Wednesday, September 2, 2015

NEW Waiver Journey Guide: Selecting Providers and Services

Follow along our step-by-step guide written by two of our Health Information Specialists as they applied for and received the Family Support Waiver for their children!

Family Support Waiver Journey - Part 2
Completing Your Journey - After you've been targeted.
NEW
Family Support Waiver Journey - Continues  Selecting Providers and Services

Hoosier Works Electronic Benefits Transfer (EBT) Outage

There will be a temporary outage of the Hoosier Works Electronic Benefits Transfer (EBT) system on Saturday, September 26 beginning at 11:00 p.m. [EDT], as the Indiana Family and Social Services Administration (FSSA) moves its business from JPMorgan Chase to Xerox. Hoosier Works is the system Indiana uses to deliver Supplemental Nutritional Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) benefits. This outage affects all SNAP/TANF EBT cardholders. EBT card benefits are expected to be available againSunday, September 27 by 12:30 p.m. [EDT] after the system transition is complete.

During the temporary system outage, EBT cardholders will not be able to make SNAP purchases or access TANF benefits at any grocery stores or ATMs. EBT cardholders should plan to do their grocery shopping and/or make cash withdrawals before or after the transition period.

The state’s current provider, JPMorgan Chase, has decided to get out of the business of providing EBT card services, necessitating the move to a new provider (Xerox). Making the change from the old provider to the new provider requires a temporary system outage.

The system transition will not change EBT card benefits or PIN numbers, and SNAP/TANF clients will continue to use their current EBT cards after the transition. The customer service website will change to www.ebt.acs-inc.com. However, the toll free EBT customer service number [1-877-768-5098] will remain the same.

More information is available at FSSA’s website.

Tuesday, September 1, 2015

Public Hearing about #ABA and #Medicaid

Your chance to comment on why you believe it’s important for ABA (applied behavioral
analysis) therapy to be a covered service under Medicaid will be at a public hearing on Thursday, Sept. 10.

Indiana FSSA is holding the hearing to discuss changes to coverage requirements for occupational, physical, respiratory and speech therapy services for children and youth under 21 and to add ABA to covered services, among other topics.

The meeting will be held at 1 p.m. Sept 10 at the Indiana Government Center South, 402 W. Washington St., Conference Center Room 14, Indianapolis.

The proposed rule sets the following requirements for ABA therapy:

1. The child is eligible for Indiana Medicaid.

2. The child is at least three years old and no more than 20 years old.

3. The child has been diagnosed with autism spectrum disorder by a qualified provider.

4. The child has had a complete diagnostic evaluation using standardized testing.

5. The child’s qualified provider recommends and refers the child for ABA therapy, including projected length of treatment.

Treatment plans are authorized for three months at a time, and the total treatment can last no more than three years. The rule also states qualifications for providers of ABA therapy. Other details of the plan can be found in the proposed rule, available in full at http://www.in.gov/fssa/4543.htm.

If you can’t attend the hearing, you can still provide written comments by sending a note to
Kim Crawford, 402 W. Washington St., Room W451, Indianapolis, IN 46204.
If you send written comment, put "COMMENT RE: LSA Document #14-337, Nursing Therapies and ABA Rule" on the envelope and the top of your note.

Saturday, August 29, 2015

CIH Waiver Transformation Public Hearings

Public Comment and Feedback

Changes to the CIH waiver will help build a sustainable system of supports and services for people with intellectual and developmental disabilities and their families. Below is a schedule of meetings across the state for providers, families, advocates and people with intellectual and developmental disabilities. The purpose of these events is to gather input on what is working well and thoughts on what residential supports and services people want to help them in achieving their desired outcomes and goals. 

*Hosting location time for providers is 3:00-5:00 and for families it is 6:00-8:00.


Wednesday, August 26, 2015

Why Health Care Costs May Rise Again: What Families Need to Know

Although increases in health care premiums have slowed in recent years (see our recent blog), they may increase more rapidly in the coming years.  In addition, out-of-pocket costs may be on the rise.  This blog examines why this could happen and what families can do to protect themselves against higher premiums and out-of-pocket costs.  

Why Could this Happen?
There are several reasons that health insurance premiums could increase.   For one, there has been an increase in the use of health care services due to improvements in the economy and more people having insurance coverage due to the Affordable Care Act (ACA).  When insurers must pay for increased use of services, those costs are often passed on to the consumer as premium increases.  Also, insurers offering plans in the ACA exchanges may have set artificially low premiums initially to attract customers, knowing that consumers tend to stick with their insurance plans.  Raising premiums is a way that insurers can offset initial low premiums. Other reasons include rising drug prices and the phase-out of ACA protections for insurers, costs which insurers will pass on to consumers to some extent.  In addition, when employers face increased benefits costs, these will often be offset by making employees pay a greater share of premiums than they used to.

According to a recent Kaiser Family Foundation analysis of preliminary 2016 premiums in 10 cities, costs for the lowest and second-lowest cost silver plans – where the bulk of enrollees tend to migrate – are changing relatively modestly in 2016, although increases are generally bigger than in 2015.  BUT, the plans which had the lowest cost last year may not be the same plans that have the lowest cost this year.  In other words, to stay in the most affordable plans, a consumer may have to switch plans or insurance companies in most of those cities. 

Generally, there is a trade-off between premiums and out-of-pocket costs.  To save money on insurance premiums, employers may choose plans with higher out-of-pocket costs for employees.  In the exchanges, plans with lower premiums are likely to have higher out-of-pockets costs.  

What Can Families Do?
To save on premiums -- 
> Shop around – don’t “stick” with a company just because it is familiar.  
> Make sure your family’s providers are still in your plan’s network.
> Find out if any family members are eligible for Medicaid or CHIP; remember that enrollment for Medicaid/CHIP is year-round.
> If you are buying insurance through an exchange, make sure you are receiving any premium tax credits to which you are entitled.
> Remember that the cheapest plans have the highest out-of-pocket costs for families, so that may not be the best deal. See http://blogs.wsj.com/washwire/2015/05/21/the-value-trade-off-in-high-deductible-health-plans/.  Although there are “catastrophic” plans for people under age 30, these only provide “bare bones” coverage. 

To save on out-of-pocket costs –
> If you are buying insurance through an exchange, make sure you are receiving any cost-sharing subsidies to which you are entitled. 
> Ask for generic instead of brand name prescriptions, or talk to your health care provider about less-expensive alternatives to your medications.
> Check for errors in your medical bills (very common) and make sure your insurance is covering what it should be by carefully reviewing “explanations of benefits” you receive from your insurance company.*
> Take advantage of any flexible spending accounts offered by your employer.
> Consider using Health Savings Accounts, which are available for individuals with high-deductible plans.  This allows consumers to set aside funds to pay for health care costs tax-free.  If the funds aren’t used, they can be rolled over into the next year.

*See the earlier blog post, What The Insurance Jargon Means for Families, which explains how to make sure that you are being billed correctly and that your insurance plan is covering what it is supposed to cover.  About 80% of medical bills include some errors.  See also the resource within that blog post about questions you should ask before paying any medical bill.  Families also may want to look at the NY Times review of “America’s Bitter Pill” which addressed how to understand medical bills, and how to appeal denial of benefits on claims.  

In summary, families of children with special needs can pick the best plans by comparing five key areas:  premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums  (also see Resources.)  There are also application assistors and a telephone help-line available if families need help.

RESOURCES
  • Help with Applications: https://localhelp.healthcare.gov/
  • Comparing Plans: https://www.healthcare.gov/choose-a-plan/comparing-plans/
  • Medicaid/CHIP Coverage: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
  • Catastrophic Plans: https://www.healthcare.gov/choose-a-plan/catastrophic-plans/
  • Premium and Cost-sharing Subsidies for Exchange Plans
  • https://www.healthcare.gov/lower-costs/ 
  • https://www.healthcare.gov/lower-costs/save-on-monthly-premiums/ 
  • https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/ 
  • Get help applying for coverage through HealthCare.gov: https://www.healthcare.gov/apply-and-enroll/get-help-applying/  
  • Families USA:  Price Transparency in Health Care: An Introduction: http://familiesusa.org/sites/default/files/product_documents/HSI%20Price%20Transparancy%20Brief_final_web.pdf 
  • What Consumers Should Know About Rising Health Care Costs: http://time.com/money/3684959/steven-brill-bitter-pill-consumers/ 
  • Why is Healthcare So Expensive?: http://www.healthcarevaluehub.org/cost-and-quality-problems/why-healthcare-so-expensive/ 

