Medicaid Managed Care
The Indiana Family and Social Services Administration (FSSA) is planning to significantly rebalance the delivery of long term services and supports (LTSS) for most older Medicaid-eligible Hoosiers in favor of more home and community based care services (HCBS). FSSA is targeting Summer to Fall of 2024 for this project; known as Indiana Pathways for Aging.
If you have not yet heard from an MCE about contracting, please feel free to contact each directly as follows:
IHSN members: As an IHSN member you have a consultant at your fingertips to help with MCE contracting and credentialing. Please contact Dawn Miller (firstname.lastname@example.org) if you haven’t heard from the MCEs noted above or if you have any questions.
Important Materials and Documents:
- Pathways Probari PPT on Care and Service Coordinator Roles
- MCE Joint Claim-Billing Presentation
- LAIN Resident Enrollment / MCE Selection Tutorial
- January 2024 Pathways Targeted Provider Work Group
- MLTSS Occupancy Penalty Change Memo for Members
- Go Live Implementation and Enrollment 12-2023
- Pathways presentation form LeadingAge Indiana‘s Fall 2023 Conference
- mLTSS 101 an overview presented by Advancing States November 3 2021
- LAIN MLTSS Summary
Looking for something? Click here for archived resources and documents.
FSSA intends to transition the member experience (eligibility, care management, etc.) and and claims-payment responsibilities to a managed care (insurance company) system. In other words, senior Hoosiers will be attached to one of the various insurance companies who won the procurement bid. Those three (3) are: Anthem, United Health Care, and Humana.
Remaining Pathways Timeline for all aspects of the implementation of mLTSS is as follows:
- RFI Co-Design and Finance Workgroups: January 2021 through the present;
- Contracting/Readiness/Implementation: Throughout 2023 - July 2024;
- Tentative Implementation Date: No earlier than July 1, 2024
LeadingAge Indiana, along with and other stakeholder groups in Indiana senior care, have been meeting with FSSA to advocate for certain operational, financial, and administrative guardrails to help ensure the Pathways transition is as smooth as is possible. We continue to work to expand this list, but some of the safeguards we secured include:
- Preservation of the IGT/UPL system;
- changes will include a value-based incentive system, but IGT/UPL payment will continue - and might increase upon hitting certain metrics;
- Fair and timely claims payment requirements;
- Adequate and Adequate appeals processes for providers;
- Uniform Appropriate and efficient PA processes;
- Uniform credentialing process;
- Any Willing Provider contracting for at least three years;
- Clear efforts to reduce administrative burdens on providers;
- Dedicated and qualified care and case managers for this vulnerable population.
Please refer to this enrollment summary for questions about resident enrollment during and after the transition to managed care. Additional material will be put out by LeadingAge Indiana as it becomes available.