Monday, November 18, 2019

How can I find out if an ACA health plan covers the prescription drugs that I take?

How can I find out if a health plan covers the prescription drugs that I take?
Health plans in the Marketplace must include a link to their prescription drug “formulary” with other on-line information about the plan. The “formulary” is a list of prescription drugs the plan will cover. If you don’t find your drug on the formulary but your doctor says it’s medically necessary for you to take that specific drug, you can appeal for an exception to the plan formulary. If there is a Consumer Assistance Program in your state, staff in this program can help you file your appeal.

Friday, November 15, 2019

How can I find out if my doctor is in an ACA health plan’s network?

How can I find out if my doctor is in a health plan’s network?
Each plan sold in the Marketplace must provide a link on the Marketplace web site to its health provider directory so consumers can find out if their health providers are included.
The provider network information that insurance companies provide may or may not tell you whether a provider is accepting new patients, or whether a provider speaks your language. It is up to your Marketplace to require insurers to provide you with this information.

Thursday, November 14, 2019

Healthy Indiana Plan Seeks Renewal

From CKF:

Healthy Indiana Plan Seeks Renewal

The Indiana Family and Social Services Administration has begun the process for renewal of the Healthy Indiana Plan (HIP) 1115 waiver and its substance use disorder (SUD) components, which are set to expire on December 31, 2020. Additionally, the pending HIP Workforce Bridge program will be a part of the HIP waiver extension request. Similarly, the current SUD 1115 waiver will add proposed Serious Mental Illness (SMI) language to its extension request.

The extension requests are for a 10 year HIP waiver approval through December 2030 and approval for the SUD and SMI waivers for 5 years through December 2025. The changes from previously approved or submitted language include:

  • Flexibility to modify the POWER Account contribution tiers below an average limit of three percent of member income with appropriate notice to members, stakeholders and CMS, without requiring the submission of a waiver amendment. Specific modifications are not proposed by FSSA, but they provide an example of increasing or decreasing the amounts of the POWER Account base contribution or the tobacco surcharge.

  • Flexibility to modify the HIP Basic copayment amounts within the Medicaid allowable limits, with appropriate notice to members, stakeholders and CMS, but without requiring the submission of a waiver amendment. Specific modifications are not proposed by FSSA, but they provide examples of decreases in copayment amounts or implementation of copayment waivers on target services. 

The Indiana Family and Social Services Administration is required to submit a request to extend these programs one year in advance of their expiration and to solicit public comment. The public comment period for these extension requests runs through Dec. 6, 2019. There will be two public hearings where public comment may be provided:

  1. Tuesday, Nov. 19, at 2:00 pm at the Indiana State Library, History Reference Room 211, 315 W. Ohio St., Indianapolis. This hearing will be a special session of the Medicaid Advisory Committee.
  2. Wednesday, Nov. 20, at 10:00 am at the Indiana Government Center South, Conference Room 18, 302 W. Washington St., Indianapolis. This hearing will also be accessible via web conference https://Indiana.AdobeConnect.com/indiana.

Written comments may be sent to FSSA via mail at 402 West Washington Street, Room W374, Indianapolis, IN 46204, Attention: Natalie Angel or via electronic mail at hip@fssa.in.gov through Dec. 6, 2019.

Wednesday, November 13, 2019

Will covered benefits under all Marketplace plans be the same? How can I compare?

Will covered benefits under all Marketplace plans be the same? How can I compare?
Not necessarily. All Marketplace health plans are required to cover the ten categories of essential health benefits. However, insurers in many states will have flexibility to modify coverage for some of the specific services within each category. Any modifications must be approved by the Marketplace before plans can be offered.  All health plans must provide consumers with a Summary of Benefits and Coverage (SBC). This is a brief, understandable description of what a plan covers and how it works. The SBC will also be posted for each plan on the Marketplace web site. The SBC will make it easier for you to compare differences in health plan benefits and cost sharing.
Plans might differ in other ways, too. For example, the network of health providers might be different from plan to plan. 

