reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-7 - Behavioral health level of need redetermination

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 7.
(a) The
				services reimbursable as behavioral health level of need redetermination are
				services associated with the DMHA approved assessment tool required to
				determine level of need, assign an MRO service package, and make changes to the
				individualized integrated care plan.
(b) The redetermination requires face-to-face
				contact with the member and may include face-to-face or telephone collateral
				contacts with family members or nonprofessional caretakers, which result in a
				completed redetermination.
(c)
				Requirements for behavioral health level of need redetermination services shall
				be as follows:
(1) Services may be provided
				for members of all ages.
(2)
				Services must be provided by individuals meeting DMHA training competency
				standards for the use of the DMHA-approved assessment tool.
(3) The DMHA assessment tool must be
				completed at least every six (6) months for the purpose of determining the
				continued need for MRO services.
(4) Reassessment may occur when there is a
				significant event or change in member status.
(5) Exclusions shall be as follows:
(A) MRO redetermination should not be
				duplicative of assessments available with clinic option services.
(B) This service may not be billed as part of
				the initial bio-psychosocial assessment when a member is entering
				treatment.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-8 - Crisis intervention

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 8.
(a) The
				services reimbursable as crisis intervention services are short-term emergency
				behavioral health services, available twenty-four (24) hours per day, seven (7)
				days per week.
(b) These services
				include crisis assessment, planning, and counseling specific to the crisis,
				intervention at the site of the crisis when clinically appropriate, and
				pre-hospital assessment.
(c) The
				goal of crisis services is to resolve the crisis and transition the member to
				routine care through stabilization of the acute crisis and linkage to necessary
				services. This service may be provided in an emergency room, crisis clinic
				setting, or in the community.
(d)
				The requirements for crisis intervention services shall be as follows:
(1) Services may be provided for all Medicaid
				members who are as follows:
(A) At imminent
				risk of harm to self or others.
(B)
				Experiencing a new symptom that places the member at risk.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-9 - Child and adolescent intensive resiliency services

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 9.
(a) The
				services reimbursable as child and adolescent intensive resiliency services
				(CAIRS) are time-limited, nonresidential services provided to children or
				adolescents in a clinically supervised setting that provides an integrated
				system of individual, family, and group interventions based on an
				individualized integrated care plan.
(b) Services are designed to alleviate
				emotional or behavioral problems. Services are curriculum-based with goals that
				include reintegration into age appropriate community settings.
(c) The requirements for CAIRS shall be as
				follows:
(1) Services may be provided for
				members at least five (5) years of age and less than eighteen (18) years of age
				with severe emotional disturbance who:
(A)
				need structured therapeutic and rehabilitative services;
(B) have significant impairment in day-to-day
				personal, social, or vocational functioning;
(C) do not require acute stabilization,
				including inpatient or detoxification services; and
(D) are not at imminent risk of harm to self
				or others.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-10 - Adult intensive rehabilitative services

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 10.
(a) The
				services reimbursable as adult intensive rehabilitative services (AIRS) are
				time-limited, nonresidential services provided in a clinically supervised
				setting to a member who requires structured rehabilitative services in order to
				maintain the member on an outpatient basis.
(b) Services are curriculum based and
				designed to alleviate emotional or behavioral problems with the goals of:
(1) reintegrating the member into the
				community;
(2) increasing social
				connectedness beyond a clinical setting; or
(3) employment.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-11 - Intensive alcohol or drug (substance-related disorder) outpatient treatment

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 11.
(a) The
				services reimbursable as intensive alcohol or drug outpatient treatment
				services are treatment programs that operate at least three (3) hours per day,
				and at least three (3) days per week, and are based on an individualized
				integrated care plan.
(b) Services
				are planned and organized with addiction professionals and clinicians providing
				multiple treatment service components for the rehabilitation of alcohol and
				drug abuse or dependence in a group setting.
(c) Requirements for intensive alcohol or
				drug outpatient treatment shall be as follows:
(1) Services may be provided for members of
				all ages with a substance-related disorder; minimal or manageable medical
				conditions; minimal or manageable withdrawal risk; or emotional, behavioral,
				and cognitive conditions that will not prevent the member from benefiting from
				this level of care.
(2) Providers
				must meet any of the following qualifications:
(A) A licensed professional.
(B) A QBHP.
(C) An OBHP.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-12 - Alcohol or drug (substance-related disorder) counseling

