10 Things Providers Should Know about HIP 2.0

As the news of federal approval of HIP 2.0 sank in for Hoosiers on Tuesday, additional details about the implementation of the new Medicaid expansion emerged. All of the basics about the new expansion are available in this overview. But the following are 10 additional facts you should know about HIP 2.0.

1. Reimbursement for most covered HIP benefits will continue at 100% of the current Medicare rate or 130% of the Medicaid allowable amount if a Medicare rate does not exist.
2. As part of the HIP 2.0 implementation, the Indiana Health Coverage Programs (IHCP) will increase reimbursement rates for providers billing physician services in its other programs as well (traditional Medicaid, Hoosier Healthwise, etc.). Effective for dates of service (DOS) on or after February 1, 2015, rates for most physician services will be adjusted, in aggregate, to 75% of the 2014 Medicare Physician Fee Schedule.
3. HIP 2.0 comprises four basic plans. As detailed in the earlier article, HIP Plus includes essential benefits plus enhanced coverage, like dental and vision, and uses Personal Wellness and Responsibility (POWER) Accounts that combine state and beneficiary contributions with no additional cost sharing. HIP Basic is the default plan for beneficiaries at or below 100 percent of the federal poverty level (FPL) who do not make POWER Account contributions. HIP Basic does not offer the enhanced benefits and requires cost sharing by beneficiaries. The HIP State Plan is available for individuals who qualify as low-income parents and caretakers, low-income 19- and 20- year-olds, and individuals with serious and complex medical conditions deemed “medically frail.” This option works within the same two-tier structure outlined above. And finally, HIP Link will allow HIP-eligible individuals who have access to qualifying employer-sponsored insurance plans to enroll in their employer’s plan and receive assistance paying the premiums and cost sharing associated with their employer sponsored plan. HIP Link will be implemented at a later date.
4. Eligibility is simple. Hoosiers ages 19-64 with incomes up to and including 138% of the federal poverty level (FPL) are eligible for the HIP Plans. The following members already enrolled in other IHCP programs will now be rolled into HIP 2.0:
   • All current HIP members
   • Nondisabled low-income parents and caretakers now enrolled in Hoosier Healthwise
   • 19- and 20-year-old members now enrolled in Hoosier Healthwise
   • Qualifying members now enrolled in the Family Planning Eligibility Program.
5. Coverage for members transitioning to the new HIP program will be effective February 1, 2015.
6. The recipient identification numbers (RIDs) for current HIP members who transition to the new HIP program will not change. Providers can continue to use the RID number for eligibility verification.
7. All members in new HIP plans will have a $2,500 deductible, as well as a POWER Account to pay the first $2,500 in claims for covered services. After the deductible is met, benefits will be paid by the member’s plan. By June 2015, all HIP members will have POWER Account debit cards that will allow them to use their POWER Account funds to pay the deductibles for approved services at the point of service. After the deductible is met, benefits will be paid without an annual or lifetime benefit cap.
8. All HIP members, regardless of plan, will be subject to copayments if they use the emergency department (ED) for nonemergency services. The copayment will be $8 for the first instance and $25 for each subsequent instance. Members may have their copayments waived if they call the 24-hour nurse hotline prior to visiting the ED and are advised to go. Also, members with emergency conditions that meet the prudent layperson standard or who are admitted to the hospital within 24 hours of their ED visit will not be responsible for paying the ED copayment amount.
9. HIP Plus coverage begins the first day of the month in which a member makes the first POWER Account payment. For members who do not make their POWER Account contributions and are transitioned to HIP Basic, coverage will begin the first day of the month in which the member’s POWER Account payment period expires. The member’s POWER Account payment period expires after 60 days.
10. All HIP members will be assigned to a managed care entity (MCE) – Anthem, MDwise, or MHS – as is done under the current HIP program. To receive reimbursement for services rendered to HIP enrollees, an IHCP provider should enroll as an in-network provider with one or more of the MCEs.

For more information, review the following IHCP Bulletins:

• http://provider.indianamedicaid.com/ihcp/Bulletins/BT201504.pdf
• http://provider.indianamedicaid.com/ihcp/Bulletins/BT201503.pdf

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.