IHCP Updates - Published 3/7

The Indiana Health Coverage Programs (IHCP) posted the following important information to the provider website at in.gov/medicaid/providers on March 7, 2019 (unless alternate date is noted).
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News and Announcements (home page)

• Settlement in Hepatitis C agent lawsuit requires IHCP to interpret prior authorization criteria
• IHCP updates Professional Fee Schedule and clarifies how to find ASC pricing on the provider website (March 6, 2019)

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Bulletin
BT201916 – Settlement in Hepatitis C agent lawsuit requires IHCP to interpret prior authorization criteria
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Provider Reference Module
Durable and Home Medical Equipment and Supplies (see the module for a full list of changes)

• Updated the Prior Authorization Requirements for Medical Equipment and Supplies section
• Clarified information in the Rental Versus Purchase section
• Clarified information in the Capped Rental Items section and added that claims for the rental of capped items for more than 15 continuous months are denied
• Expanded the information in the Repair and Servicing section, and revised the statement regarding PA requirements for repairs of purchased DME and HME
• Expanded the information in the Replacement section, and clarified requirements for replacement of large DME and HME
• In the Customized Items section, added that customized items require PA and clarified information about items not considered to be customized
• Added the Routine Maintenance section
• Updated the note regarding LTC providers in the Medical Supplies section
• Added exercise and medical criteria in the Indications section for cranial remolding orthosis
• Updated Table 1 – Preferred Diabetic Supply List
• Updated the Continuous Glucose Monitors section and added subsections with authorization criteria
• Updated the Food Supplements, Nutritional Supplements, and Infant Formulas section, including adding information about LTC facility billing
• Updated the Gloves section and its subsections, including adding examples of covered and noncovered situations

Code Tables
The following code table updates are accessible from the Code Sets page:
Durable and Home Medical Equipment and Supplies Codes

• All codes were reviewed.
• See BT201866 for details about updates to the following tables:
• Covered Procedure Codes for Durable Medical Equipment (DME) Providers (Specialty 250)
• Covered Procedure Codes for Home Medical Equipment (HME) Providers (Specialty 251)
• The following tables were removed:
• Drug-Related Medical Supplies and Medical Devices Reimbursed as Fee-for-Service for Hoosier Healthwise Prior to January 1, 2017
• Procedure Codes for Parenteral Nutrition Solution/Kit/Pump
• Procedure Codes for Enteral Nutrition Formula/Kit/Tubing/Pump
• Procedure Codes for Trend Event Monitoring and Apnea Monitors

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