In October of 2014, PHA and the Indiana Family and Social Services Administration (FSSA) partnered to receive a 90/10 matching grant (for which Purdue pays the 10%) of $2.3M from the Centers for Medicare and Medicaid Services (CMS) to extend quality reporting services to Medicaid-eligible EPs until 2017. An additional $4.39M continued the program until September of 2020 as well as expanded the service offerings. In November of 2018, $12M from CMS allowed PHA and the FSSA to continue to provide direct, technical assistance to the state’s Medicaid providers for another two years as well as to address several clinical challenges impacting long-term care and the opioids crisis.
PHA lean tools help a rural, Southern Indiana FQHC surpass CMS Healthy People 2020 goals for diabetes management
Woodlawn Hospital earns Exemplary Practice status for successful TCM implementation
Lean Daily Improvement helps improve chronic care management enrollment at multiple sites
Multi-specialty healthcare provider establishes protocol to assess opioid prescriptions for older adult patients
Northeast Indiana primary care applies practice transformation tools to hit MIPS metrics
Are you eligible to participate in the Indiana Medicaid Promoting Interoperability program?
Who is considered a potential "Eligible Provider" (EP) under the Indiana Medicaid PI Program?
Physicians (MDs & DOs); Nurse Practitioners*; Certified Nurse Midwives; Dentists; and Physician Assistants who lead a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC).
*In Indiana, Pursuant to 848 IAC 4-1-3, Advanced Practice Nurse (Provider Type 09) includes Nurse Practitioner, Certified Nurse Midwife and Clinical Nurse Specialist. Advance Practice Nurses are inclusive of all types of Nurse Practitioners and all Nurse Practitioners are included under the Advance Practice Nurse designation.
How many Medicaid patients must an EP see per year to be eligible to participate in the program?
An EP must meet one of the following criteria:
- Have a minimum of 30% Medicaid patient volume.*
- Have a minimum of 20% Medicaid patient volume, and be a pediatrician.*
- Practice predominantly in a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC), and have a minimum 30% needy patient volume.
*The Children’s Health Insurance Program (CHIP) does not count toward the Medicaid patient volume criteria
What is the time frame for seeing the Medicaid patients?
Volume must be met during one of the following two time frames:
- The previous calendar year (from the program year). Ex.: For Program Year 2016, pull data from CY 2015,
- 12 months preceding attestation date. Ex.: For a Program Year 2016 attestation completion date of Nov. 8, 2016, pull data from Nov. 8, 2015-Nov. 7, 2016
What qualifies as "needy patient volume"?
Needy individuals are persons meeting any of the following criteria:
- They are receiving medical assistance from Medicaid or the Children’s Health Insurance Program (CHIP).
- They are furnished uncompensated care by the EP.
- They are furnished services at either no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.
In addition, an EP is considered to practice predominantly in an FQHC or RHC when an FQHC or RHC is the clinical location for over 50% of the EP’s total encounters over a period of six (6) months in the most recent calendar year.