Skip to main content

VGM & ASSOCIATESHealthcare MSO

Search GO

Search GO

VGM & ASSOCIATESHealthcare MSO LEARN ABOUT VGM

Great News for Indiana Suppliers

Published in Government Relations on August 01, 2022

Indiana Medicaid Temporarily Suspends MCE PA Requirements for Respiratory Assist Devices

As reported by Great Lakes below,

We have good news to report! The Indiana Family and Social Services Administration (FSSA) published BT202260 yesterday 7/28/2022 which announced a positive change to address an issue that the Great Lakes Indiana Medicaid Workgroup has been raising with FSSA Provider Relations staff.

The IHCP bulletin states “Effective Aug. 1, 2022, through Jan. 31, 2023, the Indiana Health Coverage Programs (IHCP) is temporarily removing managed care entity (MCE) prior authorization (PA) requirements for continued use of respiratory assist devices, including continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) devices. The PA suspension is for a continuation of coverage only and not the initiation of services.” Read the bulletin for full details.

We are grateful for the agency’s action to recognize today’s challenges in providing these respiratory devices. According to our contact at FSSA, Indiana Medicaid will reevaluate this policy change at that the end of this suspension period. Thank you to the Great Lakes Medicaid workgroup for their engagement on this issue including Kathy Murzyn at Fairmeadows for her leadership.

If you have any questions, please contact Kam Yuricich (kam@greatlakeshme.org) at Great Lakes or Ronda Buhrmester (Ronda.Buhrmester@vgm.com) at VGM.

TAGS

From Our Experts

HR1 Passes House, Advances to President Trump's Desk for Signature thumbnail

HR1 Passes House, Advances to President Trump's Desk for Signature After extensive negotiations and partisan debate, the House has officially passed HR1, clearing the path for the bill to be signed into law by President Donald Trump. The legislation, which aims to reduce federal healthcare expenditures, contains several provisions that may impact the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) industry.

CMS files the Proposed Rule that sheds light on the next round of the Competitive Bidding Program thumbnail

CMS files the Proposed Rule that sheds light on the next round of the Competitive Bidding Program On June 30, 2025, CMS filed the anticipated Proposed Rule that includes updates to the Competitive Bidding Program (CBP). Public comments are due 60 days from June 30, 2025. Below is a high-level summary of the rule. It is critical to note that, according to the Proposed Rule Fact Sheet dated June 30, 2025, CMS has stated that they have not announced the specific product categories they are bidding or the specific timeframe for the next competition. Those specifics will be forthcoming in a fu

Senate Narrowly Passes HR1, Sending It Back to House for Final Approval thumbnail

Senate Narrowly Passes HR1, Sending It Back to House for Final Approval President Donald Trump's sweeping legislative package, formally titled the One Big, Beautiful Bill Act, now referred to as HR1., cleared the Senate today in a dramatic 51–50 vote, with Vice President JD Vance casting the tie-breaking vote. The bill now returns to the House, where lawmakers must decide whether to adopt the Senate's revised version or negotiate further changes before it can reach the president's desk.

Several Prominent Medicaid Provisions in Senate's Budget Bill Deemed in Violation of Byrd Rule thumbnail

Several Prominent Medicaid Provisions in Senate's Budget Bill Deemed in Violation of Byrd Rule Senate Parliamentarian Elizabeth MacDonough advised this week that multiple Medicaid provisions in the Senate's reconciliation bill would violate Senate procedure by violating the Byrd Rule. The Byrd Rule is a Senate-specific procedural process that allows Senators to prevent or block inclusion of extraneous provisions in reconciliation bills. Other provisions are still under review.

Evaluating the Value of a Payer Contract thumbnail

Evaluating the Value of a Payer Contract In our last article, Key Payers Denied Your Application Citing Their Network Is Closed – Now What?, we discussed strategies for addressing payer contracting denials due to a closed network. As indicated, this process can be an extremely time-consuming exercise with no guarantees and mixed results. Below are a few things to consider as you evaluate whether a contract is worth the extra effort.

Webinar: "Navigating The New CMS Landscape: RADs, HMVs, and Supplier Survival" on June 25 at 1 p.m. CT. The Centers for Medicare & Medicaid Services (CMS) has released its final National Coverage Determination (NCD) for RADs and HMVs used in treating chronic respiratory failure due to COPD. While the rule potentially expands access to bilevel ST therapy (RADs), it also introduces complex compliance requirements, tighter usage criteria, and increased documentation burdens—without additional reimbursement.

The Return of Competitive Bidding thumbnail

The Return of Competitive Bidding The Centers for Medicare & Medicaid Services (CMS) appear to be laying the groundwork for another round of the Competitive Bidding Program (CBP). While full implementation will take a couple of years, an official announcement is expected this summer—potentially as early as July.

Out With The Old RAC, In With The New thumbnail

Out With The Old RAC, In With The New On April 28, 2025, CMS awarded Cotiviti GOV Services LLC, the new RAC Recovery Audit Contractor (RAC) Region 3, 4, and 5 contracts. RAC Region 3 includes the following Medicare Administrative Contractor (MAC) jurisdictions: JJ, JM, and JN. RAC Region 4 includes jurisdictions: JE, JF, and JL. And RAC Region 5 includes jurisdictions: JA, JB, JC, JD, as well as the HH/H MACs: J6, J15, JK, and JM.

Give your business an advantage over the competition.

Become a Member