part 3

[Virtual Presenter] We have reimbursement policies that align with the Indiana Administrative Code (I-A-C--) regulations and waiver documentation standards established by the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) and the D-D-R-S-. Our units of service billed to the I-H-C-P must comply with the appropriate rules and standards, and services must meet the definitions and parameters published in the rules and standards. Claims for services delivered through the fee-for-service system must be submitted within 180 days of the date of service (D-O-S--), and claim voids and replacements must be handled electronically or by mail. Adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. We do not bill private insurance carriers through third-party liability (T-P-L--) or reclamation processes for claims that contain any H-C-B-S benefit modifier codes. Individuals served by the F-S-W or C-I-H Waiver may receive H-C-B-S from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital, as long as the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services..

[Audio] We are pleased to provide this information regarding the requirements for reimbursement for services rendered to the Indiana Health Care Program (I-H-C-P-). To be considered for reimbursement, the units of service billed to the I-H-C-P must be supported by documentation that adheres to the appropriate Indiana Administrative Code (I-A-C--) regulations and the waiver documentation standards issued by the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) and the D-D-R-S-. Services billed to the I-H-C-P must comply with the service definitions and parameters as published in the rules and standards. Claims for services rendered through the fee-for-service delivery system must be filed within 180 days of the date of service (D-O-S--). Claim voids and replacements must be handled electronically or by mail, and adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. The Indiana Health Care Program (I-H-C-P-) will not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any Health Care Benefit Modifier (H-C-B-M-) codes. Individuals served by the F-S-W or C-I-H Waiver may receive Home and Community-Based Services (H-C-B-S-) from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital, as long as the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services. The waiver service is being provided to ensure a smooth transition between the acute care setting and home and community-based setting and to preserve the individual’s functional abilities. The waiver service cannot be duplicative of what is being provided in the acute care setting. For those waiver services requiring electronic visit verification (E-V-V--), E-V-V must still be used. The H-C-B-S provided by the direct support professional or other support staff may not be used as a substitute for services that the hospital is obligated to provide through its conditions, requirements and expectations under any participation, licensing and/or professional partnership agreements, as well as local, state and/or federal laws. Case managers are required to document in the case notes when an individual receives acute medical care. The case manager must ensure the waiver service is identified in the P-C-I-S-P and all the following must be included in the case note: Which waiver services will be provided during the acute hospital stay, Description of how the waiver services will assist in returning to the community and preserve the individual’s functional abilities, Coordination and communication activities among individualized support team members, Anticipated length of acute hospital stay, Anticipated frequency and duration of the waiver services. Case managers may not interrupt or terminate an individual’s waiver due to an acute hospital admission or stay. Case managers must update the individual’s plan within waiver rules and service limitations as needed to accommodate for acute hospital stays. Parents and legal guardians of adults who are employed as the individual’s direct support professional may continue to provide the waiver service while the individual is receiving care and treatment in the acute care hospital setting, up to and including the current approved number of hours that exists with the current service plan at the time of hospitalization. Individuals receiving services on the C-I-H Waiver who may need additional supports while receiving care in an acute care hospital setting may submit a Short-Term Budget Request (S-T-B-R-) that documents the need for increased supports, the anticipated length of temporary supports needed, and the availability of staff to provide the support. All F-S-W and C-I-H Waiver.

[Audio] At this point in the presentation, we will be discussing important information for providers who are seeking reimbursement for services provided through the I-H-C-P-. This information is outlined in section 2 of the DDRS HCBS Waivers. It is important to note that claims for services rendered through the fee-for-service delivery system must be filed within 180 days of the date of service (D-O-S--). In the event of claim voids or replacements, they must be handled electronically or by mail. Any adjustments requested by mail must be submitted using the appropriate form, such as the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. It is also important to mention that the I-H-C-P will not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any H-C-B-S benefit modifier codes. This means that individuals who are served by the F-S-W or C-I-H Waiver cannot receive reimbursement through the T-P-L or reclamation processes for services that are covered under the H-C-B-S benefit modifier codes. In addition, individuals served by the F-S-W or C-I-H Waiver may receive H-C-B-S from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital. This is as long as the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services. Moving on to our example scenarios, let's look at how the A-L-F provider should bill for services in certain situations. In our first example, Mary was discharged from the facility on February 13, 2020 and went to the hospital, with plans to return to the A-L-F--. She stayed in the hospital for four days and then was discharged to a S-N-F for seven days. She eventually returned to the A-L-F on February 24, 2020. In this case, the A-L-F provider would need to void the original claim and only rebill for the dates of service (D-O-S--) that Mary was actually in the facility. For our second example, the A-L-F provider normally bills monthly. However, during the month, Mary was discharged to the hospital on February 13, 2020 and then went to a S-N-F for seven days before returning to the A-L-F on February 24, 2020. In this scenario, the A-L-F can still bill the monthly rate for the entire month because Mary was not completely out of the facility. It is important for providers to carefully review their billing practices and ensure they are following the appropriate guidelines. Thank you for your attention on important information for providers in the following slides..

