The Indiana Family and Social Services Administration recently announced the selection of four vendors who will administer health care services to Healthy Indiana Plan and Hoosier Healthwise members.  The four vendors are Anthem Blue Cross and Blue Shield, CareSource Indiana, MDwise Inc. and Managed Health Services of Indiana.  CareSource is a new option for members.

What you need to know:

There will be an open enrollment period later this year for Hoosier Healthwise members who would like to switch plans.  The date for the open enrollment will be announced at a later time.  Health Indiana Plan members are able to switch plans once a year during their eligibility renewal period.

Please be aware that you may be asked for assistance with this process from patients. It will also be imperative that you know which MCEs are accepted at your facility. If you are not sure which MCEs are accepted, please contact your manager.  

FSSA made the following enhancements to the Managed Care Entity (MCE) contracts:

  • Significantly increasing the payment tied to outcomes to further incentivize the MCEs to improve the health of the populations served. The contracts do this by progressively increasing the payment amount withheld and awarded based on outcomes from 2 percent in the first year to 5 percent in year six.
  • Adding new program integrity language that requires the plans to work with the state on identifying and investigating health care providers and members suspected of fraud.
  • Including pharmacy and dental services in the contract for the Hoosier Healthwise program, aligning with the Healthy Indiana Plan and Hoosier Care Connect programs. Care is improved for members when all services are included and coordinated under one comprehensive contract.

FSSA believes these key changes will ensure Indiana Medicaid members will get better coordinated health care and customer service form their plan.

Securing final contracts with the MCEs will depend on successful negotiations between the state and the companies.  Under state law, Medicaid contracts are four years in duration, with two optional one-year extensions.

 

More information is available here:http://www.in.gov/fssa/files/HIP_HHW_Contract_Award_Press_Release_6.10.16.pdf