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 12.
(a) The
				services reimbursable as individual or group alcohol or drug counseling are
				services where addiction professionals and clinicians provide counseling
				intervention that work toward goals identified in the individualized integrated
				care plan. Services are designed to be a less intensive alternative to
				intensive outpatient treatment as follows:
(1)
				The requirements for alcohol or drug counseling shall be as follows:
(A) Services may be provided for members of
				all ages with a substance-related disorder and with minimal or manageable
				medical conditions; minimal withdrawal risk; or emotional, behavioral, and
				cognitive conditions that will not prevent the member from benefiting from this
				level of care.
(B) Providers must
				meet any of the following qualifications:
(i)
				A licensed professional.
(ii) A
				QBHP.
(C) Programming
				standards shall be as follows:
(i) The member
				is the focus of the service.
(ii)
				Documentation must support how the service specifically benefits the member,
				including when services are provided in a group setting.
(iii) Services must demonstrate progress
				toward or achievement of member treatment goals identified in the
				individualized integrated care plan.
(iv) Service goals must be rehabilitative in
				nature.
(v) Services are intended
				to be a less intensive alternative to intensive outpatient treatment.
(vi) Services must be provided in an age
				appropriate setting for a member less than eighteen (18) years of age receiving
				services.
(vii) A licensed
				professional must supervise the program and approve the content and curriculum
				of the program.
(viii) Treatment
				must consist of regularly scheduled services.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-13 - Peer recovery services

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 13.
The services reimbursable as peer recovery services are
				  face-to-face, structured, scheduled activities that promote socialization,
				  recovery, self-advocacy, development of natural supports, and maintenance of
				  community living skills. Requirements for peer recovery services shall be as
				  follows:
(1) Services may be provided
				for members eighteen (18) years of age and older. Services may be provided for
				members age sixteen (16) or seventeen (17) with prior authorization. Services
				shall not be provided to or for a member less than sixteen (16) years of
				age.
(2) Services must be provided
				by individuals meeting DMHA training and competency standards for certified
				recovery specialists. Individuals providing peer recovery services must be
				under the supervision of a licensed professional or a QBHP.
(3) Programming standards shall be as
				follows:
(A) Services must be identified in
				the individualized integrated care plan and must correspond to specific
				treatment goals.
(B) Services must
				be provided face-to-face and include the following components:
(i) Assisting members with developing
				individualized integrated care plans and other formal mentoring activities
				aimed at increasing the active participation of members in person-centered
				planning and delivery of individualized services.
(ii) Assisting members with the development
				of psychiatric advanced directives.
(iii) Supporting members in problem solving
				related to reintegration into the community.
(iv) Education and promotion of recovery and
				anti-stigma activities.
(C) Documentation must support how the
				service specifically benefits the member.
(D) The member is the focus of the
				treatment.
(E) Services must
				demonstrate movement toward or achievement of member treatment goals identified
				in the individualized integrated care plan.
(F) Service goals must be rehabilitative in
				nature.
(G) Services must be
				provided in an age appropriate setting for a member eighteen (18) years of age
				and under receiving services.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-14 - Case management services

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 14.
The services reimbursable as case management services are
				  services that help members gain access to needed medical, social, educational,
				  and other services. Case management services include the assessment of the
				  eligible member to determine service needs, development of an individualized
				  integrated care plan, referral and related activities to help the member obtain
				  needed services, monitoring and follow-up, and evaluation. Case management is a
				  service on behalf of the member, not to the member, and is management of the
				  case, not the member. Requirements for case management services shall be as
				  follows:
(1) Services may be provided
				for members of all ages.
(2)
				Providers must meet any of the following qualifications:
(A) A licensed professional.
(B) A QBHP.
(C) An OBHP.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-15 - Psychiatric assessment and intervention

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 15.
The services reimbursable as psychiatric assessment and
				  intervention services are face-to-face and nonface-to-face activities that are
				  designed to provide psychiatric assessment, consultation, and intervention
				  services to members. Requirements for psychiatric assessment and intervention
				  services shall be as follows:
(1)
				Services may be provided for members eighteen (18) years and older with a
				history of multiple hospitalizations and severe challenges in maintaining
				independent living within the community. Services may be prior authorized for
				members less than eighteen (18) years of age.
(2) Providers must meet any of the following
				qualifications:
(A) A physician.
(B) An AHCP.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-16 - Diagnosis; individualized integrated care plan

Current through July 10, 2024
Authority: IC 12-15
Affected: IC
				  12-13-7-3
Sec. 16.
The supervising physician or HSPP bears the ultimate
				  responsibility for certifying the diagnosis and individualized integrated care
				  plan for MRO services. The supervising physician or HSPP is responsible for
				  seeing the patient during the intake process or reviewing information submitted
				  by a licensed professional, QBHP, or OBHP and approving the individualized
				  integrated care plan within seven (7) days. The supervising physician or HSPP
				  must provide face-to-face visits with the patient or review the individualized
				  integrated care plan at intervals not to exceed ninety (90) days. These reviews
				  must be documented and signed by the physician or HSPP assuming responsibility
				  for the care plan.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.5 - Medicaid Rehabilitation Option Services › Section 21.5-17 - Prior authorization

Current through July 10, 2024
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 17.
(a) MRO
				services are packaged according to diagnosis and level of need. Diagnosis and
				level of need qualifications for service packages, and services included within
				each service package:
(1) will be listed and
				published in a provider manual by the OMPP; and
(2) may be updated by the OMPP as
				needed.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-1 - General provisions

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 1.
The intent of this rule is to provide home and
				  community-based treatment options to individuals with serious mental illness
				  who may benefit most from a habilitation approach to care to assist in
				  maintaining the individual in the community. Eligibility for services and the
				  provision of services are based upon an individual's meeting specific AMHH
				  needs-based criteria. AMHH services will be:
(1) provided through a state plan;
				and
(2) delivered by service
				provider agencies meeting specific state-defined criteria.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-2 - Definitions

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 2.
(a) The
				definitions in this section apply throughout this rule.
(b) "Adult mental health habilitation" or
				"AMHH" services refers to medical or remedial services recommended by a
				physician or other licensed professional, within the scope of his or her
				practice, for the habilitation of a mental health disability and the
				restoration or maintenance of an individual's best possible functional level.
				Services are clinical and supportive behavioral health services that are
				provided for individuals, families, or groups of adult persons who:
(1) are living in the community;
				and
(2) need aid on a routine basis
				for a mental illness or co-occurring mental illness and addiction
				disorders.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-3 - Applicants and the application process

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 3.
(a) In order
				for an individual to receive services under this rule, an AMHH eligible
				provider agency, in collaboration with the individual seeking services, must
				submit an application in the manner required by the office.
(b) Each applicant for AMHH services must
				receive a face-to-face evaluation using the:
(1) office-approved behavioral health
				assessment tool; and
(2)
				application form developed by the office.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-4 - Eligibility

