405 Ind. Admin. Code 14-6-14

Current through October 9, 2024

Section 405 IAC 14-6-14 - Continued of care

Authority: IC 12-15-1-10

Affected: IC 12-15-5; IC 12-15-12

Sec. 14.

(a) In the first year of the PathWays program, an MCO shall provide for one hundred twenty (120) calendar days of continued of care for all pre-existing drug regimens for new PathWays members enrolled with the MCO.

(b) After the first year of the PathWays program, an MCO shall provide for ninety (90) calendar days of continued of care for all pre-existing drug regimens for new PathWays members enrolled with the MCO.

(c) In the first year of the PathWays program, an MCO shall provide continued of care for the authorizing Medicaid state plan services, as well as choice of providers for one hundred twenty (120) days. For purposes of this requirement, when receiving PathWays members from another MCO, FFS, or commercial coverage, the MCO shall honor the previous care authorizations for one (1) of the following durations, whichever comes first:

(1) One hundred twenty (120) calendar days after the member's enrollment date with the MCO.

(2) The rest of the earlier authorized dates of service.

(3) Until the approved units of service are finished.

(d) In the first year of the PathWays program, an MCO shall provide continued care for a member who meets HCBS level of care and has an existing care plan approved by the office or another MCO, by:

(1) honoring the existing care plan for ninety (90) calendar days after the date of the member's enrollment with the MCO; and

(2) allowing a member to continue with the member's current medical or HCBS provider if the provider is not a contracted provider with the MCO for at least one hundred twenty (120) days, as long as the provider is enrolled with the office as a provider.

(e) After the first year of the PathWays program, the continued care provided under subsection (c) is ninety (90) days after the date of the member's enrollment with the MCO, while the time frame for honoring an existing care plan remain the same as identified in subsection (d)(1).

(f) Skilled nursing facilities are an exception to the continued care periods otherwise identified in this section. An MCO shall provide for continued care at a member's skilled nursing facility for the duration of the program, as long as the member chooses to remain in the facility and continues to meet skilled nursing facility level of care.

405 IAC 14-6-14

Office of the Secretary of Family and Social Services; 405 IAC 14-6-14; filed 8/30/2024, 11:42 a.m.: 20240925-IR-405240180FRA