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IHCP Updates - Published 1/3

1/4/2019

 
The Indiana Health Coverage Programs (IHCP) posted the following important information to the provider website at https://www.in.gov/medicaid/providers/ on January 3, 2019, (unless alternate date is noted).

Provider Reference Modules 
Division of Disability and Rehabilitative Services Home and Community-Based Services Waivers (see the module for a complete list of updates)
  • Changed ISP references to Person-Centered/Individualized Support Plan (PC/ISP)
  • Updated 450B form references to Confirmation of Diagnosis (State Form 54727)
  • Updated the responsibilities in Section 1.2: FSSA Division of Disability and Rehabilitative Services (DDRS)
  • Updated the responsibilities and oversight activities in Section 1.4: The Bureau of Quality Improvement Services (BQIS)
  • Updated Section 2.1: Provider Application Process
  • Updated the list of items the provider is evaluated on in Section 2.2: Provider Reapproval; also clarified that a signed Provider Agreement is the document needed for reapproval
  • Updated the current process and FSW POC/CCB cap amount where needed
  • Updated information about funding and allocations in Section 6.4: Translating Algo Level into a Budget Allocation
  • Updated new policy and waiver information where needed
  • Updated the responsibilities regarding face-to-face contact in Section 7.6: Service Plan Implementation and Monitoring
  • Added Section 9.7: Case Record Reviews and Section 9.8: Data Driven Reviews
  • Updated Table 3 – Medicaid Waiver Services, Codes, and Rates, Effective August 1, 2018
  • Removed monthly limit for RHS Daily participants in the Limitations section for Community-Based Habilitation – Individual 

Surgical Services (see the module for a complete list of updates)
  • Added information in the Multiple Procedures section about surgeons serving as assistant surgeons for each other when a member requires two procedures by two different surgical specialists
  • Updated documentation requirements and the modifiers for when an assistant is needed in the Assistant Surgeons section
  • Added information to the Split Care section, including that the IHCP recognizes split care only for the intraoperative and postoperative components
  • Added the Plastic or Reconstructive Surgery section and subsections
  • Added the Maxillofacial Surgery section and subsections
  • Added the Cleft Lip and Cleft Palate section
  • Added the Sinus Surgery section and subsections
  • Added the Urethral Bulking Agents for Stress Urinary Incontinence section
  • Updated the Bariatric Surgery and Revisions section and added subsections
  • Added the Transplant Procedures section and subsections
  • Updated the Implantable DME section and subsections, including adding the Artificial Heart and Cochlear Implants subsections 

Radiology Services
  • Removed examples of situations not typically requiring radiology from the Coverage and Limitations for Radiology Services section
  • Updated the Billing and Reimbursement for Radiology Services section, including: 
    • Clarified and expanded billing and reimbursement information for professional and technical components 
    • Incorporated information from the former Angiographic Procedures section 
    • Clarified the note regarding hospice members
  • Added the Liver Elastography section 
    • Updated the PET Scans section, including:Added a reference to the new Radiology Services Codes 
    • Updated the billing instructions and provided a reference to section with full instructions
  • Updated billing instructions in the Proton Treatment section
  • Removed the Radionuclide Bone Scans section

Code Table and Other Updates
The following code table updates are now available on the Code Sets page:

Radiology Services Codes
  • New document with the following code tables: 
    • Procedure Codes for Positron Emission Tomography (PET) Scans for Myocardial Perfusion 
    • ICD-10 Diagnosis Codes Supporting Medical Necessity for PET scans for Myocardial Perfusion 
    • Procedure Codes for PET Scans for Refractory Seizures 
    • ICD-10 Diagnosis Codes Supporting Medical Necessity for PET Scans for Refractory Seizures 
    • Procedure Codes for PET Scans for Cancer (Breast, Whole Body, or Regional Head and Neck) 
    • ICD-10 Diagnosis Codes Supporting Medical Necessity for PET Scans for Cancer (Breast, Whole Body, or Regional Head and Neck)

Surgical Services Codes
  • All codes were reviewed
  • Removed service-specific procedure code tables
  • Added the following table: 
    • Implantable Durable Medical Equipment (DME) Separately Reimbursable in the Outpatient Setting

Check out these resources to stay up-to-date with the most recent changes at the IHCP. 


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