Wednesday, January 13, 2010

Care Select Frequently Asked Questions

Q: What is the Care Select program?
A: The Care Select program is an Indiana Medicaid program that provides individualized care management to the following populations: aged, blind, disabled, wards of the court, foster children, children receiving adoption assistance, and members receiving home and community-based services (HCBS) through a waiver. Persons who also have Medicare are excluded from this program.

Q: Why are waiver members being placed into the Care Select program?
A: Waiver members have always been eligible to enroll in the Care Select program. The Care Select program is now completing its phased in approach of implementation to ensure that all eligible populations are included in the program.

Q: Can I refuse to participate in Care Select?
A: No. The Care Select program requires that all members eligible for the program be enrolled to participate. Enrollment is required in order to participate and can be accomplished by calling the enrollment broker at 1- 866-963-7383 and selecting a primary medical provider (PMP).

Q: What does PMP stand for?
A: PMP stands for Primary Medical Provider. You must choose a PMP that is enrolled in Indiana Care Select. If you have been a waiver member for over 30 days and have not selected a PMP by February 1, 2010, then you will be automatically assigned to one. In this case, we will try to find an available PMP that you have either seen before or whose office is within 30 miles of your home address.

Q: Can I choose a specialist for my PMP?
A: Yes. A doctor is eligible to become a PMP if he or she is one or more of the following: general practice, family practice, general internal medicine, general pediatrics, and OB/GYN. In addition, any specialty provider can be a PMP if they enroll and if they meet all of the requirements of being a PMP.

Q: What does TPL stand for?
A: TPL stands for Third Party Liability insurance which also means private insurance. All waiver members are required to enroll in the Care Select program regardless of whether or not they have TPL.

Q: If my current TPL doctor is not a PMP, can you help me find a PMP that is also in my TPL network?
A: Yes. We can help you, but we will need to know the names of those other doctors that you are interested in seeing. If one of those doctors is already a Care Select PMP, then we can assign you to that doctor. However, if that doctor’s panel is full, we must first ask that doctor to allow you to see him or her. If there are no doctors on your TPL network that are currently enrolled in the Care Select program, then we will be happy to talk to any of those doctors about this program and ask them to sign up. Doctors who are interested can also enroll by calling either of the Care Management Organizations (CMOs) of their choosing at 1-866-504-6708 for Advantage Care
Select or 1-866-440-2449 for MDwise Care Select. Once a doctor signs up, you can request that you be reassigned to him or her.

Q: If I have a TPL doctor, do I have to see my PMP?
A: Yes. You are required to see the PMP to which you are assigned. If your PMP and your doctor from your TPL network are different, we ask that you continue to see both as necessary for better coordination of your health care.

Q: When I enroll in Care Select, can I still use my TPL?
A: Yes. The Care Select program encourages you to continue to use your TPL insurance as appropriate. Medicaid will continue to be the secondary insurance.

Q: If the doctor that I want is not enrolled as a PMP in the Care Select program, how do I request that he or she enroll?
A: You can make this request by calling the enrollment broker, Maximus, at 1-866-963-7383. You can also ask the doctor to enroll by calling either of the Care Management Organizations (CMOs) of their choosing at 1-866-504- 6708 for Advantage Care Select or 1-866-440-2449 for MDwise Care Select. Once a doctor signs up, you can ask to be changed to him or her.

Q: If the doctor that I want is already enrolled as a PMP in the Care Select program but has a full panel, how do I request that he or she to increase his or her panel size?
A: If a PMP’s panel is full, we must first ask that doctor to allow you to see him or her. Once a doctor agrees to do this, we will enroll you with that doctor. Maximus also has a full panel add form that you can take to the doctor’s office if we’re unable to get approval from the doctor.

Q: I want to avoid having to change PMPs twice if I don’t get assigned to the one that I want after enrolling. If the doctor I want is either not a PMP or has a full panel, can I wait to be assigned until he or she either enrolls as a PMP or increases his or her panel size?

A: No. Do not wait for this to happen. If you have been a waiver member for over 30 days and have not selected a PMP by February 1, 2010, then you will be automatically assigned to one. In this case, we will try to find an available PMP that you have either seen before or whose office is within 30 miles of your home address. Once the doctor that you want has either enrolled as a PMP or increased his or her panel size, you will be able to be assigned to him or her. However, the sooner you call us, the sooner you can avoid having to change PMPs once the doctor that you want is available. That’s why it is important for you to immediately call the enrollment
broker, Maximus, at 1-866-963-7383 and tell them which doctor you want.

Q: If I don’t have any PMPs in my area, how far am I expected to travel to one?
A: Indiana Medicaid’s standard for member access to PMPs is that at least one PMP’s office be within 30 miles of every member. Although there are enough PMPs enrolled in the Care Select program to meet this standard, there may be some cases in which a member must travel from one city or county to the next to see the PMP in which they are assigned. Unless a member requests a doctor who is farther than 30 miles away, the member will not have to travel that far to see his or her PMP.

Q: Can I switch to a different PMP?
A: Yes. You can ask to change your PMP at any time by calling your CMO, Advantage or MDwise. If the new PMP is enrolled in your CMO, then the change will occur by the next day. If he or she is enrolled in the other CMO, then the change can take up to about two weeks.

Need to contact us? Please choose from below.
Care Select Helpline: 1-866-963-7383
Care Select Email: careselect@fssa.in.gov
Care Select Website: http://www.in.gov/fssa/ompp/2546.htm
ADVANTAGE Care Select: http://www.advantageplan.com/advcareselect/default.html or 1-800-784-3981
MDwise Care Select: http://www.mdwise.org/careselect or 1-866-440-2449

4 comments:

Maggie T. said...

This is a great program ideal that I feel every state should have, and if not enforce. However, how do are people being informed of these kind of programs and what can be available to them? I feel that many people don't know how to start looking for these kind of things or who can help them enroll.

About Family Voices Indiana said...

As the family to family health information center for Indiana, Family Voices shares information like this so its members are aware of such programs. We're also here to help if families need assistance finding applicable programs and/or applying for them. 317 944 8982

Elisa said...

Information like this makes it so much easier for people enrolled in such programs understand. It is not all in the medical mumble jumble that they are like "okay I need to do this, because they sent me a long package, yet I have no idea what it is explaining," no instead it is worded in language and words that the "average" person could understand. I think this information has helped more people then information that the PMP or the Care Select Program has understood.

lanondria said...

I think that having the proper information for programs makes it much easier for the families of individuals with disabilities.This blog site is the a great way to let individuals with disabilities and their families know the current issues that are going on and ongoing.