1624.00.00 INDIANA PATHWAYS FOR AGING (PATHWAYS)

Indiana PathWays for Aging, also referred to as “PathWays,” is a managed care program for Medicaid members who are: • 60 years of age and older, and • Receiving Medicaid in an aged, blind or disabled category (Including MEDWorks and MASI). Members enrolled in PathWays include those who: • May or may not be enrolled in or eligible for Medicare, • May or may not be receiving LTSS (long-term support services) including those who are: • Residing in a nursing or long-term care facility, or • Receiving services under an approved PathWays waiver (formerly called the Aged and Disabled waiver). • Receiving BPHC services in a MED 1 category Medicaid members that are not eligible for PathWays include: • Those under 60 • HIP members of any age • Hoosier Healthwise Members of any age • Individuals who are only partial benefit dually eligible (QMB-only, SMLB-only, QI, or QDWI) • MAGF members who are not in the PathWays waiver • DDRS waiver recipients, including: o FSW (Family Support Waiver) o CIH (Community Integration and Habilitation Waiver) • TBI (Traumatic Brain Injury) Waiver recipients • TBI out-of-state placements • Residents of State Operated Facilities (SOF) • Program of All Inclusive Care for the Elderly (PACE) members • RCAP (Room and Board) members • Breast and Cervical cancer members on MA12 • I/DD residents in intermediate care facilities (ICF) • ESO (Emergency Services Only) members Certain populations will not be placed into the PathWays program and will remain in Fee-for- Service (FFS). These members are not required to participate in the PathWays program but have the option to Opt-in. • Individuals who are already receiving hospice upon being eligible for PathWays, • Individuals participating in self-directed Medicaid services, and • American Indians and Alaskan Natives (AI/AN). For more information refer to 2402.15.15.20. PathWays information is not stored in the eligibility system and DFR will not have visibility to PathWays assignments. If there are questions regarding the PathWays program, the member or their authorized representative can contact the MCE (managed care entity) on their insurance card. If the MCE is unable to resolve the issue/concern, then direct the member/AR to: PathWays Phone Numbers Pathways Member Support Services (MSS) Support for eligible Medicaid members, age 60 or older who are enrolled in PathWays for Aging, with navigating the various options and care transitions associated with managed care, long term care and waiver services. Pathways Member Support Services Helpline: 877-738-3511 Indiana PathWays for Aging (Enrollment Broker): Assists members with initial plan selections and plan changes, including just cause requests Indiana Pathways for Aging Indiana PathWays for Aging Helpline: 87-PATHWAY-4 (877-284-9294) 1 42 CFR 435.520 2 42 CFR 435.530 3 42 CFR 435.540 4 IC 12-10-6-1 5 IC 12-15-41; Social Security Act (SSA) 1902(a)(10)(ii)(XV); SSA 1902(a)(10)(ii)(XVI) 6 SSA 1902(a)(10)(E) 7 SSA 1905(p)(3) 8 SSA 1902(a)(10)(E) 9 42 CFR 431.625(d) 10 SSA 1902(a)(10)(E) 11 SSA 1905(p)(3)(A)(i) 12 SSA 1902(a)(10)(E) 13 SSA 1905(p)(3) 14 SSA 1902(e)(6) 15 SSA 1902(e)(16) 16 SSA 1902(e)(16) 17 405 IAC 10-4-5 18 405 IAC 10-4-1 19 405 IAC 10-4-3 20 405 IAC 10-4-3 21 405 IAC 10-4-1 22 405 IAC 10-4-1 23 42 CFR 435.222 24 45 CFR 400.211 and 90 FR 13370 25 42 CFR 435.831(1); 42 CFR 435.603 25 42 CFR §435.170 26 42 CFR 435.222 27 42 CFR 435.222 28 42 CFR 435.222 29 IC 12-17.6-3-2 30 SSA 1902(a)(10)(A)(i)(IX) 31 I.C. 29-3-3-5