[Audio] For providers seeking reimbursement from the Indiana Health Coverage Programs (I-H-C-P-), it is critical to comply with the appropriate Indiana Administrative Code regulations and the waiver documentation standards issued by the F-S-S-A Office of Medicaid Policy and Planning and the D-D-R-S-. This ensures that the services billed to the I-H-C-P meet the criteria and definitions established in the rules and standards. Claims for services rendered through the fee-for-service delivery system must be filed within 180 days of the date of service. Any voids or replacements must be handled electronically or by mail, and any adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. It is essential to note that private insurance carriers will not be billed through the third-party liability or reclamation processes for claims containing any H-C-B-S benefit modifier codes. This includes individuals who are receiving H-C-B-S through the F-S-W or C-I-H Waiver while also receiving medical care and treatment in an acute care hospital. However, waiver services may be provided by direct support professionals or other support staff as long as they are accurately documented in the person-centered individualized support plan and meet the individual's needs that are not met through hospital services. Moving on to Section 2: Provider Information, the DDRS HCBS Waivers must identify providers that appear to be outliers warranting review. The Subject Matter Expert (S-M-E--) may also conduct desk or onsite audits and directly participate in reviewing waiver providers and programs. Throughout this entire program integrity process, the F-S-S-A maintains oversight. While the fads contractor may be involved in the audit process, no audit is performed without the authorization of the F-S-S-A-. Additionally, the FSSA's oversight of the contractor's aggregate data is used to identify common problems and determine benchmarks. This data may also be shared with peer providers for educational purposes, when deemed appropriate. Thank you for considering these important guidelines for reimbursement through the I-H-C-P-. Let us continue working together to ensure that all services provided meet the highest standards of care..

[Audio] Good afternoon, everyone. In this presentation, I will discuss the requirements for reimbursement for services billed to the Indiana Health Coverage Programs (I-H-C-P-). In order to be considered for reimbursement, the units of service billed to the I-H-C-P must be substantiated by documentation that adheres to the appropriate regulations and standards. Services billed to the I-H-C-P must meet the service definitions and parameters as published in the rules and standards. Claims for services rendered through the fee-for-service delivery system must be filed within 180 days of the date of service (D-O-S--). Claim voids and replacements must be handled electronically or by mail, and adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. The I-H-C-P will not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any H-C-B-S benefit modifier codes. Individuals served by the F-S-W or C-I-H Waiver may receive H-C-B-S from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital, as long as the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services..

[Audio] We are currently discussing the four H-C-B-S waiver programs that the Division of Disability and Rehabilitative Services (D-D-R-S-) oversees. These programs are designed to provide support for individuals with disabilities and their families. Our goal is to ensure that these waivers are cost-neutral and effectively coordinated with other I-H-C-P services. Thank you for listening..

[Audio] We are discussing the DDRS HCBS Waivers, which are designed to provide services to individuals with intellectual/developmental disability (I-D-D--) who are not able to receive services in an institutional setting. To be eligible for waiver services, an individual must meet the state criteria for an I-D-D and be found to have an intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care determination. This means that the individual must have a severe, chronic disability that is likely to continue indefinitely and results in substantial functional limitations in at least three of the following areas of major life activities: self-care, understanding and use of language, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency. The DDRS HCBS Waivers also have a cost neutrality requirement, which means that Indiana must demonstrate that the average per capita expenditure for individuals participating in the waiver program is equal to or less than the average per capita expenditures of institutionalization for the same population. Additionally, the C-M-S requires that an H-C-B-S waiver member exhaust all services on the Indiana Medicaid State Plan before utilizing H-C-B-S waiver services. H-C-B-S waiver programs are considered funding of last resort and have a closed funding stream. To be considered for reimbursement for services billed to the I-H-C-P-, it is important to ensure that the documentation adheres to the appropriate regulations and standards. Claims for services rendered through the fee-for-service delivery system must be filed within 180 days of the date of service (D-O-S--). Claim voids and replacements must be handled electronically or by mail, and adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. The I-H-C-P will not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any H-C-B-S benefit modifier codes. Individuals served by the F-S-W or C-I-H Waiver may receive H-C-B-S from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital, as long as the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services..

