The Indiana Family and Social Services Administration (FSSA) recently announced the 2017 managed care contractors that will administer health care coverage for Hoosiers enrolled in the Healthy Indiana Plan and Hoosier Healthwise programs.
FSSA renewed contracts with Anthem Blue Cross and Blue Shield, MDwise Inc., and Managed Health Services of Indiana for a maximum of six years. As well, CareSource Indiana was also newly selected to help administer the FSSA programs and provide an additional option to members. Providers also will need to submit enrollment paperwork to be in network with the new plan. By Indiana law, Medicaid contracts are limited to four years, with two optional one-year extensions, thus requiring re-procurement at least every six years.
In this new round of contracts with managed care vendors, FSSA renegotiated the terms to “improve the value Hoosier taxpayers receive for the dollars spent in the Medicaid managed care entity (MCE) contracts.” Among the changes, the new contracts will:
- Increasingly tie payments to outcomes through gradually raising the amount withheld and awarded based on outcomes from 2 percent in the first year to 5 percent in year six.
- Add new requirements allowing the state to partner with MCEs to identify and investigate any fraudulent activity among health care providers or members.
- Include pharmacy and dental services as part of the Hoosier Healthwise program to better align with the current Healthy Indiana Plan and Hoosier Care Connect programs.
“We used this opportunity to really take a fresh look at what we expect the health plans to deliver and the value Hoosier taxpayers are getting from these contracts considering the more than $3 billion a year we are spending on them,” said Joe Moser, Indiana Medicaid Director, in a prepared statement. “We have made key changes to ensure Indiana Medicaid members are getting better coordinated health care and customer service from their Medicaid plan. We are confident we have selected the best managed care entities to meet or exceed these expectations.”
Contracted MCEs are paid based on a per-member per-month capitated payment. Additionally, they receive compensation through withheld payments, which are awarded to those plans who are successful at coordinating care and keeping members healthy, and through savings made by identifying and eliminating fraud and abuse.
An open enrollment period will be offered for Hoosier Healthwise members to switch plans, if desired, later this year. As well, Healthy Indiana Plan members will be able to switch plans once a year at their eligibility renewal.
— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.
