Care Select

Overview

The Office of Medicaid Policy and Planning (OMPP) contracts with care management organizations (CMOs) to perform the care management, prior authorization, and utilization management of physical, behavioral, and transportation services for members in Care Select. The CMO manages care for Care Select members through its network of primary medical providers (PMPs), specialists, and other providers who are contracted on behalf of the State by the CMO.

The goals of Care Select include the following:

  • To increase understanding regarding medical conditions, treatments, and medications
  • To provide more effective and ongoing health promotion and disease prevention activities
  • To more effectively tailor benefits to the individual's needs by using evidence-based medicine and best practices
  • To improve the quality of care and health outcomes for the Indiana Care Select population
  • To appropriately use community resources and reduce duplication of resources
  • To reduce emergency room (ER) visits and avoidable hospitalizations
  • To manage the growth of healthcare costs for the Indiana Care Select population
  • To provide cost savings

Population Served by Care Select

Care Select serves the following populations (aid categories):

  • Aged
  • Blind
  • Physically and mentally disabled
  • Wards of the court and foster children
  • Children receiving adoptive services

To be eligible, a member must be diagnosed with at least one of the following diseases. The PMP reports the qualifying disease state to the enrollment broker (EB) as part of Care Select eligibility determination.

  • Asthma
  • Chronic kidney disease (non-dialysis)
  • Congestive heart failure (CHF)
  • Coronary artery disease (CAD)
  • Depression
  • Diabetes mellitus (DM)
  • Serious emotional disturbance (SED)
  • Severe mental illness (SMI)
  • Co-morbidity of diabetes mellitus (DM) and hypertension (HTN)
  • Co-morbidities and/or combinations of any of these disease states

The following members are excluded from Care Select:

  • Members on spend-down
  • Members dually eligible for Medicare and Medicaid
  • Individuals with qualified Medicare beneficiaries (QMB) or special low-income Medicare beneficiaries (SLMB) only (not in combination with another aid category)
  • Persons in nursing homes, intermediate care facilities for the mentally retarded (ICF/MRs), and State-operated facilities
  • Members in the hospice program
  • Undocumented aliens
  • Members enrolled in the 590 Program
  • Members enrolled in the Breast and Cervical Cancer Treatment Services Program
  • Members who get room and board assistance
  • Members on M. E. D. Works (Medicaid for Employees with Disabilities)
  • Members receiving select nondisabled home and community-based services (HCBS).
  • Members in Hoosier Healthwise (HHW) or Healthy Indiana Program (HIP)

NOTE: If these members' circumstances change, they may become eligible for Care Select - for example, if a member survives breast cancer and is no longer part of Breast and Cervical Cancer Treatment Services Program; however, members must meet the population and disease-state criteria to enter Care Select.

Primary Medical Providers (PMP)

Care Select members are linked to a Care Select-enrolled PMP who provides or arranges for most of the member's medical care. Care Select has five standard PMP categories:

  • Family practice
  • General practice
  • Internist
  • Pediatrician
  • Obstetrician/gynecologist

In addition, any physician specialist such as a cardiologist, psychiatrist, urologist, and so forth, may serve as a PMP. The PMP receives a monthly administration fee for each member actively assigned to the PMP.

Enrolling as a Care Select Provider

Services are reimbursed on a fee-for-service basis. To be reimbursed for services provided to Care Select members, you must first be enrolled with the Indiana Health Coverage Programs (IHCP) and contracted with the CMO to which the member belongs. After successfully enrolling in the IHCP, contract with one or more CMOs:

The CMO will require a signed Care Select Provider Agreement Addendum and the appropriate paperwork to provide information about you and your location.

More Information

For more information about Indiana Care Select, see the following resources: