The Indiana Health Coverage Programs (IHCP) reimburses nursing facilities and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) for long-term care (LTC) services provided to eligible IHCP members with an applicable level-of-care (LOC) determination. All applicants to Medicaid-certified nursing facilities in Indiana are entered in the state’s web-based Preadmission Screening and Resident Review (PASRR) system. See the PASRR page for more information.
The IHCP has safeguards in place to protect the health and welfare of institutionalized members, as well as all individuals with mental illness or intellectual or developmental disability. The reviews described on this page assist the Indiana Family and Social Services Administration (FSSA) in meeting its responsibilities under the law while effectively monitoring, processing and ensuring appropriate payment of LTC facility claims.
For more information about IHCP policies and procedures for LTC providers, including billing and reimbursement information, see the Long-Term Care provider reference module.
Minimum Data Set Reviews
All Medicare and Medicaid certified nursing facilities (NFs) are required to conduct an assessment of individual NF residents' needs on a periodic basis, in accordance with state and federal requirements. The minimum data set (MDS) resident assessment instrument (RAI) is required for use for those periodic assessments. The FSSA leverages the MDS RAI as the basis for determining resident acuity and nursing resource needs for the Medicaid NF reimbursement system. The MDS resident assessment information is collected and processed for use in the NF reimbursement system by an independent state contractor, Myers and Stauffer.
The FSSA also contracts with Myers and Stauffer to complete periodic MDS reviews for all residents of Medicaid-certified NFs in Indiana, regardless of payer source. The purpose of the review is to provide oversight of MDS submissions and ensure that the IHCP is reimbursing for the appropriate classification of submitted MDS resident assessment, in accordance with the following manuals:
- MDS and Case Mix Index Supportive Documentation Manual, available from the Case Mix and Related Services page of the Myers and Stauffer website at myersandstauffer.com
- Minimum Data Set (MDS) Resident Assessment Instrument (RAI) Manual, available from the Resident Assessment Instrument page of the CMS website at cms.gov
The Myers and Stauffer Long-Term Care review team (LTC review team) may also perform reviews of LOC and PASRR documentation for NF residents.
RAC Audits
The IHCP Recovery Audit Contractor (RAC) performs comprehensive reviews of financial activity for each Medicaid-enrolled resident in IHCP extended care facilities, including nursing facilities and ICF/IIDs as well as residential care facilities and psychiatric residential treatment facilities (PRTFs).
For more information about RAC audits, see the Medicaid Recovery Audit Contractor (RAC) Overview page on this site.
Additional Support
Providers with questions about long-term care may refer to the following resources for assistance.
Myers and Stauffer Help Desk
For questions related to the Medicaid MDS reviews and supportive documentation requirements, call:
Indiana Help Desk
317-816-4122
inhelpdesk@mslc.com
For questions related to record sequencing, error messages, assessment corrections, Resident Roster Reports and Medicaid Resource Utilization Group (RUG-IV) calculations associated with all OMPP reports, call 317-816-4122.
Gainwell Technologies Long-Term Care Help Desk
For questions related to correcting erroneous autoclosures, call the Long-Term Care Help Desk at 317-488-5094, or email at inxix_ltc@gainwelltechnologies.com.
Indiana Department of Health
MDS/RAI Clinical Help Desk
For questions related to the clinical definition, intent, completion or interpretation of the MDS and RAI, contact the MDS/RAI Clinical Help Desk via email at LTCRulesandRegulations@health.in.gov.
MDS/OASIS Technical Help Desk
For questions related to all Centers for Medicare & Medicaid Services (CMS) reports, including error messages, the Initial Feedback Report and Final Validation Report, user IDs and passwords for the CMS, and difficulties with transmission to the CMS, contact the MDS/OASIS Technical Help Desk at 317-233-7206.