This tip sheet is based on an ACA blog authored by Lauren Agoratus, M.A.  Lauren is the parent of a child with multiple disabilities who serves as the Coordinator for Family Voices-NJ and as the southern coordinator in her the New Jersey Family-to-Family Health Information Center, both housed at the Statewide Parent Advocacy Network (SPAN) at www.spanadvocacy.org. More of Lauren’s tips about the ACA can be found on the website of the Family Voices National Center for Family/Professional Partnerships: http://www.fv-ncfpp.org/. -

Tuesday, August 18, 2015

Public Hearing about Proposed #Medicaid #ABA Rule: Sept 10

Family Voices Indiana shares this opportunity to attend a public hearing about a proposed rule for ABA under Medicaid.

Notice of Public Hearing

Under IC 4-22-2-24, notice is hereby given that on September 10, 2015, at 1:00 p.m., at the 
Indiana Government Center South, 402 West Washington Street, Conference Center Room 14, 
Indianapolis, Indiana, the Office of the Secretary of Family and Social Services will hold a public hearing on a proposed rule which amends 405 IAC 5-22-1 to update the definitions of certain categories of necessary services; amends 405 IAC 5-22-6, 405 IAC 5-22-8, and 405 IAC 5-22-10 to make changes to coverage requirements for medically necessary occupational therapy services, physical therapy services, respiratory therapy services, and speech and pathology services for individuals under 21 years of age; amends 405 IAC 5-22-11 to update the licensure and supervision requirements for occupational therapy assistants in accordance with IC 25-23.5-1-6 and IC 25-23.5-3; and adds 405 IAC 5-22-12 to add applied behavioral analysis therapy services as a reimbursable component.

Pursuant to IC 4-22-2-24(d)(3), the Indiana Family and Social Services Administration’s (FSSA)
has determined that the proposed rule will impose requirements and may impose costs on regulated entities affected by the proposed rule. Regulated entities will be required to comply with licensure and supervision requirements for occupational therapy assistants as required by law under IC 25-23.5-3 and

IC 25-23.5-1-6. The proposed rule also adds ABA therapy services, which serve a public need by
promoting health.  Regulated entities that want to provide ABA therapy services will be required to
comply with Medicaid regulations regarding Medicaid providers.
All parties interested in the proposed rule are invited to attend the public hearing and to offer 
public comments.

In lieu of attendance at the public hearing, written comments may be sent to: FSSA, 

Attention: Kim Crawford, 402 W. Washington St., Room W451, Indianapolis, IN 46204. 

COMMENT RE: "LSA Document #14-337, Nursing Therapies and ABA Rule". 

Copies of the proposed rule and this notice are now available on the Family Social Services 
Administration website at: http://www.in.gov/fssa/4543.htm

Copies of the proposed rule and this notice are now available and may be inspected by
contacting the director of the local county Division of Family Resources office, except in Marion County, where public inspection may be made at 402 West Washington Street, Room W451, Indianapolis, Indiana.

Copies of the proposed rule are now on file at the Indiana Government Center South, 402 West
Washington Street, Room W451 and Legislative Services Agency, 100 North Senate Avenue, Room N201, Indianapolis, Indiana and are open for public inspection.

Here is proposed language about ABA:

SECTION 6. 405 IAC 5-22-12 IS ADDED TO READ AS FOLLOWS:

405 IAC 5-22-12 Applied behavior analysis therapy services

Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2

 Affected: IC 12-13-7-3; IC 12-15

Sec. 12. (a) ABA therapy services shall be available to an individual who:

(1) is eligible for Medicaid services;

(2) is three (3) years of age up to and including twenty (20) years of age;

(3) has been diagnosed as having Autism Spectrum Disorder by a qualified

provider; and

(4) has a completed diagnostic evaluation. A qualified provider, when completing

such evaluation, shall:

(i) utilize a standardized assessment tool approved by the office; and

(ii) include a recommended treatment referral for ABA services, including

projected length of treatment.

