The Indiana Health Coverage Programs (IHCP) reimburses nursing facilities and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) for long-term care (LTC) services provided to eligible IHCP members with an applicable level-of-care (LOC) determination. All applicants to Medicaid-certified nursing facilities in Indiana are entered in the state’s web-based Preadmission Screening and Resident Review (PASRR) system. See the PASRR page for more information.
The IHCP has safeguards in place to protect the health and welfare of institutionalized members, as well as all individuals with mental illness or intellectual or developmental disability. The reviews described on this page assist the Indiana Family and Social Services Administration (FSSA) in meeting its responsibilities under the law while effectively monitoring, processing and ensuring appropriate payment of LTC facility claims.
For more information about IHCP policies and procedures for LTC providers, including billing and reimbursement information, see the Long-Term Care provider reference module.
Myers and Stauffer performs retrospective, onsite service-provision and case-mix reviews of certified nursing facilities on behalf of the IHCP. Oversight is provided by the FSSA through the Division of Aging (DA) and the Office of Medicaid Policy and Planning (OMPP) to help providers achieve compliance in documentation and billing, as well as help ensure the health and safety of IHCP members.
The FSSA contracts with Myers and Stauffer to complete periodic Minimum Data Set (MDS) reviews for all residents of Medicaid-certified nursing facilities in Indiana, regardless of payer source. Every Medicaid-certified nursing facility in Indiana is reviewed a minimum of once every three years. (Year is defined as the state fiscal year – July 1 through June 30.)
The OMPP reserves the right to perform additional case-mix reviews as deemed necessary at any time.
The IHCP Recovery Audit Contractor (RAC) performs comprehensive reviews of financial activity for each Medicaid-enrolled resident in IHCP extended care facilities, including nursing facilities and ICF/IIDs. For more information about RAC audits, see the Medicaid Recovery Audit Contractor (RAC) Overview page on this site.
Other resources for providers with questions about long-term care follow.
Myers and Stauffer Help Desk
For questions related to the Medicaid case-mix reviews and supportive documentation requirements, call:
Indiana Help Desk
For questions related to record sequencing, error messages, assessment corrections, Resident Roster Reports and Medicaid Resource Utilization Group (RUG-IV) calculations associated with all OMPP reports, call 317-816-4122.
Gainwell Technologies Long-Term Care Help Desk
For questions related to correcting erroneous autoclosures, call the Long-Term Care Help Desk at 317-488-5094, or email at firstname.lastname@example.org.
Indiana Department of Health
MDS/RAI Clinical Help Desk
For questions related to the clinical definition, intent, completion or interpretation of the MDS and Resident Assessment Instrument (RAI), email Christina Samuels email@example.com.
MDS/OASIS Technical Help Desk
For questions related to all Centers for Medicare & Medicaid Services (CMS) reports, including error messages, the Initial Feedback Report and Final Validation Report, user IDs and passwords for the CMS, and difficulties with transmission to the CMS, contact the MDS/OASIS Technical Help Desk at 317-233-7206 or via email at firstname.lastname@example.org.