State Demonstrations Group March 20, 2020 Allison Taylor Medicaid
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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-25-26 Baltimore, Maryland 21244-1850 State Demonstrations Group March 20, 2020 Allison Taylor Medicaid Director Indiana Family and Social Services Administration 402 W. Washington Street, Room W461, MS25 Indianapolis, IN 46204 Dear Ms. Taylor: The Centers for Medicare & Medicaid Services (CMS) is issuing technical corrections to the Indiana section 1115 Medicaid demonstration, entitled “Healthy Indiana Plan” (HIP) (Project Number 11-W- 00296/5), the amendment for serious mental illness (SMI) was approved on December 20, 2019, under the authority of section 1115(a) of the Social Security Act (the Act). CMS has issued the following technical corrections to the Special Terms and Conditions (STC), in accordance with Indiana’s request: • Removed the language “and withdrawal management services” from the expenditure authority description for inpatient treatment for individuals with serious mental illness (SMI). This treatment modality does not apply to individuals receiving short-term treatment for SMI in facilities that meet the definition of an institution of mental disease (IMD). • Updated the budget neutrality table in Section XV STC 3 as follows (changes are italicized): MEG Trend Rate DY 4 DY 5 DY 6 SMI FFS 4.6% $5,121.27 $5,356.85 SMI Managed 4.6% $1,046.32 $1,094.45 Care To reflect the agreed terms with the state, CMS has incorporated the technical changes into the latest version of the STCs. Please find enclosed the updated STCs. Your project officer for this demonstration is Ms. Rachel Nichols. She is available to answer any questions concerning your section 1115 demonstration. She can be contacted at [email protected]. Page 2 – Allison Taylor Sincerely, 3/20/2020 X Andrea J. Casart Signed by: Andrea J. Casart -A Andrea J. Casart Director Division of Medicaid Expansion Demonstrations Enclosure cc: Mai Le-Yuen, State Monitoring Lead, Medicaid and CHIP Operations Group CENTERS FOR MEDICARE & MEDICAID SERVICES WAIVER LIST NUMBER: No. 11-W- 00296/5 TITLE: Healthy Indiana Plan (HIP) AWARDEE: Indiana Family and Social Services Administration (FSSA) All requirements of the Medicaid program expressed in law, regulation, and policy statement, not expressly waived in this list, shall apply to the demonstration populations. The demonstration will operate under these waiver authorities beginning February 1, 2018. The waivers will continue through December 31, 2020, unless otherwise stated. As discussed in the Centers for Medicare & Medicaid Services (CMS) approval letter, the Secretary of Health and Human Services has determined that this section 1115 demonstration, including the waivers described below, is likely to assist in promoting the objectives of title XIX of the Social Security Act. The following waivers shall enable Indiana to implement the HIP Medicaid section 1115 demonstration. These waivers may only be implemented consistent with the approved special terms and conditions (STC). Title XIX Waivers 1. Premiums Section 1902(a)(14) insofar as it incorporates Section 1916 and 1916A To the extent necessary to enable the state to charge monthly premiums, as described in the STCs. 2. Reasonable Promptness Section 1902(a)(8) To the extent necessary, as described in the STCs, to enable Indiana to start enrollment in HIP Plus on the first day of the month in which an individual makes their initial contribution to the POWER account, or, for individuals with incomes at or below 100 percent FPL who fail to make an initial POWER account payment within 60 days following the date of invoice, the first day of the month in which the 60 day payment period expires, except for individuals who are found eligible through presumptive eligibility. Healthy Indiana Plan February 1, 2018 through December 31, 2020 Amendment Approved: December 20, 2019 Page 1 of 3 3. Provision of Medical Assistance Section 1902(a)(8) and 1902(a)(10) To the extent necessary to enable Indiana to suspend eligibility for, and not make medical assistance available to, beneficiaries who fail to comply with community engagement requirements, as described in the STCs, unless the beneficiary is exempted as described in the STCs. 4. Eligibility Section 1902(a)(10) and 1902(a)(52) To the extent necessary to enable Indiana to make a determination of ineligibility, and terminate eligibility for, beneficiaries who are in a suspension of coverage for failure to meet the community engagement requirements described in the STCs on their redetermination date, unless the beneficiary meets the requirement or is exempted as described in the STCs during the month of redetermination. To the extent necessary to enable Indiana to prohibit reenrollment, and deny eligibility, for up to six months, for individuals with income over 100 percent of the FPL who are disenrolled for failure to make POWER Account premium contributions within sixty (60) days of the date of invoice, subject to the exceptions and qualifying events described in the STCs. To the