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Nursing Facility Frequently Asked Questions

General Program

  • How does Indiana PathWays for Aging Impact Long-stay Nursing Facility residents?

    If nursing facilities have residents who are 60 and over receiving Medicaid or Medicaid and Medicare (dually eligible), then these individuals will transition to Indiana PathWays for Aging. These identified individuals will enroll with one of Indiana’s three PathWays managed care entities, Anthem, Humana, or UnitedHealthcare (UHC).

  • When will individuals be notified about the transition to Indiana PathWays for Aging?

    In spring 2024, the enrollment broker (Maximus) will send notices through the mail to each eligible member currently served through Indiana Medicaid about the transition to PathWays. The notice will have contact information for the member including a phone number for questions to select a health plan as well as the PathWays website. Maximus will also call members and mail copies of the notices to authorized representatives. Additionally, FSSA will be conducting member engagement across Indiana during March 2024 to answer questions from members about notices as well as any other transition questions.

  • Can nursing facility providers assist residents select an MCE?

    If the nursing facility is the Authorized Representative on file for the member, the nursing facility can assist the member select an MCE. If the member has a designated health care representative or a court appointed power of attorney or guardian, MCE selection decisions are made by these individuals.

Health Plans

Care and Service Coordination

  • What is a Care Coordinator?

    A care coordinator is a person who may contact an individual to create a personalized care plan based on their preferences and needs. They can also help answer questions about the individual’s health care.

  • What is a Service Coordinator?

    A Service Coordinator is a person who will work with an individual to create a personalized Service Plan to help coordinate their Home and Community-Based Services (HCBS). The Service Plan will help develop a plan of care of services and supports that best meet the individual’s needs and goals.

  • In the PathWays Program, what is the reporting structure within each MCE for care and service coordinators?

    Each MCE, Anthem, Humana and UnitedHealthcare (UHC) will have their own staffing structure.  However, all MCEs are required to employ a full-time Care Coordination Manager and a Service Coordination Administrator to oversee staffing of care and service coordination dedicated to the PathWays program.

    MCE compliance will be assessed through FSSA review of staff trainings and regulatory reporting.

  • What is the role of care and service coordinators when a member wants to transition out of nursing facility?

    FSSA’s expectations of care and service coordinators is to ensure any outside clinical care and social services a member needs in a nursing facility are coordinated for the member. If a member wishes and is able to transition to a home and community-based setting, the care and service coordinator are responsible for leading the integrated care team to support a successful discharge, which means ensuring that the person has in-home supports when returning home. Additionally, the care and service coordinator are required to support an individual transitioning into a nursing facility (long-term or short-term stay). Care and service coordinators are not permitted to be incentivized or rewarded for transitioning members out of nursing facilities, and MCEs are not allowed to establish a minimum number of members that must be transitioned back to the community. Care and service coordinators will only explore community-based options for members who have the ability and/or desire to transition from a nursing facility to the community, and the decision is based on the individual’s needs and preferences.

  • How will MCEs communicate with nursing facility staff to schedule visits with residents?

    Nursing facilities should provide the MCEs their facility’s preferred contacts for care coordinators and service coordinators.  OMPP expects the MCEs to honor nursing facilities requests regarding contacting and develop staff polices for outreaching facilities.

  • How will MCEs coordinate virtual visits with residents?

    For all MCEs in the PathWays program, care coordinators and service coordinators are required to complete in-person visits with the resident. The care coordinator and service coordinator will visit in-person annually. The service coordinator will visit with the member in-person to assist with coordinating any outside supports needed by the resident as well as nursing facility.

    Any virtual calls should be the request of the resident and it is expected that the MCE will work with the nursing facility to coordinate the virtual visit.

  • Do the service and care coordinator positions require nursing facility work experience?

    Care coordinators are not performing hands-on clinical care nor are they making clinical decisions for members. They are coordinating medical activities to support the member while service coordinators coordinate HCBS services.

    While there is not language directly requiring nursing facility experience, care and service coordinators either have a clinical background in health care coordinating clinical type services for individuals, or an individual who has previous experience working in a field with older adults coordinating long-term services and supports.

  • Are care and service coordinators replacing the central intake process within nursing facilities?

    No. The service and care coordinators will act as a liaison and connector between the individual, provider(s), and the MCE. These positions work for the MCE and should not be doing any activities that are part of the SNF's requirements when providing services to their patients.

PathWays Member Eligibility and MCE Selection