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Medicaid and CHIP Levers to Promote Lead Screening and Treatment: Indiana’s Experience
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Addressing lead hazards today generates future economic benefits and improved health outcomes for children. In partnership with the Health Resources and Services Administration, NASHP is publishing a series of case studies highlighting state initiatives to promote lead screening and treatment. This study explores Indiana’s efforts to address this issue within its Medicaid and Children’s Health Insurance Program.
- View or download: State Levers to Promote Lead Screening and Treatment: Maryland’s Strategies
- View or download: Medicaid and Children’s Health Insurance Program Levers to Promote Lead Screening and Treatment: Indiana’s Experience
- To learn about other state initiatives, read NASHP’s 50-State Scan of State Health Care Delivery Policies Promoting Lead Screening and Treatment.
States Utilize Cross-Agency Resources to Address Health Care Workforce Shortages
The National Academy for State Health Policy examined how Indiana and Alaska leverage their resources and build new partnerships to implement innovative, cross-agency approaches to bolster their health care workforces. These case studies explore:
- Cross-agency coalitions that develop and implement innovative workforce strategies;
- Opportunities to use data to identify and address workforce shortages;
- Strategies to support and promote a non-traditional health care workforce; and
- Options to support education and training for current and future health care workers.
Read or download: Case Study: How Indiana Addresses Its Health Care Workforce Challenges
Read or download: Case Study: How Alaska Addresses Its Health Care Workforce Challenges
Additional resources:
- Read State Agencies Partner to Address Health Care Workforce Shortages, which highlights state and federal resources, such as Workforce Innovation and Opportunity Act funding, Section 1115 waivers, and federal and state loan repayment programs, that can be used to address workforce challenges.
Review presentations from #NASHPCONF18’s session: May the (Work) Force Be With You.
Surgeon General Jerome Adams Discusses Opioids and the Importance of Partnerships at NASHPCONF17
Cheryl J. Roberts, Deputy Director of Programs, Virginia Department of Medical Assistance Services, and US Surgeon General, Vice Admiral Jerome M Adams, MD, MPH
View the Surgeon General’s full remarks here
US Surgeon General, Vice Admiral Jerome Adams, MD, whose motto is “better health through better partnerships,” spoke at NASHP’s 30th annual State Health Policy Conference. It was a familiar venue for Adams, who as Indiana state health commissioner has attended NASHP conferences in the past and is a former NASHP Academy member.
As a state health commissioner, he worked to address an HIV outbreak in his state, spurred by unsafe injection practices resulting from the opioid epidemic, and worked on Indiana’s state Medicaid expansion. “I would not be where I am if it weren’t for NASHP,” he said during his opening remarks, complimenting the organization’s ability to share best practices and innovations in state health policy nationwide.
Adams, who was in Week 6 of the job when he spoke at the conference in Portland, OR, on Oct. 24, is head of the nation’s Public Health Service and serves as the nation’s doctor and its voice for communication and cultural.
What are you doing to address the opioid crisis?
I was Indiana state health commissioner during the largest HIV outbreak in the United States, with 225 cases of HIV infection in Austin, IN. This was higher than anywhere in the world (225 of the community’s 3,700 residents were infected).
It was a resource-poor community and didn’t have the capacity or cultural readiness to accept some of the remedies. Folks hammer me because they want the science, my work will always be informed by the evidence, but science is just one variable when you talk about public health policy.
We need to invite new and different people to the table. At the end of the day, we had to bring in business, faith-based, and police communities to talk about the science. I want you to keep thinking about who is not at the table, and bring them into the fold.
The Department of Health and Human Services has put out a toolkit, and the Centers for Disease Control and Prevention is working to identify opioid hotspots in communities. For example, you will be law enforcement’s best friend if you can help them focus their law enforcement and interdiction efforts, they will help you set up diversion programs so they can turn people turn toward recovery, instead of putting them in jail.
What about responding to the current increase in hepatitis C?
I think we are at a tipping point with hepatitis C, there are more people with hepatitis C than all of the other CDC-reportable diseases combined. The opioid epidemic allows us to raise discussions about hepatitis C as never before. (Hepatitis C and B have begun to increase for the first time in decades because of unsafe injection practices that transmit these bloodborne diseases.)
I would challenge you to take this opportunity, so we can ride this wave and get this into public discussions. The opioid epidemic is tragic, but it gives us an opportunity to talk about mental health, HIV and hepatitis C. Have those discussions and bring other partners to the table.
What concrete steps can the people in this audience take to support these efforts?
It’s OK to have partisan camps from a political view, but don’t let that blind you from working with the other side. It hurts my heart to see the political dissent. Try to find common goals. Think of one person who is not at the table and reach out to them and invite them to your next meeting to start that discussion.
One person alone may not seem that they’ll make a big difference, but all of us together can.
How are you reconciling all of the opposition to issues that impact public health?
I am a public health advocate, and I know we need to change some basic things. We’re focused on jobs, safety and security, and they’re ranked equally high by Republicans and Democrats. I try to reframe the public health discussion in a way that doesn’t mean me telling people that they should think the way we do.
Instead of telling teachers you should care about obesity, instead offer exercise as a way to increase test scores and fight obesity. Yes, things can seem disappointing from a public health point of view, but there are opportunities to show people how prevention can help.
