In accordance with public notice requirements of 42 CFR 447.205 the Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) publishes this notice of proposed reimbursement methodology for End Stage Renal Disease (ESRD) case management.

The OMPP proposes to add ESRD case management as a covered service and to reimburse providers for this service, for consumers who meet specific criteria for eligibility, and level of need, under an approved assessment tool developed by FSSA. This will provide continued Medicaid eligibility to individuals with ESRD who would otherwise lose access to kidney transplant services with the state's transition from 209(b) to 1634 status. Due to their ESRD diagnosis, these individuals are not eligible for Medigap or Medicare Advantage. Additionally, due to their Medicare eligibility they are ineligible to receive a tax credit to purchase insurance on the federal Marketplace. Therefore, Medicaid coverage through this new program and service is the only supplemental coverage option available to ensure continued placement on the kidney transplant list.

Reimbursement for ESRD case management will be paid on a fee-for-service basis. Only a registered nurse (RN) or licensed practical nurse (LPN) may perform ESRD case management services. OMPP will establish the rate based on actual costs submitted by Home Health Agencies (HHA) for services provided by RN and LPN staff. The rate is a statewide rate, computed by dividing RN and LPN salaries, benefits, and overhead by the number of RN and LPN hours reported on HHA cost reports. The result of this calculation is an hourly RN cost and an hourly LPN cost. The RN and LPN hourly costs for each HHA are arrayed from highest to lowest to identify the median. The ESRD case management rate is the average of the RN and LPN median hourly cost amounts. Payment will be based on the lower of the provider's submitted charge or the established rate. The unit of service will be 15 minutes.

It is estimated that the fiscal impact for the added service will result in an estimated increase in state and federal expenditures of $34.5 million for Federal Fiscal Year (FFY) 2015 ($6.76 million in state appropriations) and $37.33 million for FFY 2016 ($7.49 million in state appropriations). The proposed effective date of the addition of the new reimbursable service is October 1, 2014.

A copy of this notice is now on file at the Indiana Government Center South, 402 West Washington Street, Room W451, Indianapolis, Indiana and is open for public inspection. Also, a copy of this notice is now available and may be inspected by contacting the local county office of the FSSA Division of Family Resources, except in Marion County where public inspection may be made at 402 West Washington Street, Room W374, Indianapolis, Indiana.

Anyone who wishes to comment on this matter may submit written comments to: IFSSA, Office of Medicaid Policy and Planning, Attention: Matthew Cesnik, 402 West Washington Street, Room W374, MS07, Indianapolis, IN 46204. Correspondence should be identified in the following manner: COMMENT RE: ESRD CASE MANAGEMENT. Written comments received will be made available for public display at 402 West Washington Street, Room W374, Indianapolis, Indiana.

Debra Minott

Secretary

Office of the Secretary of Family and Social Services Administration