Skip to main content

Managed Care Orgs for Hoosier Healthwise, HIP and Hoosier Care Connect

Indiana Health Coverage Programs (IHCP) relies primarily on a managed care delivery model to serve the healthcare needs of its members. This model is designed to combine quality of care with the efficient use of tax dollars. Contracted managed care entities (MCEs) provide members with medical homes, also known as primary medical providers (PMPs), responsible for all the members’ physical and mental health needs. Payment structures offer incentives for coordinating care, keeping members healthy, and identifying and eliminating fraud and abuse. 

Under state law, MCE contracts are four years in duration, with two optional one-year extensions, necessitating the need for reprocurement at least every six years. Accordingly, the Indiana Family and Social Services Administration (FSSA) recently conducted a procurement for MCEs to serve the approximate 1 million members enrolled in the Healthy Indiana Plan (HIP) and the Hoosier Healthwise programs. 

As a result of the procurement process, the FSSA has begun negotiation with four selected MCEs: 
 Anthem Blue Cross and Blue Shield 
 CareSource Indiana 
 MDwise Inc. 
 Managed Health Services of Indiana (MHS) 

Contracting with the MCEs will be dependent upon successful negotiations between the State and the companies as well as demonstration by each MCE of its readiness to serve members applying FSSA’s readiness review criteria. The intent is for contracts to begin January 1, 2017. 

Anthem, MDwise, and MHS are the current MCEs serving the HIP and Hoosier Healthwise programs. CareSource will be a new option for members. Hoosier Healthwise members will have an open enrollment period later this year to switch plans, if desired. The IHCP will provide more information about the open enrollment period at a later date. HIP members are able to switch plans once a year at their eligibility renewal.

To participate in the Hoosier Healthwise and HIP MCE networks, providers must be enrolled with the IHCP as well as contracted with one or more of the MCEs. Providers currently contracted with an existing MCE may be required to enter into new contracts to remain in-network as of January 1, 2017; providers should contact the MCE directly for further direction. CareSource will be establishing an IHCP provider network and can be contacted directly for more information.

Please note that beginning January 1, 2017, MCE networks for the Hoosier Healthwise program will be enhanced to include pharmacy and dental services. 

Popular posts from this blog

Pandemic Snap benefits: Free and Reduced Lunch Recipients

Pandemic Snap benefits: Those that have children on free and reduced lunch will receive their EBT card in the mail by the end of May if you are not already receiving SNAP benefits. It will be $319 per school aged child. You do not need to apply for this benefit. The DOE will provide your information to FSSA. 5767.htm?fbclid= IwAR0zhdr9tS1wMovtNNPngc55HCms QSX_4k_E_ GRAjPpNRHWF5ExZgCLUjOE

Sample Medical Order, Letter of Medical Necessity and Appeal Letter for #ABA Services

From The Arc Autism Insurance Project in collaboration with Family Voices Indiana and About Special Kids Feel free to contact Family Voices Indiana at 317 944 8982 or if you need additional resources or support. Sample Medical Order, Letter of Medical Necessity and Appeal Letter for ABA Services – Medicaid under EPSDT (ages 0-21) EPSDT – Early, Periodic Screening Diagnosis and T reatment MEDICAL TREATMENT ORDER SAMPLE FORMAT The prescribing physician should include: Physician’s order for ABA therapy Letter of medical necessity written by the physician or ABA provider, which includes: Patient history Diagnosis and prognosis Description of recommended services and explanation of why the services are medically necessary What the benefit to the patient will be, and Recommended length of time for the services Medical Necessity According to the Health and Human Services website: Medical Necessity under EPSDT   In a rep