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Indiana Health Coverage Programs
DXC Technology
Fee-for-Service
Home and Community-Based
Waiver Services
Annual Provider Seminar ‒ October 2018
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Agenda• Reference materials
• Overview
• Service descriptions and codes
• Service information
• Billing
• Submitting claims on the Portal
• Electronic visit verification (EVV)
• Helpful tools
• Questions
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Reference materials
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Waiver reference modules
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Overview
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Overview
• Section 1915(c) of the Social Security Act permits states to offer, under a
waiver of statutory requirements, an array of HCBS that an individual
needs to avoid institutionalization.
• These programs allow the Indiana Health Coverage Programs (IHCP) to
provide services in an individual’s home or other community setting that
would ordinarily be provided only in an institution.
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Overview
• Individuals must qualify for institutional care to be eligible for HCBS.
• The term “waiver” refers to waiving of certain federal requirements that
otherwise apply to Medicaid program services.
• Waiver services are not Medicaid entitlement programs.
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Overview
• Division of Aging (DA)– Aged & Disabled (A&D) waiver
– Traumatic Brain Injury (TBI) waiver
• Division of Disability and Rehabilitative Services (DDRS)– Family Supports (FS) waiver
– Community Integration and Habilitation (CIH) waiver
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Service descriptions and codes
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A&D & TBI Waiver ‒ Services
Service Description Service Description
Adult Day Services Home Delivered Meals
Adult Family Care Homemaker
Assisted Living Nutritional Supplements
Attendant Care Personal Emergency Response System
Case Management Respite
Community Transition Transportation
Environmental Modification Vehicle Modification
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FSW & CIH Waiver ‒ Services
Service Description Service Description
Adult Day Services Physical, Speech, Occupational Therapy
Behavioral Support Services Participant Assistance and Care
Case Management Personal Emergency Response System
Community Based Habilitation Prevocational Services
Facility Based Habilitation Respite
Family and Caregiver Training Transportation
Intensive Behavioral Intervention Workplace Assistance
Music Therapy Wellness Coordination
Recreational Therapy Structured Family Caregiving
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A&D and TBI Waiver ‒ Codes
• DA HCBS Waivers reference module
Table 1 – Service codes and rates
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FSW and CIH Waiver ‒ Codes
• Provider Bulletin BT201766
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Service information
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Service information
• Service definition
• Allowable activities
• Service standards
• Documentation standards
• Limitations
• Activities not allowed
• Provider qualifications
– The following slides use attendant care as an
example
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Service information
• Attendant care services primarily involve hands-on assistance for aging
adults and persons with disabilities.
• These services are provided to allow aging adults or persons with
disabilities to remain in their own homes and to carry out functions of daily
living, self-care, and mobility.
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Allowable activities
• Provision of assistance with personal care,
which includes: – Bathing, partial bathing
– Oral hygiene
– Hair care, including clipping of hair
– Shaving
– Hand and foot care
– Intact skin care
– Application of cosmetics
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Service standards
• Attendant care services must follow a written service plan
addressing specific needs determined by the individual’s
assessment.
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Documentation standards
• Need must be identified in the service plan.
• Services must be outlined in the service plan.
• Data record of services must be provided, including:
– Complete date and time of service (in and out)
– Specific services or tasks provided
– Signature of employee providing the service
• Each staff member providing direct care or supervision of care to
the individual must make at least one entry on each day of service.
• All entries should describe an issue or circumstance concerning the
individual.
• Documentation of service delivery must be signed by the
participant or designated participant representative.
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Activities not allowed
• Services will not be provided to medically unstable individuals as a
substitute for care provided by a registered nurse, licensed practical
nurse, licensed physician, or other health professional.
• Services will not be provided to household members other than to the
participant.
• Services will not be reimbursed when provided as an individual
provider by a parent of a minor child participant, the spouse of a
participant, the power of attorney (POA) of a participant, the healthcare
representative (HCR) of a participant, or the legal guardian of a
participant.
• Services will not be provided to participants receiving adult family care
waiver service, structured family caregiving waiver
service, or assisted living waiver service.
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Provider qualifications
• Licensed home health agency
• Licensed personal services agency
• FSSA/DA-approved attendant care individual
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Billing
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HCBS waiver billing
• The waiver case manager is responsible for completing the service
plan that results in an approved Notice of Action (NOA).
