Indiana Health Plan

Effective January 1, 2012, the Indiana Health Coverage Programs (“IHCP”) expanded the provider enrollment classifications to include comprehensive outpatient rehabilitation facilities (“CORFs”) and independent diagnostic testing facilities (“IDTFs”).  CORFs and IDTFs may enroll in the following IHCP programs: traditional Medicaid, Assistance to Residents in County Homes (“ARCH”), 590 Program, Hoosier Healthwise, and Care Select.  CORFs and IDTFs are enrolled under the moderate risk category and are subject to an application fee during enrollment or revalidation. 

A CORF is a facility primarily engaged in providing outpatient rehabilitation services to the injured or disabled, or patients recovering from illness with a plan of treatment under the supervision of a physician.  CORFs are required to provide outpatient mental health services (405 IAC 5-20-8), physical therapy and physician services; and may provide speech-language therapy and occupational therapy services.  CORFs should use provider type code “04-Rehabilitation Facility” and provider specialty code “041-Comprehensive Outpatient Rehabilitation Facility.”   The billing criteria states CORF services should be billed on a CMS-1500 Professional claim form or the Health Insurance Portability and Accountability Act (“HIPAA”) 837P transaction using place-of-service code 62-CORF. 

An IDTF is a diagnostic testing facility that is independent of a physician’s office or hospital and furnishes diagnostic tests but does not use test results to directly treat patients.  An IDTF can be differentiated from similar facilities by ownership structure and types of services provided.  Before enrolling in IHCP, an IDTF must be enrolled in Medicare where it will be required to provide a list of all the Current Procedural Terminology (CPT®1) and Healthcare Common Procedure Coding System (HCPCS) codes for the services to be performed as well as a list of equipment used to perform the tests.  In order to perform additional tests not on the original Medicare application, the IDTF will need to amend its Medicare application to add codes and equipment.  An IDTF must also employ at least one supervisory physician, not a physician group practice, who is proficient in the performance and interpretation of each type of diagnostic procedure performed by the IDTF.  IDTFs should use provider type code “28-Laboratory” and provider specialty code “282-Independent Diagnostic Testing Facility” or “283-Independent Diagnostic Testing Facility, Mobile.”  The billing criteria states IDTF services should be billed on a CMS-1500 Professional claim form or HIPPA 837P transaction using place-of-service code 81-Independent Laboratory.  If you have any further questions please contact Meghan Linvill McNab at 317-808-5863 or Kristen L. Gentry at 317-238-6288.

Questions remain frequent among long term care providers in Indiana regarding facility-level impacts of the decision by the Indiana Office of Medicaid Policy and Planning (“OMPP”) to eliminate reimbursement for bed-hold days.  The elimination of reimbursement for bed-holds was effective February 1, 2011 (For a copy of this bulletin, click here), and the Indiana Medicaid State Plan will be amended in the coming months to finalize elimination of reimbursement.  OMPP has also posted, and periodically updated, a news summary on www.IndianaMedicaid.com that discusses the impact of the reimbursement changes on Indiana’s long term care facilities and their residents (Click here for the news summary).

More recently, requirements for long term care facilities to maintain updated bed-hold policies were discussed during a panel presentation at the 2011 Indiana Health Care Association's ("IHCA") Convention & Expo in May.  In addition to the above OMPP-issued materials, the IHCA offers the following points for long term care facilities when developing bed-hold policies. 

·         Facilities must have a bed-hold policy that states whether or not the facility allows a resident to pay to hold a bed during a leave of absence

o    Though facilities are not required to allow a resident to pay to hold a bed, facilities must still have a policy that states whether or not payment for holding a bed is permitted by the facility

·         The duration of the bed-hold period must be clearly stated in the facility policy

·         Bed-hold policies should state that Indiana Medicaid does not reimburse for bed-holds

·         Payment by residents for bed-holds must follow applicable Medicare and Medicaid guidelines regarding billing for non-covered services

·         Charges for bed-holds should be set at fair market value and must be equally applied to all residents regardless of payor source

o    Facilities may be at risk for Anti-Kickback violations related to improper inducements to government program beneficiaries if charges for bed-holds are not fair market value and equal application of those charges are not maintained.  However, an exception to the Anti-Kickback statute may apply in certain circumstances for bed-hold charges that are unable to be collected.  This exception depends on certain elements regarding facility advertisements, other relevant services and financial need of the resident. 

