HCBS Provider Frequently Asked Questions
HCBS Provider Frequently Asked Questions
The purpose for this FAQ is to inform HCBS providers with relevant information related to the Indiana PathWays for Aging program. This information is accurate as of October 2023, and FSSA will provide updated FAQs in the future as needed.
Eligibility, Enrollment, and Plan Selection
- Who is eligible for the Indiana PathWays for Aging program?
Individuals who are 60 and over who are aged, blind and disabled and Qualify for traditional Medicaid services,
or Receive services through Hoosier Care Connect,
or Qualify for both Medicare and Medicaid,
or Receive services on the Aged and Disabled Waiver
or Receive services in a nursing facility - When does PathWays for Aging start?
Health coverage in PathWays starts July 1, 2024.
- When will individuals be notified about the transition to Indiana PathWays for Aging?
Individuals identified in the population groups listed above will be notified of the transition to PathWays for Aging in February and March 2024. Please remind individuals to update their address (if it has changed since their Medicaid enrollment) with the Division of Family Resources. Benefits Portal (in.gov)
- When will the MCEs begin reaching out to clients?
The MCEs are not allowed to contact waiver clients and future enrollees. FSSA will be sending information to current waiver clients to help them through the MCE selection process.
Once individuals select an MCE, the MCE will reach out to each individual and provide a “welcome packet” around June 2024. All materials sent to individuals by MCEs have been reviewed and approved by FSSA.
- How will plan information be available to future PathWays for Aging members?
Each person eligible to enroll in PathWays will receive a notice in the mail in February and March 2024. The notices will include information about the PathWays for Aging program and how to select an MCE. Individuals will also be able to call the enrollment broker to discuss their plan options at 87-PATHWAY-4 (1-877-284-9294).
- Where can I, as a provider, go to educate myself about each PathWays MCE?
We encourage anyone who missed the roundtables in the spring to obtain the information that was handed out via this link: http://www.advancingstates.org/mcehcbs-provider-roundtable-events. There is also general information about the program at in.gov/pathways.
- How will FSSA be involved in outreach to individuals? Will MCEs be allowed to directly outreach to individuals?
FSSA will be doing extensive stakeholder outreach to all individuals who will transition to PathWays to support them in selecting an MCE. This outreach will include many methods such as TV commercials, radio ads, mailed notices, townhalls, phone calls, etc. The MCEs will only perform direct outreach to individuals who have selected that specific MCE as their plan.
- What if a client doesn't choose a plan? How long do they have to choose? How will clients be assisted to choose an MCE?
Members will be auto enrolled in a plan if they don't self-select an MCE by April 2024. The Enrollment Broker (Maximus) will assist members in selecting their MCE. The Enrollment Broker is independent and not affiliated with any MCE.
- What role do providers have in members selecting a health plan (MCE)?
Providers should direct their clients to the Enrollment Broker (Maximus) to support them in choosing a health plan. Individuals will be able to call Maximus at 87-PATHWAY-4 (1-877-284-9294) for support beginning in November 2023. Providers should remain impartial and not attempt to influence MCE selection.
- Will individuals be able to change their MCEs?
Yes. Individuals will have the chance to change their MCE: within ninety (90) days of starting coverage; at any time their Medicare and Medicaid plans become unaligned (e.g. member disenrolls from one MA plan to another during quarterly Special Enrollment Period (SEP); once per calendar year for any reason; at any time using the just process; and Additionally, during a plan selection period which will be aligned with the Medicare open enrollment window (mid-October to mid-December) to be effective the following calendar year.
- Will the MCEs offer different benefits to their members? How will individuals know which MCE to choose?
Each MCE will offer value-added benefits. These are benefits that the MCEs pay for out of their pocket; the state does not pay them to provide. The value-added benefits may include things like meal delivery services (Hello Fresh) and over-the-counter (OTC) pharmacy allowance. FSSA is creating a side-by-side comparison chart that each eligible person will receive with their notice to select an MCE.
