Ind. IHCP Hospice Services Provider Reference Module, Section 2, Affordable Care Act Risk Category Requirements

The Affordable Care Act assigns all providers to a risk category, describing the degree of probability of

fraud or abuse. Hospice providers are assigned to the Moderate risk category. As a result, the following

activities occur for hospice providers that are newly enrolling:

• Unscheduled, unannounced site visits (these visits can occur before and after enrollment)

• License verification

• Proof of Medicare enrollment, if Medicare-enrolled

• Denial of enrollment to providers sanctioned by Medicare or another state’s Medicaid program

• Validation of disclosed individuals such as owners and managerial persons responsible for day-to-day operations, including members of a board of directors)

• Application fee

➢ Providers already enrolled in Medicare pay the fee to Medicare, not to the IHCP.

➢ Medicaid-only providers pay the fee to the IHCP.

• Revalidation

➢ Hospice providers are required to revalidate (reenroll) in the IHCP every five years.

These screening activities are also applicable to existing IHCP-enrolled providers during the revalidation

process.

Because Medicare also performs the screening activities required by the Affordable Care Act, the IHCP

accepts the results of screening activities performed by Medicare.