programs workshop

Transcription

1 Serving Hoosier Healthwise, Healthy Indiana Plan Medicaid 101: Managed care in Indiana 2017 First quarter Indiana Health Coverage Programs workshop

2 Learning objectives This presentation is intended to enhance provider knowledge of: o The Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect programs. o The structures of the listed programs. o Products offered by the listed programs. o Managed care entities (MCEs). 2 2

3 Office of Medicaid Policy and Planning The Indiana Family and Social Services Administration (FSSA) is the umbrella agency responsible for administering the state s public assistance programs. FSSA includes the offices and divisions listed below: o Office of Medicaid Policy and Planning (OMPP) o Division of Disability and Rehabilitative Services (DDRS) o Division of Family Resources (DFR) o Division of Mental Health and Addiction (DMHA) o Division of Aging (DOA) 3 3

4 Key players* FSSA OMPP HP Enterprise Services Cooperative Managed Care Services LLC Risk-based managed care Myers and Stauffer LC OptumRx Anthem Blue Cross and Blue Shield (Anthem) MDwise, Inc. Managed Health Services CareSource *Not all IHCP programs/ contractors are listed. 4 4

5 Managed Care entities in Indiana 5 5

6 Risk-based managed care Plans serviced by Anthem: o Hoosier Healthwise o Healthy Indiana Plan o Hoosier Care Connect 6 6

7 Medicaid programs Indiana Health Coverage Programs (IHCP): o Healthy Indiana Plan o Hoosier Healthwise o Hoosier Care Connect o Traditional Medicaid o Medicaid for Employees with Disabilities (M.E.D. Works) o HoosierRx o Presumptive Eligibility (PE) o PE for Pregnant Women 7 7

8 Eligibility Eligibility is determined by the state after a person fills out an application. The MCE does not determine a member s eligibility. 8 8

9 Eligibility (cont.) To learn more about enrollee eligibility, you can view the state Eligibility Guide at caid.com/am-ieligible/eligibilityguide.aspx. 9 9

10 Enrollment Healthcare Reform: o Determines the best place to start the application process by walking people through the different options for Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect services. DFR: o Uses an online screening tool to see if person is eligible for Hoosier Healthwise, Healthy Indiana Plan services. o Offers in-person applications at physical office locations

11 Enrollment (cont.) Indiana FSSA: o Offers online applications. o Allows members to print an application or request one by mail

12 Enrollment (cont.) Website and contact information: o Healthcare Reform: o DFR: o FSSA:

13 Hoosier Healthwise Hoosier Healthwise is a health care program for children and pregnant women with low incomes. Children up to age 19 may be eligible to enroll. The goals of Hoosier Healthwise are: o To provide health care services to children under 19 years of age. o To provide health care services to women who are pregnant or have become pregnant. o To ensure access to primary and preventive care services

14 Hoosier Healthwise (cont.) o To encourage quality, continuity and appropriateness of medical care. o To provide cost-effective medical coverage

15 Hoosier Healthwise (cont.) There are three benefit packages available: o Package A Standard Plan: This is a full service plan for children, pregnant women and families. o Package C Children s Health Insurance Program: This is a full service plan for children only

16 Hoosier Healthwise (cont.) o Package P PE for Pregnant Women: This is a limited service plan for pregnant women that provides coverage for prenatal care and covers only pregnancyrelated services. Women may be eligible for Package P services while their full application is being processed

17 Hoosier Care Connect This is a managed care program for eligible individuals with any of the following conditions and who meet the following criteria: o Adults 65 years of age or older or child who is a ward of the state, is receiving adoption assistance or is a foster child. o Individuals who are blind or have another disability. o Individuals who receive supplemental security income. o Individuals enrolled in M.E.D. Works

18 Hoosier Care Connect (cont.) o Not currently enrolled in a Home- and Community- Based Services (HCBS) waiver. o Not currently enrolled in any Medicare program. o Not currently residing in an institution. o Note: Individuals who reside in an institution, are receiving services through an HCBS waiver or are enrolled in Medicare will not be enrolled in Hoosier Care Connect. These members will remain traditional Medicaid members

19 Healthy Indiana Plan The Healthy Indiana Plan provides health care services to adults ages 19 to 64 with low incomes. The Healthy Indiana Plan offers several different service plans depending upon the member s needs and income

