Indiana

Nursing homes report payment disruption under managed care

Published

6 months ago

July 17, 2024

Nursing homes report payment disruption under managed care

(INDIANA CAPITAL CHRONICLE) — Jeff Huffman and other nursing home operators in the state say they haven’t been paid for their work since the state transitioned to managed care for certain Medicaid services on July 1 — marking two weeks in limbo for providers in the PathWays to Aging program.

“Basically, we rely on Medicaid reimbursements to keep our bills paid and keep operating. When all of a sudden the spigot gets turned off … that’s not going to last long for a small company,” said Huffman, the chief operations officer and chief development officer of The Strategies.

The Strategies operates five nursing home and rehabilitation facilities across the state in Muncie, Loogootee and Vincennes and employs roughly 300 Hoosiers to care for 230 residents.

“We’re two or three payrolls away from not being sure what we’re able to do,” Huffman said.

Paul Peaper, the president of the Indiana Health Care Association that represents the interests of operators like Huffman, said he’s heard from several facility teams about issues submitting claims.

“We’ve got three different managed care entities all with their own claims portals. As you’re submitting your claims into each of their claims portals, it looks different and reports out different information at different times,” Peaper said. “It’s trying to track — okay, is this claim pending? Is this claim denied? Is this claim rejected? Is this claim paid?

“But certainly there have been some challenges in that new system and some issues on the tech side of that to facilitate the claim.”

Adding more complications to the process, providers bill on different schedules — either weekly, twice a month or monthly. So while the first rounds of weekly providers have started billing, only a handful of bimonthly providers have started billing and monthly bills haven’t been submitted at all.

The Family and Social Services Administration (FSSA) tasked with overseeing the transition to managed care clarified that electronic nursing facility claims are not considered late until after 21 days.

During the transition period, FSSA has sent periodic updates to stakeholders about continuity of care, essentially saying that the Managed Care Entities (MCE’s) couldn’t withhold payments due to issues like prior authorizations.

The July 1st transition

Under managed care, the state contracts with major insurers Anthem Blue Cross and Blue Shield, Humana Healthy Horizons in Indiana and United Healthcare Community Plan to pay for and manage the health care of a Medicaid population. While the delivery model stabilizes expenses for states, enrollees have more mixed results.

Hoosiers enrolled in the Healthy Indiana Plan or traditional Medicaid were already under managed care but Indiana shifted its last major population — elderly and disabled Hoosiers utilizing long-term services and supports — on July 1.

Long-term care providers vigorously tried to delay — if not outright stop — the state’s managed care proposal, pointing to reported issues and costs in other states.

“At the heart of it, we’re dealing with an aged and disabled population in a small care setting. There’s just a real concern that putting any layer — a la a managed care entity — in between the care our members provide and their residents could delay or impact their care,” Peaper said.

Post-rollout, Huffman said he’s had varying levels of success communicating with the managed care entities about the denials.

“They’re aware of the issues, I just don’t think anyone’s aware of the ramifications. I think from an FSSA standpoint, from a (managed care entity) standpoint, this is just one of those things that happens in a transition. But a small, family-owned company like ours, with only five buildings, we don’t have $10 million laying around to get through expenses and payroll until (they) figure out how to start reimbursing correctly.

“I’ve talked to some of the biggest companies in the state and some of the smallest companies in the state, and we’re all feeling pretty stressed,” he concluded.

Prior to the transition, Huffman said that Indiana was “the most efficient Medicaid system in the country,” saying that facilities “could bill on a Friday and get paid on Wednesday or Thursday the following week.”

Peaper said much of that efficiency came from having just one portal for one payer — the state — and the processing seemed to be “near instantaneous.”

“So now that there is a lag or a delay — or it’s maybe not even populating … there’s immediate concern,” Peaper said. “That’s been, certainly, a real challenge.”

Additionally, long-term care facilities operate on thinner margins than their counterparts, Peaper said. Nursing homes and assisted living facilities are also the one segment of the health care industry workforce that has yet to recover from the COVID-19 pandemic.

“At the end of the day, the concern is: if the timely and steady payment systems don’t continue, then you’re going to have potential cash flow issues that impact your payroll,” Peaper said.

Potential remedies ahead?