- If a person has a current dedicated case manager, will they sign-up for PathWays through them?
No, members will select a plan with the help of the Enrollment Broker (Maximus). Individuals will be able to call Maximus at 87-PATHWAY-4 (1-877-284-9294) for support beginning in November 2023.
- How will enrollment work for clients not currently in a waiver, but may be eligible for waiver services?
Individuals will receive an eligibility assessment by an Area Agency on Aging (AAA) until July 2025. If the individual qualifies, the AAA will provide a warm handoff to the Enrollment Broker (Maximus) for MCE selection. Beginning in July 2025, the Level of Care Assessment Representative (LCAR) with Maximus will complete the front-end level of care assessments for the Aging & Disability waiver and PASRR function. If the individual qualifies for PathWays, the enrollment broker will assist the member in selecting an MCE.
- Can individuals have Medicare and Medicaid at the same time? What is a Dual Eligible Special Needs Plan (D-SNP)?
Yes. A person can be eligible for both Medicaid and Medicare and receive benefits from both programs at the same time. A Dual Eligible Special Needs Plan is a type of health insurance plan. It’s for people who have both Medicaid and Medicare. If that’s you, you’re “dual-eligible.”
- Where can members on dual eligible special needs plans (D-SNPs) get more information?
To get information on D-SNPs, contact the State Health Insurance Assistance Program (SHIP) at (800) 452-4800 to speak to a counselor. SHIP is a free counseling program for people with Medicare. You can get one-on-one assistance in person, on the phone, or virtual.
- Once an individual turns 60 years, will they automatically switch over to the PathWays program, or is this just an option available alongside the waiver?
If an individual receives Medicaid or both Medicaid and Medicare, they should expect to receive a letter from the Enrollment Broker (Maximus) 90 days before their 60th birthday. This letter will inform them that they are eligible for the PathWays. If the individual receives services through the Aged and Disabled Waiver, they will transition to PathWays when they turn 60 years of age. Individuals who are in a federally recognized tribe as well as those receiving hospice services have the choice to opt-into PathWays.
- Will members under 60 years of age continue with their current providers and Service Coordinators?
Members under 60 will not be enrolled in the PathWays program and can remain with their current providers.
Service Plans/Processes
- Will MCEs require Electronic Visit Verification (EVV)?
EVV is not going to change, you will continue to use the process the State has now.
- Will providers receive access to the care plans for their clients? Will providers have to sign off on the care plan?
Yes, providers will have access to care plans with services they are authorized to provide.
- Will clients continue to use the same Indiana Medicaid ID number with your company?
Yes. The same Indiana Medicaid ID will be used.
- Does FSSA anticipate a cut in attendant care hours?
There are no decreases to a member’s authorized services for the first 90 days of the PathWays program. Members can request to change their authorized hours and services.
- What is going to happen with the Integrated Health Care Coordination (IHCC) service for waiver recipients in assisted living facilities?
IHCC is not going away and MCEs have to contract with at least one IHCC provider. Providers delivering IHCC services have an opportunity to share data about how this service supports individuals in reducing the number of medication errors, missed doctor’s appointments and hospitalizations.
- How will MCEs notify providers that a client called with an issue?
Each MCE will have their own methods of communication with providers enrolled in their network.
- Will there by copayments for members?
There will be no copayments for members in the Indiana PathWays for Aging program. However, members may have copayments as part of their Medicare plan.
- Can family members serve as paid caregivers?
Yes, family members can be paid providers in the Structured Family Caregiving (SFC) program. There are also self-direction options or they could become an employee of a provider agency to provide care if they are not a legally responsible individual.
- Will there be spend downs?
Medicaid eligibility requirements remain the same.
- Will the quarterly visit change for the Structured Family Caregiving (SFC) provider since Service Coordinators will also be visiting quarterly?
Structured Family Caregiving will not change; the Service Coordinators will complete quarterly visits.
- What type of workforce development support will MCEs offer? How can providers be involved?