extent necessary to enable Indiana to prohibit reenrollment, and deny eligibility, for up to three months following the end of the 90-day reconsideration period for individuals who are disenrolled for failure to provide the necessary information for the state to complete an annual redetermination, subject to the exceptions and qualifying events described in the STCs. 5. Methods of Administration Section 1902(a)(4) insofar as it incorporates 42 CFR 431.53 To the extent necessary to relieve Indiana of the requirement to assure transportation to and from medical providers for HIP demonstration populations. No waiver of methods of administration is authorized for pregnant women, individuals determined to be medically frail, and section 1931 parents and caretaker relatives. 6. Comparability Sections 1902(a)(17) and 1902(a)(10)(B) To the extent necessary to enable the state to vary cost sharing requirements for beneficiaries for cost sharing to which they otherwise would be subject under the state plan, such that beneficiaries who are in HIP Plus will be charged only one co-payment (for non-emergency use of the emergency department) and individuals who are in HIP Basic will be subject to copayments at Medicaid permissible levels, as described in the STCs. Healthy Indiana Plan February 1, 2018 through December 31, 2020 Amendment Approved: December 20, 2019 Page 2 of 3 To the extent necessary to enable Indiana to vary premium requirements, as described in the STCs, for different HIP Plus program beneficiaries based on income and on tobacco use, and in a manner consistent with all otherwise applicable law. 7. Retroactivity Section 1902(a)(34) To enable the state not to provide three months of retroactive eligibility for beneficiaries receiving coverage through the HIP program as described in the STCs, except for pregnant women. Healthy Indiana Plan February 1, 2018 through December 31, 2020 Amendment Approved: December 20, 2019 Page 3 of 3 CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITIES NUMBER: No. 11-W- 00296/5 TITLE: Healthy Indiana Plan (HIP) AWARDEE: Indiana Family and Social Services Administration (FSSA) Under the authority of section 1115(a)(2) of the Social Security Act (the Act), expenditures made by the state for the items identified below (which would not otherwise be included as matchable expenditures under section 1903 of the Act) shall, for the period beginning February 1, 2018 through December 31, 2020, unless otherwise specified, be regarded as matchable expenditures under the state's Medicaid state plan, but are further limited by the special terms and conditions (STC) for the HIP section 1115 demonstration. As discussed in the Centers for Medicare & Medicaid Services (CMS) approval letter, the Secretary of Health and Human Services has determined that this section 1115 demonstration, including the expenditure authorities described below, is likely to assist in promoting the objectives of title XIX of the Social Security Act. The following expenditure authorities shall enable Indiana to implement the HIP section 1115 demonstration: 1. Managed Care Expenditures. Expenditures under contracts with managed care entities that do not meet the requirements in section 1903(m)(2)(A) of the Act specified below. Indiana's managed care organizations (MCO) participating in the demonstration will have to meet all the requirements of section 1903(m) except the following: a. Section 1903(m)(2)(A)(vi) of the Act insofar as it requires compliance with requirements in section 1932(a)(4) of the Act and 42 CFR 438.56(c)(2)(i) that enrollees be permitted an initial period to disenroll without cause, except as described in the terms and conditions. b. Section 1903(m)(2)(A)(vi) of the Act insofar as it requires compliance with requirements in section 1932(a)(4) of the Act and 42 CFR 438.56(g) that automatic MCO reenrollment occur only if the beneficiary’s disenrollment was due to a Medicaid eligibility lapse of two months or less, as described in the terms and conditions. 2. Residential and Inpatient Treatment for Individuals with Substance Use Disorder. Expenditures for otherwise covered services furnished to otherwise eligible individuals who are primarily receiving treatment and withdrawal management services for substance use disorder (SUD) who are short-term residents in facilities that meet the definition of an institution for mental diseases (IMD). Healthy Indiana Plan February 1, 2018 through December 31, 2020 Amendment Approved: December 20, 2019 Page 1 of 2 3. Inpatient Treatment for Individuals with Serious Mental Illness. Expenditures for Medicaid state plan services furnished to eligible individuals who are primarily receiving short-term treatment services for a serious mental illness (SMI) in facilities that meet the definition of an IMD. Healthy Indiana Plan February 1, 2018 through December 31, 2020 Amendment Approved: December 20, 2019 Page 2 of 2 CENTERS FOR MEDICARE & MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS NUMBER: 11-W- 00296/5 TITLE: Healthy Indiana Plan (HIP) AWARDEE: Indiana Family and Social Services Administration I.