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Date ArticleType
5/1/2017 Payment/Reimbursement
Switching Medicaid Managed Care to Traditional Medicaid and Level of Care Processing

Over the past 9 months facilities across the state have encountered a fair bit of frustration when dealing with residents being switched from Traditional Medicaid benefits to a Medicaid Managed Care program, HIP 2.0 or Hoosier Care Connect primarily.  The frustration has been in understanding why the switch is occurring in the first place, but also in how to get the resident switched back to Traditional Medicaid.   The typical pattern usually ends in the facility being told three different things as to which office or entity is responsible.  Going forward and until a permanent fix can be implemented, using the PASRR@fssa.IN.gov email address to ensure the PASRR and LOC processes have been finalized before the managed care switch can occur.

To help solve part of the mystery, IHCA has continually engaged the Indiana Division of Aging and more recently the Division of Family Resources (DFR) on what their internal roadmap is for solving these issues.  The DFR provided IHCA this internal memo that discusses the internal roadmap between the DFR and Division of Aging for these switches.  Much of the process relies on using the PASRR@fssa.IN.gov email address to communicate with the Division of Aging regarding PASRR and LOC screenings.  Emails should use the subject line Managed Care Switch and include specific information as noted in the memo.  Once LOC is finalized in the Division of Aging’s system, they are able to directly communicate with the managed care team if the resident is not removed from managed care and placed in traditional Medicaid.

Unfortunately, the PASRR and LOC system is still slow due to significant volume that continues to occur and is complicated by the new Core MMIS system.  The Division of Aging and Indiana Medicaid are working on the issues, but it will still be some time before significant relief is seen.  According to the Division of Aging, since Core MMIS launch they are seeing spikes of 1000 to 1500 entries at the beginning of each month.  Backlogs are occurring.  While more personnel are being assigned, the volume is hard to clear.  Short terms solutions include additional staffing, with medium to long term solutions including IT fixes that will eliminate duplicate entries being created between Ascend and Core MMIS.  The ultimate long term solution is an automated process between Ascend and Core MMIS. This automation is expected in the next several months.

Please continue to communicate issues you are experiencing with Indiana Medicaid eligibility and claims processes and IHCA will continue to advocate for you and get solutions.