I was able to get a syringe exchange program instituted in one of the most conservative communities in the country by working with police and letting them know they can reduce arrests and jail over-crowding through this program, and working with businesses to see how this program would improve the community and its reputation.
Click here to read the Surgeon General’s comments that accompanied President Trump’s comments on the opioid epidemic delivered Oct. 26, 2017.
Pictured are Cheryl J. Roberts, Deputy Director of Programs, Virginia Department of Medical Assistance Services, and Surgeon General Jerome Adams.
Indiana
In Indiana:
- As of July 1, 2011, there were 1,055,779 beneficiaries enrolled in the state’s Medicaid program, 741,744 of whom were enrolled in managed care through one of six commercial managed care organizations (MCOs) or a primary care case management program.
- Physical and behavioral health benefits are delivered through MCOs. Dental benefits are carved out from managed care and are delivered on a fee-for-service basis.
- Two home and community-based services waivers can be used to provide services to children:
- A Community Integration and Habilitation Waiver and a Family Supports Waiver that provide services to beneficiaries of any age who have developmental disabilities, intellectual disabilities, or autism.
As of 2013, 765,985 individuals were eligible for Indiana’s Early Periodic Screening, Diagnostic and Treatment Benefit (EPSDT), known in the state as HealthWatch. According to 416 data from 2013, the state achieved an EPSDT screening ratio of 100% and a participant ratio of 77%. 259,465 children received dental services of any kind, with 225,918 receiving preventive dental services.
Last updated September 2014
| Medical Necessity |
The Indiana Administrative Code (405 IAC 5-2-17) defines medically reasonable and necessary services for Medicaid.
“‘Medically reasonable and necessary service’ as used in this title means a covered service (as defined in section 6 of this rule) that is required for the care or well being of the patient and is provided in accordance with generally accepted standards of medical or professional practice. For a service to be reimbursable by the office, it must:
(1) be medically reasonable and necessary, as determined by the office, which shall, in making that determination, utilize generally accepted standards of medical or professional practice; and
(2) not be listed in this title as a noncovered service, or otherwise excluded from coverage.” |
| Initiatives to Improve Access |
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| Reporting & Data Collection |
Managed care organizations (MCOs) are required to collect quality measurement data on areas that include: EPSDT services, immunization rates, and blood lead testing.
MCOs also offer performance bonuses to providers based on HEDIS measures as part of the Indiana 2014 Performance Bonus Program for Hoosier Healthwatch. Among the measures determining performance bonuses are:
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| Behavioral Health |
Managed care entities in Indiana are required to:
Medicaid providers can bill for structured developmental screenings at select well-child visits (at 9 months, 18 months, and 30 months). The state suggests the following tools be used when billing for a developmental screening:
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| Support to Providers and Families |
Support for Providers
Indiana’s Medicaid program operates a provider website that collects a variety of information on the program. This includes claims and billing guidelines, fee schedules, form, provider manuals, and information on each managed care organization in the state. The site also contains virtual provider training on program procedures. The state also produces an EPSDT/Healthwatch provider manual.
Support for Families
A Medicaid member website provides information on the program for enrollees. The site helps beneficiaries to choose a health plan and understand available benefits. It also provides tips for prevention and staying healthy.
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| Care Coordination |
Coordination of physical and behavioral health services for Medicaid beneficiaries with co-morbidities is required of managed care organizations (MCOs). MCOs provide case management for Medicaid beneficiaries receiving behavioral health services, coordinating between physical and behavioral health providers.
Children with special health care needs receive care coordination services through a special program, Care Select. They enroll in special managed care organizations designed to improve communication across provider settings and arrange more holistic, whole-person service delivery (addressing physical, behavioral, and social needs).
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| Oral Health |
Indiana EPSDT provider manual provides information on dental observation and screening as part of well-child visits, as well as guidelines on providing dental anticipatory guidance to parents.
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Indiana
NASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@nashp.org.
Last updated: October 2012
Indiana – Medical Homes
We have no information on medical home activity that meets the following criteria: (1) program implementation (or major expansion or improvement) in 2006 or later; (2) Medicaid or CHIP agency participation (not necessarily leadership); (3) explicitly intended to advance medical homes for Medicaid or CHIP participants; and (4) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
Last Updated: April 2014
Indiana
No HIE Strategic Plan available yet.
Indiana
Governor Mitch Daniels issued an executive order (#05-10) in January 2005 directing the Indiana Department of Health to promulgate regulation and, if necessary, propose legislation requiring each hospital in the state to implement a medical error reporting and quality system (MERS) and to report all MERS data to the Department of Health. The system has been operating since January 2006.
| Authorizing statutes or regulations | Indiana Executive Order 05-10 | |
| Authorizing statutes or regulations | Indiana Administrative Code, Title 410, Article 15, Rule 1.4, Sections 2 and 2.2 | |
| Lists or clarifications of reportable events | 28 Reportable Events | |
| Lists or clarifications of reportable events | Definitions | |
| Public reports | 2006 and 2007 Medical Errors Reports (scroll to bottom of page) | |
| Public reports | Indiana Medical Error Reporting System: Final Report for 2008 | |
| State website | Indiana State Department of Health, Medical Errors Reporting System |
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
