Indiana PathWays for Aging – managed long-term services and supports (MLTSS)

Indiana PathWays for Aging program benefits

Anthem’s MLTSS Care and Support Coordination teams work to support member choice and independence by providing access to and coordination of services and supports. This allows members to live with dignity in their community or long-term care facility, improving their quality of life and achieving their self-identified goals.

To ensure members’ needs are being met, MLTSS staff work closely with our Case Management and Behavioral Health teams, Primary Medical Provider (PMPs), and Indiana PathWays for Aging MLTSS providers to identify and connect with members who could benefit from MLTSS services. For more information on MLTSS requirements and covered benefits, please refer to your provider manual or access the FSSA page for Indiana PathWays for Aging covered benefits.

Indiana PathWays for Aging 

Exclusions

• All individuals who are 60 years of age or older in the target eligibility categories will be included unless they meet one of the following exclusions:
• Individuals who are only partial benefit dually eligible (Qualified Medicare beneficiary (QMB)-only, specified low-income Medicare beneficiary (SLMB)-only, Qualifying Individual (QI), or Qualified disabled working individual (QDWI)
• Individuals who are Department of Disability and Rehabilitative Services (DDRS) waiver recipients
• Program of All Inclusive Care for the Elderly (PACE) members
• Resident care assisted program (RCAP) members
• End stage renal disease (ESRD) 1115 members
• Breast and cervical cancer (MA-12) eligible members
• Individuals who are Traumatic brain injury (TBI) waiver recipients
• TBI out-of-state placements
• Intellectual or developmental disability (IDD) residents of intermediate care facilities (ICF) (in other words, group homes)
• Emergency services only (ESO) members
• Family planning only members
• Members with modified adjusted gross income (MAGI) eligibility in Healthy Indiana Plan (HIP) or Hoosier Healthwise
• Individuals who are registered members of a federally recognized tribe that are eligible for HIP but have opted out into non-HIP, Fee for Service (FFS) coverage; in other words, Medicaid for Native Americans (MANA)
• Anyone 59 years of age or younger (including those on the Aged and Disabled Waiver)

Fee for Service (FFS)

Eligible Medicaid enrollees that are age 59 and under, who are on the Aged and Disabled Waiver, will receive waiver services by Department of Disability and Rehabilitative Services (DDRS) in conjunction with Fee for Service (FFS).  Individuals who are hospice recipients prior to age 60 will remain in FFS unless they choose to opt-in to Indiana PathWays for Aging.

Individuals who are in the American Indian/Alaskan Native population and in an Indiana PathWays for Aging eligible category may voluntarily enroll in Indiana PathWays for Aging. If they do not choose to opt-in, these enrollees will remain in FFS.

For information on the Department of Disability and Rehabilitative Services (DDARS), please visit the Family and Social Services Administration’s (FSSA) page dedicated to DDARS.

Indiana PathWays for Aging Provider Services Helpline

Please reach out via phone or email to verify eligibility or refer a member for LTSS or LTC services.

Hospice care

Anthem covers hospice care to members meeting the criteria established in the IHCP Hospice Provider Module and applies to hospice in all settings, including:

  Routine home hospice care

  Continuous home hospice care

  Inpatient respite hospice care

  General inpatient hospice care

Service plan authorization

LTSS services are authorized as part of the person-centered planning process and development of the Integrated Care Plan and service plan. Care and Service Coordinators complete assessments and discuss needs with the member/family to determine the type, amount, duration and frequency of LTSS services.

Requests for authorizations for non-LTSS Home- and community-based services (HCBS) such as skilled nursing facility and nursing facility services (long-term), long-term acute care hospitalization and home health services may be made through Availity or via fax. Prior authorization requests may be faxed via the Anthem provider helpline.

Note: Facilities who have multiple members needing authorization for LTSS services should submit each request separately.

For more information about Indiana PathWays for Aging, please visit the Indiana FSSA site.

Required network participation documentation

To apply and participate in our network, providers must be able to supply the following materials when submitting their enrollment application through the portal:

  A copy of certification documents verifying that the provider is approved/certified through the Division of Aging and Indiana Medicaid

  Their primary email address and signatory name (if Anthem Blue Cross and Blue Shield does not already have this on file)

  Copy of Secretary of State letter authorizing provider to do business in the state of Indiana

  Copy of current Certificate of Insurance (COI)

  Copy of current W-9 form

Please note: All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete. If any of these materials are not included in the request, it will be deemed incomplete.

Post-enrollment application submittal process

Providers may view their application status following successful completion of the provider enrollment application within the portal dashboard. Then:

  Providers will be notified within 24 hours in the event the application is determined to be incomplete

  Anthem will process all applications within 30 calendar days of receipt of the completed application 

  Anthem will be notified upon receipt of the application and will reach out to the provider directly to review and confirm documents received

  Provider will receive a welcome letter, including their effective date once application is approved and loaded

Providers—new or part of an existing contract—will be effective with Anthem the first of the month following the receipt of a complete network participation request.

Please note:

  The effective date will be no sooner than the IHCP effective date

  The network participation receipt date is the date Anthem receives the provider’s complete network participation request electronically via an online portal, email, postal mail, or fax

  If you would prefer to submit your network participation application to us by email or postal mail, please download the form, complete the necessary application information, attach all necessary documentation and send the completed form to either:

• Email: INMLTSSProviderRelations@anthem.com
• Mail: Anthem Blue Cross and Blue Shield 220 Virginia Ave. IN0204-C497 Indianapolis, IN. 46204

If you have questions about the application or application process, you may contact Anthem via phone or email:

Do HCBS providers have to receive NCQA credentialing?

HCBS providers are excluded from the National Committee for Quality Assurance (NCQA) guidelines and therefore are not required to go through a traditional credentialing process. Instead, Anthem reviews the providers’ compliance with contractual requirements and ensures their eligibility to participate in the program—resulting in a deemed credentialed or “certified” status.

Provider contracting terminology

Enrollment – The process of loading a contracted and credentialed provider to all MCE internal systems, loading for claims payment, and loading to the provider directory (if applicable).

Credentialing – The process of reviewing the qualifications and appropriateness of a provider to join the health plan's network. Credentialing requirements and processes will follow NCQA guidelines.

Contracting/Negotiating – The process of the provider and MCE formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scope of services, etc.