[Audio] We are pleased to present to you on the Indiana Health Care Partnership (I-H-C-P-) reimbursement process. To obtain reimbursement, the units of service billed to the I-H-C-P must be supported by documentation that conforms to the relevant Indiana Administrative Code (I-A-C--) regulations and the waiver documentation standards issued by the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) and the D-D-R-S. Services billed to the I-H-C-P must comply with the published service definitions and parameters as outlined in the rules and standards. Claims for services delivered through the fee-for-service system must be submitted within 180 days of the date of service (D-O-S--). Electronic or mail-in claim voids and replacements must be handled accordingly, and adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. It is important to note that the I-H-C-P does not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any H-C-B-S benefit modifier codes. Individuals served by the F-S-W or C-I-H Waiver may receive H-C-B-S from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital, provided that the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services. Individuals served under the Community Integration and Habilitation (C-I-H--) Waiver program may receive.

[Audio] We are pleased to present this information regarding the requirements for reimbursement for units of service billed to the Indiana Health Care Program (I-H-C-P-). To be considered for reimbursement, the units of service must adhere to the appropriate Indiana Administrative Code (I-A-C--) regulations and the waiver documentation standards issued by the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) and the D-D-R-S-. Services billed to the I-H-C-P must meet the service definitions and parameters as published in the rules and standards. Claims for services rendered through the fee-for-service delivery system must be filed within 180 days of the date of service (D-O-S--). Claim voids and replacements must be handled electronically or by mail, and adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. The I-H-C-P will not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any H-C-B-S benefit modifier codes. Individuals served by the Family and Supports Waiver (F-S-W--) or the Community Integrated Healthcare (C-I-H--) Waiver may receive H-C-B-S from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital, as long as the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services. For more information regarding the services that can be covered through the Family and Supports Waiver (F-S-W--), please refer to Section 4: Disabilities Services Waivers. The F-S-W program provides Medicaid H-C-B-S to individuals residing in a range of community settings as an alternative to care in an ICF/IID. The F-S-W serves persons with intellectual/developmental disabilities or autism, who have substantial functional limitations, as defined in Code of Federal Regulations 42 CFR 435.1010. Individuals may choose to live in their own home, family home or community setting appropriate to their needs. Individuals develop a P-C-I-S-P using a person-centered planning process guided by an Individualized Support Team (I-S-T--). The I-S-T consists of the individual, the individual’s case manager and anyone else of the individual’s choosing, but typically family and friends. The individual, with the I-S-T--, selects services, identifies service providers of the individual’s choice and develops a plan of care/service plan. Please note that the plan of care (P-O-C--)/service plan is subject to an annual waiver services cost cap of $26482. For more information regarding the Family Supports Waiver (F-S-W--) program, please refer to Section 4.6: Family Supports Waiver (F-S-W--). The purpose of the F-S-W program is to provide Medicaid H-C-B-S to individuals residing in a range of community settings as an alternative to care in an ICF/IID. The F-S-W serves persons with intellectual/developmental disabilities or autism, who have substantial functional limitations, as defined in Code of Federal Regulations 42 CFR 435.1010. Individuals may choose to live in their own home, family home or community setting appropriate to their needs. Individuals develop a P-C-I-S-P using a person-centered planning process guided by an Individualized Support Team (I-S-T--). The I-S-T consists of the individual, the individual’s case manager and anyone else of the individual’s choosing, but typically family and friends. The individual, with the I-S-T--, selects services, identifies service providers of the individual’s choice and develops a plan of care/service plan..

