MedicaidAdministrativeHigh impact
BT2026130: Performance standards for PE qualified providers are transitioning to Indiana Code standards
Indiana Medicaid (IHCP)·IN·Provider Bulletin
Effective date
Sep 3, 2026
We identified it
Aug 5, 2026
Summary
Indiana Medicaid (IHCP) is transitioning Presumptive Eligibility (PE) provider performance standards from administrative code percentage-based metrics to new statutory standards under Indiana Code IC 12-15-4-1.5, effective September 3, 2026. Providers must now meet three specific standards: notify OMPP within 5 business days of PE determination, ensure full Medicaid applications are received before PE period expires, and have individuals determined eligible for Medicaid after application review. Each violation is tracked individually with escalating consequences (notice, mandatory training, or loss of PE qualification).
Action Required
By September 3, 2026: All staff involved in making Presumptive Eligibility determinations must understand and comply with the three new performance standards. Billing and administrative teams must: (1) Implement tracking systems to document PE notification dates to OMPP (must occur within 5 business days of determination); (2) Monitor application receipt dates to ensure full Medicaid applications reach FSSA before PE period expires; (3) Track final eligibility determinations post-application. Establish internal compliance monitoring to catch violations before OMPP notification. Designate staff responsible for reviewing PE determinations against these three standards on an ongoing basis. Violation escalation path: First violation = written notice; Second violation (within 12 months) = mandatory OMPP training required; Third violation (within 12 months of second) = immediate loss of PE qualification. For providers who received prior notices under old 405 IAC standards, those count as the first violation under new standards. Contact presumptiveeligibility@fssa.in.gov with compliance questions.