Care Select
The State of Indiana has created a care management program,
Care Select, to serve the population of:
- The aged (excluding dually eligible members)
- The blind
- The physically and mentally disabled
- Wards and foster children
- Children receiving adoptive services
Beginning October 1, 2010, the Care Select program
focuses on disease management, particularly for members with
chronic conditions, including members with:
- Asthma
- Chronic kidney disease (nondialysis)
- 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 or combinations of any of these disease
states
Members with these conditions documented by their claims
histories or their medical providers have the option to participate
in the disease management programs that the care management
organizations (CMOs) provide for members' chronic conditions.
Members who meet the requirements for Care Select but opt
out are placed in Traditional Medicaid.
The Office of Medicaid Policy and Planning (OMPP) contracts with
CMOs to perform care management and authorization, and to provide
for the physical, behavioral, and transportation needs of its
membership. The healthcare of Care Select members enrolled
in the CMO is managed by the CMO through its network of primary
medical providers (PMPs), specialists, and other providers
contracted on behalf of the State by the CMO.
Care Select members are linked to a Care
Select-enrolled PMP, who provides and arranges for most of the
members' medical care. Services are reimbursed on a fee-for-service
basis, and the PMP receives a monthly administration fee for each
member actively assigned to the PMP. Physicians of any specialty
can apply through one or all of the CMOs to serve as a PMP for
Care Select members by completing an addendum to the
physicians' IHCP enrollment agreement. The State's contracted CMOs
are ADVANTAGE Health SolutionsSM and MDwise.
As of April 1, 2011, any Indiana Health Coverage Programs (IHCP)
provider may submit a Care Select Provider Referral Form
to the enrollment broker to recommend assigning a member to
Care Select, because one or more of the required disease
states is present. The Care Select Provider Referral
Form contains the enrollment broker's fax number and is
available on the Forms
page of this website. If the member meets all other
requirements for Care Select eligibility, the provider's
verification of disease state is the last component qualifying the
member for eligibility in the program.
For more information, see bulletin BT201043 -
"Changes to the Care Select Program."
Auto assignment is currently suspended for initial
enrollment. An updated Auto Assignment document will be posted in
2011.