Presumptive Eligibility for Inmates Quick Reference Guide

Transcription

1 1 Presumptive Eligibility for Inmates Quick Reference Guide The Indiana Health Coverage Programs (IHCP) has created a limited Presumptive Eligibility (PE) for Inmates program. This program will allow PE qualified providers (QPs) to enroll eligible inmates into Indiana Medicaid for temporary coverage of inpatient hospitalization services. The following quick reference guide has been created to assist QPs until the permanent solution has been finalized. Eligible Population The PE for Inmates program is available to inmates who meet the following requirements: The individual must be an inmate from an Indiana Department of Correction (IDOC) facility operating under the memorandum of understanding with FSSA. The individual must not be on house arrest. The individual must not be pregnant or admitted for labor and delivery. The individual must be admitted for inpatient hospitalization. The individual must be under the age of 65. All other standard PE requirements, including income requirements, also apply. For complete information on PE requirements, please refer to the Hospital Presumptive Eligibility Qualified Provider Manual. Covered Benefits The PE for Inmates program does not include a standard PE benefits package. Individuals enrolled through the PE for Inmates program will be limited to inpatient hospitalization services only. Claims are submitted and paid through the fee-forservice delivery system. Reimbursement is set at 130% fee-for-service rates. Coverage Length Eligible inmates will remain covered for inpatient hospitalization services for up to one year from the PE application date or until notification of release. The inmate must complete a full application and be approved for full coverage; if no application is filed and approved, PE for Inmates coverage will end on the last day of the following month.

2 2 If the inmate remains incarcerated after one year, he or she may reapply for coverage through the PE for Inmates program if he or she continues to meet the program requirements. Application Process The application for the PE for Inmates program is accessed in the same way as the application for the IHCP s other PE programs. The following process is a step-by-step guide to completing the PE for Inmates application, including the notable differences from the other PE programs: 1. Select the Eligibility Inquiry Feature from the left navigation menu in Web interchange to verify that the individual is not already in an IHCP program. When no active IHCP coverage is located for the individual, the Subscriber/Insured Not Found message will appear. If a 600 RID is already active for that inmate, use that RID to bill, and do not complete a new application. 2. Click the PE Application Button, as shown in the screenshot below, to begin the application process. The PE Member Application screen will appear.

3 3 3. Complete all fields by asking the applicant for the required information - These fields should be completed in the same way as the other PE programs with the following exceptions: Home Address Use the correctional facility s name and address as the inmate s home address. A complete list of the participating IDOC facilities and their addresses is provided at the end of this document. Line One of the Home Address field should contain the correctional facility s name, while Line Two should contain the correctional facility s address. Phone Number Use the correctional facility s phone number as the inmate s phone number. A complete list of the participating IDOC facilities and their phone numbers is provided at the end of this document. Is the Applicant Incarcerated Select yes. During this interim process, selecting yes for this question will result in a PE application denial. This is normal and expected, and you should not attempt to complete multiple applications. 4. Check the Attestation Statement I attest that I have been trained to process applications for HPE/PE. 5. Review the PE Application Take this time to review the application data to confirm that there are no typos or data entry errors. Be sure to check the applicant s name spelling, income, date of birth, and Social Security Number. 6. Submit Application HIT THIS BUTTON ONLY ONE TIME! If any of the required fields are missing or the data entered is invalid, a pop-up notification will appear to indicate the list of fields that are missing data. Complete those required fields and submit the application. You will then see the denial screen shown below. This is the expected outcome, so you should not complete an additional PE application for the inmate. If the application is denied for any reason other than incarceration, the inmate will not be eligible for the PE for Inmates program.

4 4 7. Print the Summary Page You should print a copy of the summary page document and save the document to your computer. You should also write the name of the individual within the hospital who inputted the application on the summary page. During the interim process for the PE for Inmates program, you will need to know information about the inmate s application to allow the inmate to complete the PE process. The final steps in the process will occur on the first business day after submitting the PE application. 8. Watch for a telephone call from HP The HP Eligibility unit will call your hospital s primary PE contact individual and request the prison facility s name, the hospital s name, the name of the hospital worker who inputted the inmate s application, and any missing information from the inmate s application. This information will allow HP to manually reset the inmate s application from denied to approved. 9. Receive an or fax with the inmate s approval After the application has been reset to approved, your hospital s primary PE contact and IDOC will receive an or fax with the inmate s approval notification. Once you have received this document, the hospital is able to begin submitting claims for payment of inpatient services.

5 5 Branchville Presumptive Eligibility for Inmates Program Eligibility Requirements General Requirements The PE for Inmates program is available to inmates who meet the following requirements: The individual must be an inmate from an Indiana Department of Correction (IDOC) facility operating under the memorandum of understanding with FSSA (provided below). The individual must not be on house arrest. The individual must be admitted for inpatient hospitalization. The individual must not be pregnant or admitted for labor and delivery. The individual must be under the age of 65 years old. Covered Benefits Inpatient hospitalization services only. Indiana Department of Correction (IDOC) Facilities Facility Name Facility Address Facility Phone Number Old State Rd 37, Branchville, IN (812) Chain O' Lakes Correctional Industrial Edinburgh Henryville Heritage Trail Indiana State Prison Indiana Women's Prison Indianapolis Logansport (Juvenile) Madison Madison (Juvenile) Miami New Castle Pendleton Pendleton (Juvenile) Plainfield Putnamville Rockville South Bend Wabash Valley Westville 3516 E 75 South, Albion, IN W. Reformatory Rd, Pendleton, IN PO Box 470, 23rd & Schoolhouse, Edinburgh, IN PO Box 148, 1504 Schlamn Lake, Henryville, IN W. Main Street, Plainfield, IN Park Row, Michigan City, IN Girl's School Rd, Indianapolis, IN N. Randolph St, Indianapolis, IN South St. Rd. 25, Logansport, IN MSH Bus Stop Drive, Madison, IN MSH 4th St., Madison, IN W 850 S, Bunker Hill, IN Van Nuys Rd, PO Box E, New Castle, IN W Reformatory Rd, Pendleton, IN South St. Rd. 67, Pendleton, IN Moon Rd., Plainfield, IN West US Hwy 40, Greencastle, IN W 50 N, Rockville, IN Old Cleveland Rd, South Bend, IN S Old US Hwy 41, PO Box 500, Carlisle, IN S 1100 W, Westville, IN (260) (765) (812) (812) (317) (219) (317) (317) (574) (812) (812) (765) (765) (765) (765) (317) (765) (765) (574) (812) (219) ***During the temporary interim process, the PE application will be denied for incarceration. THIS IS NORMAL, AND YOU SHOULD NOT FILL OUT AN ADDITIONAL PE APPLICATION.***