• The NOA details:– Waiver-funded services
– Number of units for the waiver service to be provided
– Name of the authorized waiver provider
– Approved billing code with the appropriate modifiers
• The case manager transmits NOA information to the waiver
database, INsite.
• INsite communicates NOA data to CoreMMIS, where the data is
stored in the prior authorization database.
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HCBS waiver billing
• Claim filing:
– 837P electronic transaction
– Paper CMS-1500 professional claim form (version 02/12)
– Provider Healthcare Portal
• Providers must register to access the Portal, which is fast,
free, and easy to use.
• Instructions for completing paper forms are included in the
Claim Submission and Processing provider reference
module.
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HCBS waiver billing
• Claims deny if no authorization exists in the database or if a code other
than the approved code is billed.
• Providers are not to render or bill services without an approved NOA.
• It is the provider’s responsibility to contact the case manager if there is any
discrepancy in the services authorized or rendered on the approved NOA.
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Submitting claims on the
IHCP Provider Healthcare Portal
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Provider Healthcare Portal
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Verifying eligibility
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Two ways to access claim submission
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Professional claim: Step 1
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Professional claim: Step 1
Professional claim: Step 2
Add the diagnosis in the Diagnosis Code field.
After the diagnosis is located, click
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Professional claim: Step 2
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Professional claim: Step 3
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Professional claim: Step 3
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Professional claim: Step 3
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Professional claim: Step 3
Modifiers ‒ required
Review the NOA for the required modifiers
The modifiers on the claim must exactly match the NOA.
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Professional claim: Step 3
Add Provider ID Choose Provider
ID from ID Type
Choose Unit
from Unit Type
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Professional claim: Step 3
After information is entered, click
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Professional claim: Step 3
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Confirm professional claim
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Submit professional claim:
confirmation
Payment/Denied
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Electronic Visit Verification
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Electronic Visit Verification
• The 21st Century Cures Act directs state Medicaid programs to
require providers of personal care services and home health
services to use an electronic visit verification (EVV) system to
document services rendered.
• Use of an EVV system to document personal care services must be
implemented by January 1, 2020.
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Electronic Visit Verification
Affected providers may use an EVV system of their choice; however, providers
are responsible for ensuring that the system selected complies with federal
requirements, including documentation of the following information:
• Type of service performed
• Individual receiving the service
• Date of service (DOS)
• Location of service delivery
• Individual providing the service
• Time the service begins and ends
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Electronic Visit Verification
• The IHCP is in the process of developing a federally compliant EVV
system for providers that will interface with the State’s Medicaid
Management Information System (MMIS).
• The EVV system will offer aggregator functionality to accept data
from other EVV systems that providers may already be using or will
opt to use in the future.
• The IHCP will use the Sandata system as the State-sponsored
solution for implementing federal EVV requirements.
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Reminder
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Claim filing limit
The IHCP will mandate a 180-day filing limit for fee-for-service (FFS)
claims, effective January 1, 2019. Refer to BT201829, published on
June 19, 2018, for additional details.
• The 180-day filing limit will be effective based on date of service:– Any services rendered on or after January 1, 2019, will be subject to the 180-day filing
limit.
– Dates of service before January 1, 2019, will be subject to the 365-day filing limit.
Watch for additional communications!
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Helpful tools
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JIRA web help desk
• Division of Aging (DA)– https://dmha.fssa.in.gov/helpdesk/?div=da
• Division of Disability and Rehabilitative Services (DDRS)– https://dmha.fssa.in.gov/helpdesk/?div=ddrs
• Providers should no longer use– [email protected]
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Helpful tools
Provider Relations
Consultants
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Helpful tools
IHCP website at indianamedicaid.com:
• IHCP Provider Reference Modules
• Medical Policy Manual
• Contact Us – Provider Relations Field Consultants
Customer Assistance available:
• Monday – Friday, 8 a.m. – 6 p.m. Eastern Time
• 1-800-457-4584
Secure Correspondence:
• Via the Provider Healthcare Portal
• Written Correspondence:DXC Technology Provider Written Correspondence
P.O. Box 7263
Indianapolis, In 46207-7263
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QuestionsFollowing this session, please review your schedule for the next session
you are registered to attend.