State law does permit providers, including nursing homes, to petition for emergency relief in the first 210 days of the managed care transition period.

“The office of Medicaid policy and planning shall establish a temporary emergency financial assistance program for providers that experience financial emergencies due to claims payment issues while participating in the risk based managed care program,” Senate Enrolled Act 132 reads.

An excerpt of Senate Enrolled Act 132 from 2024 concerning payment failures in the first weeks after the managed care transition.

Under the law, a financial emergency is when claims denials exceed 15% during one billing cycle or when a provider goes 21 days without payment for a minimum of $25,000 in aggregate claims.

Additionally, the state’s Medicaid director has the discretion to categorize something as a financial emergency for providers. To qualify, providers must have participated in the claims testing process and submit relevant documentation to FSSA. The state agency then has seven days to respond and — if the circumstances qualify as a financial emergency — then the office “shall” direct the managed care entities to provide an emergency payment within seven days.

However, that payment will only cover 75% of the average claim — “which is kind of like giving the insurance company a 25% discount,” Huffman said.

The insurers then “shall reconcile the temporary emergency assistance payment funds with actual claims payment amounts,” according to the law.

The law also authorizes a workgroup, made up of MCEs, state officials and providers — including nursing homes, Area Agencies on Aging and home health services — to address claims issues.

“Everyone’s trying to make sure that these early issues — as they’re identified — are resolved quickly,” said Peaper.

Peaper isn’t a member but the IHCA does have a representative with the claims workgroup.

Still, he expressed caution when monitoring the rollout of PathWays, noting the importance of getting the program right considering the ramifications on providers and residents.

“I think over the next week or two, we’ll have an answer to the question on how it’s going,” Peaper said.

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Indiana

Latest forecast: How much snow will Indiana get Friday? When will it fall?

Published

21 minutes ago

January 10, 2025

Press Room

Latest forecast: How much snow will Indiana get Friday? When will it fall?

The Bloomington area will get more snow today. Here’s how much the National Weather Service now expects to fall and when.

How much snow will Monroe County get Friday?

Aaron Updike, meteorologist with the National Weather Service in Indianapolis said the Bloomington area is expected to get between 2 and 4 inches of snow.

Southern parts of Indiana could see even more, with Bedford projected to get close to 4 inches and areas closer to Louisville possibly seeing 6 inches.

When will the snow fall today in the Bloomington area?

Updike said the NWS expects the snow to begin around 11 a.m. and end about 12 hours later. However, he said, the day will bring periods of lulls and peaks, though those are more difficult to predict.

Generally, Updike said, the heaviest accumulation will occur from mid-to-late afternoon, around 2 to 6 p.m.

He urged commuters to take extra time and care, as they may experience slippery roads and sidewalks on their way home.

What kind of snow will be falling in Indiana on Friday?

Updike said the snow should be light and fluffy. The NWS expects only light wind, with gusts of 10 to 15 mph, which means the area should not expect to see much drifting snow.

How cold will it get in the Bloomington area tonight?

The NWS projects that the cloud cover will hang around the area for a while, which will contribute to temperatures falling only to about 20 degrees.

Is there a chance of snowmelt any time soon in Indiana?

Updike said temperatures should rise to near freezing on Sunday, and the area also might see some pockets of sunshine, which should help melt some snow especially on pavement and roads.

However, he said temperatures will not rise enough in the next few days to melt all of the snow.

Boris Ladwig can be reached at bladwig@heraldt.com.

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Indiana

Indiana Fever linked to trade for 2-time All-Star

Published

9 hours ago

January 10, 2025

Press Room

Indiana Fever linked to trade for 2-time All-Star

Satou Sabally was immediately linked to the New York Liberty after announcing that she has played her final game for the Dallas Wings during Unrivaled Basketball’s media availability on Thursday. However, the Indiana Fever are another team who were recently mentioned as a possible trade suitor for the two-time All-Star, via Chloe Peterson of indystar.com.

Satou Sabally announced during Unrivaled media availability that she will not be returning to Dallas, and she has already communicated that with the franchise.
She could be a huge target for the Fever, if Indiana is able to put together a lucrative enough trade package.
— Chloe Peterson (@chloepeterson67) January 9, 2025

Sabally’s announcement was the primary discussion swirling around the WNBA world on Thursday. The Wings will have the option to core Sabally, which will likely lead to a trade given her comments on Thursday. The chances of Dallas simply letting Sabally walk in free agency while passing on the option to core her are slim, but Sabally will likely still end up with a new team for the 2025 season.