20 Healthy Indiana Plan (cont.) Healthy Indiana Plan Plus o This is the best value plan, which offers enhanced benefits, dental and vision services. o This plan requires a monthly Personal Wellness and Responsibility (POWER) Account contribution. o This plan has no copays other than for nonemergency ER services

21 Healthy Indiana Plan (cont.) Healthy Indiana Plan Basic o This plan requires no POWER Account contribution. o Under this plan, copays are required for most medical services

22 Healthy Indiana Plan (cont.) Healthy Indiana Plan State Plan Plus o Offers transitional medical assistance (TMA) and enhanced benefits. o Requires monthly POWER Account contributions. o Is recommended for members who meet any or all of the following criteria: Medically frail Parent/caretaker with a low income 19 to 20 years of age 22 22

23 Healthy Indiana Plan (cont.) Healthy Indiana Plan State Plan Basic o Offers TMA and enhanced benefits. o Does not require a POWER Account contribution. Copay is required for most medical services. o Is recommended for members who meet any or all of the following criteria: Medically frail Parent or caretaker with a low income 19 to 20 years of age 23 23

24 Presumptively eligible adults Members who were presumptively eligible for Healthy Indiana Plan enrollment were formerly designated as Adult PE in the IHCP Eligibility Verification System. Adult PE members remained in conditional status until their full IHCP application was approved and a Fast Track or POWER Account payment was made. Effective August 5, 2016, members who were initially enrolled under the Adult PE category will be moved to Healthy Indiana Plan (HIP) Basic Potential Plus. These members will receive Basic benefits but have a Potential Plus indicator, which allows them time to buy in for Plus benefits

25 Presumptively eligible adults (cont.) As members transition from enrollment under the conditional Adult PE status to full enrollment in the Healthy Indiana Plan Basic or Healthy Indiana Plan Plus categories, they will be issued a traditional recipient identification (RID) number. Providers should use the traditional RID for billing instead of the PE RID as soon as it is effective. See IHCP Bulletin BT for more details

26 Medically frail Members are considered medically frail when they have any of the following conditions: o Cancer o Transplanted organs o AIDS o Aplastic anemia o Diabetes with comorbidity o Coagulation defects 26 26

27 Medically frail (cont.) o Lipid storage diseases o Disabling mental disorders o Chronic substance abuse disorders o Any physical, intellectual or developmental disability that significantly impairs the individual s ability to perform one or more activities of daily living 27 27

28 Eligibility verification In Availity, select Patient Registration from the top menu bar. Select Eligibility and Benefits Inquiry from the drop-down menu

29 Eligibility verification (cont.) The New Request page will appear. Input the required information. An Anthem ID or RID can be used to verify eligibility. The health care ID prefix (YRK) must be entered with the Anthem ID or RID. Select Submit

30 Contact information through March 31, 2017 Provider Services: o Hoosier Healthwise: o Healthy Indiana Plan: o Hoosier Care Connect: Member Services: o Hoosier Healthwise and Healthy Indiana Plan: o Hoosier Care Connect: /7 NurseLine o

31 Contact information through March 31, 2017 (cont.) Prior authorization (PA) requests o Hoosier Healthwise : o Healthy Indiana Plan: o Fax:

32 Contact information effective April 1, 2017 Provider Services o Hoosier Healthwise: o Healthy Indiana Plan: o Hoosier Care Connect: Member Services o Hoosier Healthwise and Healthy Indiana Plan: o Hoosier Care Connect:

33 Contact information effective April 1, 2017 (cont.) 24/7 NurseLine o Hoosier Healthwise and Healthy Indiana Plan: o Hoosier Care Connect: PA requests utilization management and pharmacy o Hoosier Healthwise: o Healthy Indiana Plan: o Hoosier Care Connect:

34 Contact information (cont.) PA behavioral health o Hoosier Healthwise : o Healthy Indiana Plan:

35 Network Relations team Marvin Davis Northwest Region Franciscan Network Community Health Angela Love Northeast Region Indiana University Health Angelique Jones West Central Region St. Vincent Health Michelle Cox Southwest Region Angel Dodson Central Region Eskenazi Randall Mills Central Region Donnica Hinkle Behavioral Health Jovita Mielke Southeast Region

36 Thank you Thank you for your participation in serving our members! is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. AINPEC February