Public Comment: Renewal of the Community Integration and Habilitation Waiver and Family Supports Waiver

DDRS Updates


Public Notice Regarding Renewal of the Community Integration and Habilitation Waiver and Family Supports Waiver
In accordance with public notice requirements established at 42 CFR 441.301 the Indiana Family and Social Service Administration Division of Disabilities and Rehabilitative Services intends to submit a renewal of the Community Integration and Habilitation waiver and a renewal of the Family Supports waiver to the Centers for Medicare and Medicaid Services for consideration. These waiver renewals will allow DDRS to continue providing home and community-based services to individuals who, but for provisions of such services, would require institutional care. The anticipated effective date is April 17, 2020.
The FSW and CIH waivers provide Medicaid HCBS services to participants in a range of community settings as an alternative to care in an intermediate care facility individuals with developmental disabilities or related conditions. These waivers serve persons who have a developmental disability, intellectual disability or autism and who have substantial functional limitations, as defined under the paragraph for “Persons with related conditions” in 42 CFR 435.1010. Participants may choose to live in their own home, family home, or community setting appropriate to their needs. Participants develop a Person-Centered/Individualized Support Plan using a person centered planning process guided by an Individualized Support Team. The IST is comprised of the participant, their case manager and anyone else of the participant’s choosing but typically family and/or friends. The DDRS Bureau of Developmental Disabilities Services has proposed the following changes to be effective with April 17, 2020 renewals:
  • Add Environmental Modification as a service option under the FSW, using the same definition and rate methodology as provided under CIH waiver.
  • Add Electronic Monitoring as a service option under FSW, using the same definition and rate methodology as provided under CIH waiver.
  • Increase the rate for Community Transition on the CIH waiver from $1,000 to $2,500.
Fiscal Impact (in millions) of Proposed Changes:
Federal Budget Impact:                 FFY 2020 $ 1.42                  FFY 2021 $ 2.83
State Budget Impact:                     FFY 2020 $ 0.74                  FFY 2021 $ 1.47(4/1/2020-9/30/2020)
Federal Budget Impact:                 SFY 2020 $ 0.71            SFY 2021 $ 2.84
State Budget Impact:                     SFY 2020 $ 0.37            SFY 2021 $ 1.47
(4/1/2020 – 6/30/2020)
The 30-day public comment period will run November 13, 2019, through December 13, 2019. Comments may be emailed to DDRSwaivernoticecomment@fssa.IN.gov or mailed to the address below:
FSSA–Division of Disabilities and Rehabilitative Services
RE:CIH and FSW Renewal Public Comment
402 West Washington Street, Room W453 P.O. Box 7083
 Indianapolis, IN 46027
The FSW and the CIH waiver renewal drafts are available for review and public comment on the DDRS public comment webpage. Hard copies of the proposed renewal are available upon request by emailing DDRSwaivernoticecomment@fssa.IN.gov. Copies of the renewal are also available at local Division of Family Resources offices as well as local Area Agencies on Aging. In-person consultations or phone calls are available upon request..

Tuesday, November 12, 2019

Public Comment: Employment First plan

ndiana Commission on Rehabilitation Services:
In April, 2017, Indiana passed legislation regarding Employment First, meaning that employment is the first and preferred outcome for individuals with disabilities. The Employment First Act pertains to state agencies that provide services and support to help obtain employment for individuals with disabilities, and requires those agencies to effectively implement this employment first policy to advance competitive, integrated employment outcomes, including self-employment, for individuals with disabilities of working age. The Indiana Commission on Rehabilitation Services is responsible for developing a plan for advancing competitive, integrated employment as the first and preferred option, and the plan must include:
  1. Identification of barriers to employment for individuals with disabilities;
  2. An analysis of federal, state, and local agency policies concerning the provision of services to individuals with disabilities, including the impact of those policies on opportunities for competitive integrated employment; and
  3. Recommendations to advance competitive integrated employment for individuals with disabilities.
The Indiana Commission on Rehabilitation Services has worked over the past year to draft an Employment First plan. This draft plan is now posted for public review and comment. The draft plan may be viewed by clicking here and the Commission on Rehabilitation Services welcomes comments from individuals with disabilities and their families, state agencies, schools, stakeholders, employers, provider organizations, advocacy groups, members of the public, and others. Comments may be submitted to VRCommission.vr@fssa.in.gov through Friday, December 13, 2019.

Monday, November 11, 2019

What health benefits are covered under Marketplace plans?

What health benefits are covered under Marketplace plans?
All qualified health plans offered in the Marketplace will cover essential health benefits. Categories of essential health benefits include:
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including dental and vision care
The precise details of what is covered within these categories may vary somewhat from plan to plan.