Each MCE is required to submit a workforce development plan and will hire a workforce development administrator. Contact the MCE to learn about how to support in their workforce efforts.
- Will new home assessments/Authorization be completed at the start of this new plan?
There will be no decreases to authorized service plans for 6 months. However, new assessments/authorizations will be completed during that time.
- How will providers receive notice if a member is deceased, moved to nursing care, or in the hospital?
Each MCE will have their own methods of communication with providers enrolled in their network.
Claims/Contracts/Authorizations
- What is the contact information for each PathWays MCE?
Anthem: Email: INMLTSSProviderRelations@anthem.com; Phone: 833-310-3775
Humana: Email: LTSSContracting@humana.com; Phone: 866-274-5888
UnitedHealthcare: Email: in_providerservices@uhc.com - How do providers build relationships with the three MCEs to share what services they provide?
- What if a provider doesn’t contract with an MCE within 3 years of PathWays live?
While each MCE must contract with any willing provider for at least 3 years, providers have a choice with which MCEs they choose to partner. If providers are serving individuals on the Aged and Disabled Waiver or in nursing facilities, who are 60 years of age and older, those individuals will move to PathWays and be required to select an MCE. If the provider does not enroll with the MCE selected by the individual, the provider will not be reimbursed for rendering services after July 1, 2024. FSSA encourages all impacted providers to enroll with the three PathWays MCEs.
- How will FSSA ensure the process of billing and paying providers follows the PathWays scope of work?
FSSA will review each of the MCE’s processes and policies regarding processing claims as part of readiness review. FSSA also requires the MCEs to submit monthly reports regarding claims processing timeliness.
- How long does an appeal process take for billing denial?
The Contractor must have written Provider Claims Dispute Resolution policies and procedures for responding to claims disputes for both in-network and out-of-network providers, in accordance with the rules for the claims dispute resolution process for non-contracted providers outlined in Indiana law, 405 IAC 1-1.6. Informal claim disputes must be resolved by the MCE within 30 days. In the event the matter is not resolved to the provider's satisfaction within thirty (30) days after the provider commenced the informal process, the provider shall have sixty (60) days after the end of the thirty (30) day period to submit a formal appeal notice to the MCE.
- Will any/all of these MCEs be able to receive billing claims through Electronic Data Interchange (EDI)?
Yes, MCEs will be able to receive claims through EDI. An EDI is the electronic interchange of business information using a standardized format; a process which allows a company to send information to another company electronically.
- Will there be a deadline for providers contracting with MCEs?
No. Providers can contract with MCEs any time after PathWays go-live.
- Will FSSA implement performance pay by outcomes (e.g. reduced hospitalization, or improved outcomes)?
The current contract includes Year One pay-for-outcomes measures for the MCEs. The State is in the process of developing additional Value-Based Payment (VBP) measures that will be implemented across all PathWays MCEs, which will take at least two years. This process requires provider feedback, public comment and approval by CMS. The State will share details for VBP once we are further along with planning.
- What provider training will be offered by the MCEs?
Each MCE will offer training; contact the MCE’s designated provider relations representative for training information.
- Will provider contracts be different than what they currently have with FSSA?
Yes, each MCE will have their own contracts.
- Will MCEs be required to contract with small providers as well?
Each MCE must contract with any willing provider for at least 3 years. For HCBS providers, they must be approved through the Indiana Health Coverage Programs (IHCP) and be certified by the Division of Aging prior to contracting with any MCE.
- Will all three health plans do trial periods with billing before go-live?
Yes, each MCE is required to participate in readiness review. Readiness review is a systematic large-scale review, where FSSA reviews the MCEs’ processes, polices, procedures, etc. As part of readiness review, each MCE must demonstrate to FSSA that they are able to process claims.
- When does FSSA anticipate allowing the MCEs to contact the providers? Do the MCEs have the providers contact info?