·         If a resident on leave is expected to return to the facility, regardless of whether they have paid to hold a bed, the facility is not required to discharge the resident

·         If a resident is discharged from a facility, however, the facility must permit the resident to return to the first available semi-private bed when (i) the resident continues to qualify for Medicaid, (ii) the resident requires nursing-level care and (iii) the facility is able to provide appropriate care for the resident.

o    A resident may be discharged from the facility for many reasons including, but not limited to, the resident’s failure to pay for a bed-hold or when the bed-hold period expires.  Facilities must follow applicable regulations and procedures when discharging a resident.

If you have questions about this article or about bed hold policies, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001 or Leigh Ann O'Neill at 317-238-6346.  .

Facilities will access the ISDH Survey Report System through the ISDH State Health Gateway.  Instructions for accessing the State Health Gateway are included in the User's Manual and will be provided to facilities when surveyors begin a survey.  The system will require a username and password which will be provided to the facilities by surveyors at the time of the facility's first survey after implementation of the system. 

In ISDH LTC Newsletter Issue # 11-04, the ISDH requested facilities to complete a registration form providing the ISDH with the facility email address that they wish to use for this system.  Any facilities that have not yet completed the registration form are encouraged to do so.  The online registration form is found at www.in.gov/isdh/25053.htm.

The registration is solely to ensure that the ISDH has the email address that the facility wishes to use for survey notifications.  The ISDH needs every nursing home to provide the facility email address to which they wish survey document notifications to be sent.  A facility may, but is not required to, select a second email address for notifications to be sent.  Some facilities may want to use the second email notification address for their corporate office or owners.  At the time of entry into a facility, surveyors will confirm these email addresses and provide the facility with the username and password needed to access the system. 

If the Indiana comprehensive care facility (nursing home) and residential care facility (licensed assisted living) has not already done so, the facility should complete the following action items: 

1.  Review the Survey Report System User's Manual.

2.  Identify (or create) a facility email address for ISDH survey notifications.

3.  Determine an additional office or individual entity that the facility would like to receive ISDH survey notifications.

4.  Complete the online registration form at www.in.gov/isdh/25053.htm providing the ISDH with information needed to register your facility into the Survey Report System.

Recently, at least one facility experienced a problem receiving their survey report. The survey system had a glitch that resulted in the facility not receivng their survey report until days before their plan of correction was required.  A quick response and resolution was required to avoid a negative outcome for the facility.   

Should your facility experience any problems or if you have any questions, please contact any one of the following attorneys who have significant experience in handling licensure and survey issues for LTC facilities:  Lori McLaughlin at lmclaughlin@kdlegal.com or (219) 227-6075; Randy Fearnow at rfearnow@kdlegal.com or (317) 238-6279; David Jose at Djose@kdlegal.com or (317) 238-6211; Mindy Shapiro at mshapiro@kdlegal.comm or (317) 238-6226; or Susan Ziel at sziel@kdlegal.com or (317) 238-6244.

On March 31, 2011, CMS released the long-awaited rules proposed to implement the provisions in PPACA, the Health Care Reform legislation enacted on March 23, 2010, referred to as the Affordable Care Act, on Accountable Care Organizations ("ACOs") and the Medicare Shared Savings Program that is designed to contract with these organizations. Likewise, the same day, the antitrust agencies, the Federal Trade Commission ("FTC") and the Antitrust Division of the Department of Justice ("DOJ"), issued proposed enforcement guidelines relating to the size, scope and ability of an ACO to contract in the commercial market and how that affects Medicare Shared Savings Program contracts as well. Additionally, the Centers for Medicare and Medicaid ("CMS") and the HHS Office of Inspector General ("OIG") proposed various waivers for standard Stark, Antikickback and Civil Money Penalty rules relating to ACO activities. Finally, the Internal Revenue Service ("IRS") issued a notice requesting comments on its existing private inurement and private benefit rules relating to tax-exempt entities and their financial relationships with "insiders".