The Indiana Health Coverage Programs (IHCP) have introduced the “HIP Workforce Bridge,” a new program for Healthy Indiana Plan members who lose eligibility solely due to exceeding income limits. IHCP also will reinstitute the requirement for rendering providers to be linked to all group enrollments’ service locations to receive reimbursement. And the FSSA announced CMS approval of a carve-out for long-acting reversible contraceptive (LARC) devices for federally qualified health centers and rural health clinics.
HIP Workforce Bridge
HIP Workforce Bridge, announced in
BT202319, is a $1,000 account that can be used for up to 12 months. The account funds can serve as a standalone when in the waiting period for insurance or as a payment for copays, coinsurance, and deductibles for a primary policy. Participants may use their accounts to pay employer or individual insurance policy premiums.
The scope of services covered under this benefit plan includes all Medicaid state plan services except the following:
- Noncovered services, defined under Indiana Administrative Code 405 IAC 5-29-1
- Medicaid rehabilitation option (MRO) services
- Preadmission screening and resident review (PASRR)
- Medical review team (MRT)
- Hospice
- Services provided by chiropractors (provider type 15 and specialty 150)
- Nonemergency medical transportation (NEMT)
Initial opt-in offer letters will be sent to eligible individuals in April 2023, and the first accounts can be awarded effective May 1.
Temporary provider enrollment changes rescinded
Starting Oct. 1, IHCP will reinstitute the requirement that all rendering providers must be linked to all group enrollments’ service locations to receive reimbursement. Rendering providers that are not appropriately associated with a group enrollment after Oct. 1 will begin seeing claim denials with an explanation of benefits code 1010.
According to IHCP, in
BT202318, providers are “strongly encouraged to use this time to verify that all participating group enrollments accurately reflect all rendering providers associated with a practice. Group practices may add or remove rendering providers through the Provider Maintenance section of the IHCP Provider Healthcare Portal or as part of the revalidation process.”
Prescriptions written from rendering providers that are associated with no active group will be denied.
FSSA announces CMS approval for LARC device carve-out for FQHC and RHC
The Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) recently announced the approval from the Centers for Medicare and Medicaid Services (CMS) for the long-acting reversible contraceptive (LARC) device carve-out that was announced in
BT202309.
IHCP will separately reimburse federally qualified health centers (FQHCs) and rural health clinics (RHCs) for LARC devices from the prospective payment system (PPS) rate.
Changes are effective retroactively for dates of service (DOS) on or after Nov. 1, 2022. FQHC and RHC providers are asked to bill the Healthcare Common Procedure Coding System (HCPCS) codes listed in Table 1 with place of service (POS) code 71 and without the HCPCS code T1015 for DOS on or after Nov. 1, 2022.
Providers can bill for LARC devices and supplies on the same day as an encounter that has a T1015 – but it must be billed on a separate claim.
FQHCs and RHCs should not bill using the HCPCS code T1015 – Clinic, visit/encounter, all-inclusive. Providers can bill for LARC devices/supplies on the same day as an encounter that has a T1015, but it must be billed on a separate claim.
After approval has been received from the CMS, claims for LARC devices that included the T1015 code for dates of service on or after Nov. 1, 2022, will be reprocessed as a denied claim, and wrap payments will be recouped.
See the bulletin for further details.