HCBS Provider Frequently Asked Questions

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

Health coverage in PathWays starts July 1, 2024.

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)

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.”

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.

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.

Members under 60 will not be enrolled in the PathWays program and can remain with their current providers.

EVV is not going to change, you will continue to use the process the State has now.

Yes, providers will have access to care plans with services they are authorized to provide.

Yes. The same Indiana Medicaid ID will be used.

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.

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.

Each MCE will have their own methods of communication with providers enrolled in their network.

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.

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.

Medicaid eligibility requirements remain the same.

Structured Family Caregiving will not change; the Service Coordinators will complete quarterly visits.

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.

There will be no decreases to authorized service plans for 6 months. However, new assessments/authorizations will be completed during that time.

Each MCE will have their own methods of communication with providers enrolled in their network.

Anthem: Email: INMLTSSProviderRelations@anthem.com; Phone: 833-310-3775
Humana: Email: LTSSContracting@humana.com; Phone: 866-274-5888
UnitedHealthcare: Email: in_providerservices@uhc.com

Contact the provider relations representative at each MCE. The contact information can be found above.

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.

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.

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.

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.

No. Providers can contract with MCEs any time after PathWays go-live.

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.

Each MCE will offer training; contact the MCE’s designated provider relations representative for training information.

Yes, each MCE will have their own contracts.

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.

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.

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

Yes. All three MCEs are required to operate statewide.

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.

MCEs can employ service coordinators directly and/or contract with AAAs and ICMs to provide service coordination.

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.

You can ensure the ability to continue serving your current waiver clients regardless of which MCE they are enrolled.

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.

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.

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.

Providers will continue to bill through the IHCP portal as you do today.

Current processes for SSBG/CHOICES will remain the same.

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.

Yes, if the member chooses an MCE that the service coordinator is contracted through.

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.

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.