[Audio] Welcome to the presentation. During this session, we will discuss the requirements for reimbursement under the Indiana Health Care Program (I-H-C-P-). To be considered for reimbursement, the units of service billed to I-H-C-P must be substantiated by documentation that adheres to the appropriate Indiana Administrative Code (I-A-C--) regulations and the waiver documentation standards issued by the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) and the D-D-R-S-. Services billed to I-H-C-P must meet the service definitions and parameters as published in the rules and standards. Claims for services rendered through the fee-for-service delivery system must be filed within 180 days of the date of service (D-O-S--). Claim voids and replacements must be handled electronically or by mail, and adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. The I-H-C-P will not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any H-C-B-S benefit modifier codes. We will now move on to the Disabilities Services Waivers (D-S-W--) program, which aims to provide access to meaningful and necessary home and community-based services and supports that respect the individual’s personal beliefs and customs, are cost-effective, facilitate the individual’s involvement in the community where they live and work, facilitate the individual’s development of social relationships in their home and work communities, and facilitate the individual’s independent living. The D-S-W program offers the following services: Adult Day Services, Behavioral Support Services, Career Exploration and Planning, Case Management (the only mandatory service), Day Habilitation, Extended Services, Facility-Based Support Services, Family and Caregiver Training, Home Modification Assessment, Home Modifications, Intensive Behavioral Intervention, Music Therapy, Occupational Therapy, Participant Assistance and Care, Personal Emergency Response System, Physical Therapy, Prevocational Services, Psychological Therapy, Recreational Therapy, Remote Supports, Respite, Specialized Medical Equipment and Supplies, and Speech/Language Therapy..

[Audio] We are here today to discuss the requirements for billing services to the Indiana Health Care Program (I-H-C-P-). In order to be considered for reimbursement, the units of service billed to the I-H-C-P must be substantiated by documentation that adheres to the appropriate Indiana Administrative Code (I-A-C--) regulations and the waiver documentation standards issued by the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) and the D-D-R-S-. Services billed to the I-H-C-P must meet the service definitions and parameters as published in the rules and standards. Claims for services rendered through the fee-for-service delivery system must be filed within 180 days of the date of service (D-O-S--). Claim voids and replacements must be handled electronically or by mail, and adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. The I-H-C-P will not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any H-C-B-S benefit modifier codes. We would now like to discuss the DDRS HCBS Waivers. Individuals served by the F-S-W or C-I-H Waiver may receive H-C-B-S from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital, as long as the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services. The D-D-R-S administers Indiana’s Money Follows the Person (M-F-P--) program to help individuals transition from qualifying facility settings to community settings with needed supports. An applicant must be living in a qualifying Medicaid institution or facility to be eligible for Indiana’s M-F-P program. To apply for Indiana’s M-F-P program, the applicant must be a resident of a qualifying institution/facility for at least 60 consecutive days or more, have needs that can be met safely through services available in the community, and meet the minimum requirements for a funding source that is currently partnering with Indiana’s M-F-P program. An Indiana M-F-P participant completes their transition and enters the participation phase of the program on the day they are discharged from the qualifying institution/facility and begin living in the community. Participation in Indiana’s M-F-P program lasts for 365 participation days. At the end of the 365 participation days in the M-F-P program, funding for the supports received by the participant will seamlessly change from M-F-P to the partnering funding source for which the participant is eligible and that they have chosen..

[Audio] We will discuss the requirements for reimbursement through the Indiana Health Care Program (I-H-C-P-) for services provided to individuals with disabilities. To be eligible for reimbursement, the services must be documented in accordance with the appropriate Indiana Administrative Code (I-A-C--) regulations and the waiver documentation standards issued by the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) and the D-D-R-S-. Services must also meet the service definitions and parameters as published in the rules and standards. Claims for services provided through the fee-for-service delivery system must be filed within 180 days of the date of service (D-O-S--). Claim voids and replacements must be handled electronically or by mail, and adjustments requested by mail must be submitted on the I-H-C-P Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request form. The I-H-C-P will not bill private insurance carriers through the third-party liability (T-P-L--) or reclamation processes for claims containing any H-C-B-S benefit modifier codes. Individuals served by the F-S-W or C-I-H Waiver may receive H-C-B-S from their direct support professional or other support staff while receiving medical care and treatment in an acute care hospital, provided that the waiver service is accurately documented in the person-centered individualized support plan (P-C-I-S-P) and the waiver service provided meets the needs of the individual that are not met through the provision of hospital services..