The question is which team will she end up with? The defending-champion Liberty have Satou’s sister Nyara Sabally on the roster, so that may catch Satou’s attention. Joining an up-and-coming team like the Fever may also entice Satou, though.

There will be other candidates aside from Indiana and New York, of course. The Fever and Liberty both make sense as possible trade destinations for Satou Sabally, however. At only 26 years old, Sabally features the ceiling of a true superstar. If she can stay healthy, Sabally can significantly impact any team she joins.

Fever could trade for Satou Sabally

Sabally would add more star-power alongside Caitlin Clark in Indiana. Clark instantly became one of the most popular players in the WNBA in her rookie season during the 2024 campaign. Adding a star or two would help Indiana, though.

The Fever reached the postseason but were quickly eliminated in the first round. Indiana’s future remains bright, but they need to upgrade the roster around Clark. Sabally would turn the Fever into serious contenders.

If the Liberty find a way to acquire Sabally, however, the rest of the WNBA may be in trouble. With Breanna Stewart, Sabrina Ionescu and Jonquel Jones already on the roster, the Liberty project to be a championship contender once again. Assuming Stewart returns, the Liberty will compete with or without Sabally, but adding her to the roster would turn New York into a super-team.

Sabally’s announcement on Thursday is already changing the landscape of the WNBA. Rumors will continue to swirl over the next few months. If Sabally is traded, which is seemingly expected at this point, whichever team acquires her will take a big step forward.

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Indiana

Winter Weather Advisory issued for Friday morning across central Indiana

Published

17 hours ago

January 9, 2025

Press Room

Winter Weather Advisory issued for Friday morning across central Indiana

It was the coldest morning of the season so far across Central Indiana. For Indianapolis, we had our coldest temperatures since January 21, 2024 with a low of 5°. Crawfordsville and Columbus both had balmy lows of -8°. The clear skies, light winds and fresh snowpack allowed more heat to be released into the atmosphere. For tonight, it will still be chilly. But, we’ll have increasing clouds overnight ahead of our next snowmaker.

Tracking our next snow

This behemoth of a weather maker prompts winter headlines across several states across the United States. This includes Winter Storm Warnings from Raleigh, North Carolina through Dallas, Texas. Some spots in the northern Dallas suburbs could approach half an inch of snowfall overnight and into Friday. We’ll get our share of the snow Friday, too and it will come with commute impacts. Winter Weather Advisory kicks in at 4:00 a.m. Friday and sticks with us through 4:00 a.m. Saturday.

Most of the Friday morning commute should be okay. However, the tail-end of the commute could see some snow showers starting SW and west of Indianapolis. Because of this, a few slick spots can’t be ruled out but those will be few and far between. That activity will gradually spread NE throughout the morning and afternoon. It will become a steady snow from that time and stick around through the Friday p.m. commute. We anticipate that the p.m. commute will come with slowdowns and headaches. So plan ahead!

The snow will taper through the evening before exiting into the overnight hours. When all is said and done, most will end up with 2-4″ of snow. This will be the story through much of Central Indiana. Less snow likely further NW but more possible south and southeast. Those spots could approach 5.0″ in spots.

This will continue what has been a busy winter season for Central Indiana. Since October 1st, Indianapolis has 12.0″ of snow under its belt. Compared to last year’s 2.2″ to date, we have 10″ more snow overall. It’s the most snow to date in 11 years. A typical season (October 1st to May 1st) sees 25.5″ for Indianapolis.

Cold (and more snow) follow

The cold temperatures aren’t going anywhere following Friday’s snow. High temperatures in the 20s will be around through the weekend. We’ll “peak” with highs near 30° Sunday ahead of a frontal boundary. This clipper system could bring some snow showers Sunday night into Monday but those chances are low. If any snow were to occur, amounts would be low.

That will pass through late Sunday into Monday which will give us our next cold blast. Temperatures will tumble during the day Monday setting the stage for more cold. Highs in the teens on Tuesday and Wednesday as we remain dry. Lows in the single digits with subzero wind chills are also likely.