Ind. IHCP Hospice Services Provider Reference Module, Section 3, IHCP-Pending Individuals

The IHCP program cannot provide prior authorization for services for an individual who is not enrolled

in the IHCP. An individual who is not enrolled in the IHCP when initiating hospice care is considered

private pay. If hospice providers choose to provide hospice care for an IHCP-pending individual, those

providers do so at their own financial risk. The IHCP cannot guarantee that the individual meets all criteria

to be IHCP-eligible or Medicare-eligible as of the date hospice care was initiated.

The Division of Family Resources (DFR) is the agency within the Indiana FSSA that has the authority to

determine an individual’s IHCP eligibility status. Hospice patients, or their representative, must apply for

IHCP coverage online at the FSSA Benefits Portal, by telephone at 800-403-0864, or at a local DFR office.

The DFR state eligibility consultant assigned to review the hospice patient’s Medicaid eligibility then

notifies the applicant or the applicant’s representative in writing of the eligibility decision.

If appropriate, the local DFR state eligibility consultant can establish the individual’s IHCP eligibility

retroactively, to 90 days before the date of the individual’s IHCP application. If the DFR state eligibility

consultant determines that the hospice patient is IHCP-eligible, the hospice patient receives written

notification from the DFR state eligibility consultant that specifies the start date of the hospice patient’s

IHCP coverage. The DFR state eligibility consultant can establish eligibility even if an applicant has died

during the application process.

IHCP hospice analysts cannot review and approve the certification forms for an IHCP-pending individual.

The hospice provider must hold all paperwork until the IHCP-pending individual is notified of IHCP

eligibility. It is recommended that the hospice provider complete the IHCP hospice forms at the same

time the agency completes its own hospice agency forms so that the forms are ready to submit to the

appropriate prior authorization and utilization management (PA-UM) contractor when IHCP eligibility

is established. A hospice provider can determine the date of IHCP enrollment by verifying member

eligibility on the IHCP Portal or phone-based virtual assistant (GABBY), using the individual’s IHCP

Member ID, Social Security number and birth date, or first and last name and birth date. For detailed

instructions, see the Member Eligibility and Benefit Coverage module. For IHCP-pending individuals,

hospice providers are encouraged to check the IHCP Portal or GABBY on a regular basis so that they can

submit the certification forms to the appropriate PA-UM contractor as soon as the member’s eligibility has

been established.

Note: Hospice services may be requested for individuals with presumptive eligibility (PE)

coverage under PE Package A or PE Adult. If the hospice benefit is approved,

hospice services will be covered for the duration of the PE period. Coverage after the

PE period, as well as retroactive coverage prior to that period, would be dependent

on a determination by the DFR as described in the Presumptive Eligibility module.