(b) The following providers may provide ABA therapy services:

(1) A licensed or board certified behavior analyst.

(2) A provider holding a BCBA or BCaBA under the supervision of a health service

provider in psychology or a licensed psychologist holding a BDBA-D.

(3) a credentialed registered behavior technician under the supervision of a health

service provider in psychology or licensed psychologist holding a BCBA-D. Services

provided by a registered behavior technician will be reimbursed at seventy-five

percent (75%) of the rate on file.

(c) A provider described in subsection (c) shall develop a treatment plan for each

recipient eligible for services under this section. The treatment plan shall be based criteria

such as the individual’s:

(1) needs;

(2) age;

(3) school attendance; and

(4) other daily activities as documented in the treatment plan not otherwise excluded

from coverage under subsection (g).

(d) All covered ABA therapy services shall be subject to prior authorization. A

provider shall abide by the prior authorization requirements under 405 IAC 5-3, with the

exception that a BCBA may also submit a prior authorization request to the office for

review and approval. Each prior authorization request shall include, at a minimum, the

following:

(1) the individual’s treatment plan and supporting documentation;

(2) the number of therapy hours requested and supporting documentation; and

(3) other documentation as requested by the office.

(e) Prior approval for the initial course of treatment may be approved for up to

three (3) months. In order to continue providing ABA therapy services, a provider shall

submit a new prior authorization request and receive approval. The prior authorization

request shall include an updated treatment plan along with the documentation specified in

subsection (d)(2)-(3).

(f) ABA therapy services shall only be available to a recipient for a period of 3 years

and shall not exceed a period of 40 hours per week. The office shall not approve any prior

authorization request that provides ABA services for a period longer than the following:

(1) For an individual three (3) years of age up to and including twelve (12) years of

age, six (6) months

(2) For an individual thirteen (13) years of age up to and including twenty (20) years

of age, three (3) months.

(g) Coverage under this section shall not be available for services that:

(1) Focus solely on recreational outcomes.

(2) Focus solely on educational outcomes.

(3) Are rendered when measurable functional improvement is not expected or

documented.

(4) Are duplicative, such as services rendered under an individualized educational

plan.

(5) Are provided by a registered behavior technician in the home or school settings.

 (Office of the Secretary of Family and Social Services; 405 IAC 5-22-12; filed

Monday, August 17, 2015

Public Forums about CIH waiver

Mark Your Calendars Now! The Division of Disability and Rehabilitative Services is sponsoring a series of town hall meetings across the state of Indiana to gather input on changes to the Community Integration and Habilitation (CIH) home and community based services (HCBS) waiver. Changes to the CIH waiver are an important part of CIH Transform, a multi-year systems change process underway to build a sustainable system of supports and services for people with intellectual and developmental disabilities and their families. For additional information on the multi-year change, please visit the CIH Transform web page

The town hall meetings will be held in the following locations on the following dates:
District 5 Indianapolis 9/9/15 
District 4 Terre Haute 9/9/15 
District 6 Muncie 9/10/15 
District 1 Gary/Merrillville 9/10/15
District 2 South Bend 9/16/15 
District 7 Evansville 9/16/15 
District 8 Clarksville 9/17/15 
District 3 Ft. Wayne 9/17/15 

There will be morning meetings for providers and afternoon meetings for families and persons with intellectual and developmental disabilities, as well as advocates. Both meetings are open to anyone to attend and provide their input. The purpose is to gather input on what is working well and thoughts on what residential supports and services people would like to buy that would be helpful to them in achieving their desired outcomes and goals. 



Additional details on times and locations will be posted on the CIH Transform website: Questions for people to think about and to help them prepare their comments will also be posted. We hope to see you at one of these meetings in September!