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Payment & Reimbursement

Your Guide to Payment & Reimbursement Policy

Navigating payment and reimbursement policy for Indiana’s senior living sector.

Obtaining payment for the important services provided to Indiana’s elderly and disabled is critical to the success of communities and the hands-on care provided each and every day.  IHCA/INCAL has led the way in the development of Medicaid policy and advocacy, while AHCA/NCAL concentrates on policy and advocacy in the Medicare program, to help skilled nursing facilities and assisted living communities to receive compensation for their services.

CMS Releases Proposed Medicare Eligibly and Coverage Changes

On April 27, 2022, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register a proposed rule entitled, Medicare Program; Implementing Certain Provisions of the Consolidated Appropriations Act, 2021 and Other Revisions to Medicare Enrollment and Eligibility Rules. The Notice of Proposed Rulemaking (NPRM) includes proposed changes to Medicare eligibility, including elimination of the Medicare coverage waiting period under specific circumstances, as well as new Special Enrollment Periods (SEP).

The NPRM also proposes extending months of immunosuppressive drugs for kidney transplant patients, simplification of Medicare enrollment forms and proposes to update various regulations that affect a state’s payment of the Medicare Part A and B premiums on behalf of low-income individuals (often known as “state buy-in”). These changes could better align the regulations with federal statute, policy and operations that have evolved over time.

Medicaid

Indiana’s Case Mix reimbursement system is complex and frequently changing. We track and provide guidance on a range of matters from Quality Assessment Fee to Payment Add-ons to Value based Purchasing to Cost Reports and Audits.

We also engage in policy development and expansion of Medicaid Long Term Services and Supports, Medicaid Waiver and Home and Community Based Services.

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Medicare

The intersection of quality and payment in the Medicare program continues to advance at a rapid pace. We help members learn and adapt to these changes. Data and guidance on the Patient Driven Payment Model, SNF VBP, Quality Reporting Program, are available for members to access.

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I have appreciated the support of IHCA/INCAL for many years. Long-term and post-acute healthcare is complex and is constantly changing. The association provides a larger voice to the issues that plague our profession and hinder our ability to thrive. It also facilitates the needed tools, training and support for survival and success.


Mary Pankey RN HFA

Revenue Cycle Director , CarDon and Associates, Inc.

Upcoming Events

Workshop

Directors of Nurses (DON) Workshop

June 29, 2022 8:00 am - June 30, 2022 5:00 pm

Join us for a two-day in-person workshop that is designed for new Directors of Nursing or new Nurse Leaders in a SNF setting.

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Webinar

2022 Convention & Expo

August 15, 2022 3:00 pm - August 16, 2022 1:00 pm

Join us August 15-16 for our Annual Convention & Expo , a premier event for all LTC and AL professionals.

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IHCA/INCAL CONTACT

Elizabeth Eichhorn, eeichhorn@ihca.org