MCEs have the contact information for providers who attended the MCE/HCBS Provider roundtable events hosted by ADvancing States and are allowed to contact providers now. FSSA also encourages providers to do proactive outreach with the PathWays MCEs directly, if they are interested in becoming a provider in their network. Information from the roundtable events including MCE here: http://www.advancingstates.org/mcehcbs-provider-roundtable-events
- Are all the MCEs statewide?
Yes. All three MCEs are required to operate statewide.
- How will rates for Medicaid, and specifically Structured Family Care be determined?
The State determines the Medicaid rate and rate structures for Structured Family Caregiving (SFC). Each MCE is required to pay at least the established Medicaid rate.
- Will providers have to work with service coordinators from AAAs and MCEs? Or do providers work with just the service coordinators they’re used to working with today?
MCEs can employ service coordinators directly and/or contract with AAAs and ICMs to provide service coordination.
- How is FSSA working with each MCE to develop claims portal operations?
MCEs have their own portal, FSSA is working together with all three MCEs to develop unified operations. While portals may be different, MCEs are aligning as much as possible with operations.
- What is a benefit of contracting with all three MCEs?
You can ensure the ability to continue serving your current waiver clients regardless of which MCE they are enrolled.
- Will the state and health plans have different reimbursement rates?
The state determines the Medicaid rate and rate structures for all waiver services. Each MCE is required to pay at least the established Medicaid rate.
- Right now, a client gets two bids for a home modification and then chooses a provider. How will home modifications work if it goes through an MCE?
The MCE will be authorizing all waiver services, and the MCEs are required to follow the regulations outlined in each waiver service. The PathWays Waiver carries over services from the Aged and Disabled Waiver. The bid requirement for home modifications does not change.
- Will pest control providers have to contract with each MCE?
Providers will have to contract with each MCE separately. It is recommended that providers contract with all three MCEs to assure that they can continue to serve existing clients.
Other Services/Service Change Questions
- Who will providers bill (claims) for under age 60 Medicaid clients?
Providers will continue to bill through the IHCP portal as you do today.
- Will SSBG/Choice processes stay the same?
Current processes for SSBG/CHOICES will remain the same.
- How will MCEs address network adequacy? Will MCEs help support transportation in rural areas?
Each MCE is responsible for meeting network adequacy requirements and have their own transportation providers. FSSA requires MCEs to frequently and consistently monitor provider networks to proactively identify any network deficiencies, filling gaps and reporting on those metrics. MCEs are required to review of analytics reports to determine any network gaps, conduct ongoing monitoring of network access, network composition (including cultural and linguistic competency), provider compliance with access standards through surveys and member complaints, monitoring of single-case agreements (SCAs) to identify barriers with current providers and identification of new providers to include in the network. FSSA requires MCEs to have key staff positions for network development, dedicated Provider Relations team, and contracting experts across provider types who work in tandem with cross-functional leaders to assure the MCEs network strategy aligns with the comprehensive and complex needs of members.
AAA and Case Manager Questions
- Can the member keep their current AAA service coordinator?
Yes, if the member chooses an MCE that the service coordinator is contracted through.
- What will the role of the Area Agencies on Aging (AAAs) be in the enrollment process?
Until July, 2025, enrollment processes will remain the same where individuals receive an eligibility assessment from their AAA. If the individual qualifies, the AAA will provide a warm handoff to the Enrollment Broker (Maximus) for MCE selection. Beginning in July 2025, the Level of Care Assessment Representative (LCAR) with Maximus will complete the front-end level of care assessments for the Aging & Disability waiver and PASRR function. If the individual qualifies for PathWays, the enrollment broker will assist the member in selecting a MCE.
- How will the AAAs fit into the new MCE model? Will the MCEs utilize a pick list similar to how CICOA currently does?
AAAs can decide to contract with the MCE to provide service coordination services as subcontractors. It is also possible the MCE may employ independent service coordinators not affiliated with an AAA. MCEs are not required or recommended to utilize a pick list, as members in the PathWays program are encouraged to have choice in choosing their providers along with education about provider selection to ensure there is a good match between member and provider.