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5; IC
				  25-33-1-5.1
Sec. 4.
(a) An
				applicant may be eligible for participation in the AMHH services program if the
				applicant meets all of the following core criteria:
(1) The applicant is enrolled in
				Medicaid.
(2) The applicant is at
				least thirty-five (35) years of age or older.
(3) The applicant is unlikely to make
				improvements in a variety of life domains, with such a determination being
				based on the state evaluation team's review of all relevant referral
				materials.
(4) Based upon the
				office-approved behavioral health assessment tool, the applicant has a
				recommendation for intensive community-based care, as indicated by a rating
				level of four (4) or higher.
(5)
				The applicant has been diagnosed with an AMHH-eligible primary mental health
				diagnosis, which may include, but is not limited to, any of the following
				general categories:
(A) Schizophrenic
				disorder.
(B) Major depressive
				disorder.
(C) Bipolar
				disorder.
(D) Delusional
				disorder.
(E) Psychotic
				disorder.
(6) The
				applicant either:
(A) resides in a
				community-based setting that is not an institutional setting; or
(B) will be discharged from an institutional
				setting back to a community-based setting.
(7) Based on the behavioral health clinical
				evaluation, the applicant must meet all of the following needs-based criteria:
(A) Without ongoing habilitation services, as
				demonstrated by written attestation from a psychiatrist or a health services
				provider in psychology (HSPP) as defined in IC
				25-33-1-5.1, the applicant will
				likely deteriorate and be at risk of institutionalization.
(B) The applicant demonstrates the need for
				significant assistance in major life domains related to the applicant's mental
				illness, for example, the following:
(i)
				Physical problems.
(ii) Social
				functioning.
(iii) Basic living
				skills.
(iv) Self-care.
(v) A potential for harm to the self or to
				others.
(C) The applicant
				demonstrates significant needs related to the applicant's behavioral
				health.
(D) The applicant
				demonstrates:
(i) significant impairment in
				self-management of the applicant's mental illness; or
(ii) significant needs for assistance with
				mental illness management.
(E) The applicant demonstrates a lack of
				sufficient natural supports to assist with mental illness management.
(F) The applicant is not a danger to the self
				or others at the time the application for AMHH service eligibility is submitted
				for state review and determination.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-5 - Eligibility period; renewal

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 5.
(a) A member
				who is approved to receive AMHH services under this rule shall be eligible for
				such services for up to a twelve (12) month period, as long as eligibility and
				needs-based criteria continue to be met.
(b) A reevaluation will be conducted at least
				every twelve (12) months and shall include the following:
(1) A face-to-face holistic clinical and
				biopsychosocial evaluation completed by an office-approved AMHH service
				provider.
(2) Administration of the
				office-approved behavioral assessment tool to determine whether the member
				still meets the level of need for intensive community-based services, as
				demonstrated by a rating level of four (4) or higher.
(3) Assessment of the member's progress
				towards meeting treatment goals on the IICP.
(4) Documentation that the member continues
				to meet AMHH financial, target group eligibility, and needs-based
				criteria.
(5) An updated referral
				application.
(6) An updated IICP
				documenting the member's choice of AMHH service or services and AMHH service
				providers.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-6 - Clinical documentation requirements

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 6.
(a) To be
				reimbursable under this rule, the AMHH service must be supported by clinical
				documentation that is maintained in the member's clinical record.
(b) The documentation required to support
				billing for an AMHH services must meet the following standards:
(1) Focus on recovery and
				habilitation.
(2) Emphasize member
				strengths.
(3) Reflect progress
				toward the habilitation goals reflected in the member's IICP.
(4) Be updated with every member encounter
				when billing is submitted for reimbursement.
(5) Be written and signed by the agency staff
				rendering services.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-7 - Coverage requirements; limits

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 7.
(a) For an
				AMHH service to be reimbursable under this rule, the service must:
(1) be listed in this rule as a covered
				service;
(2) be habilitative in
				nature;
(3) promote member
				stability;
(4) demonstrate the
				member's movement toward the individual goals identified in the member's IICP;
				and
(5) continue to provide a
				benefit to the member.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-8 - Adult day services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC 25-14.5;
				  IC 25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 8.
(a) The
				services reimbursable as adult day services consist of community-based group
				programs designed to meet the needs of adults with significant behavioral
				health impairments as identified in a member's IICP. These comprehensive,
				nonresidential programs provide health, wellness, social, and therapeutic
				activities. The day services are delivered in a structured, supportive
				environment and provide the member with supervision, support services, and
				personal care as required by the member's IICP.
(b) Adult day services may include any of the
				following services as they relate to the member's IICP:
(1) Care planning.
(2) Treatment.
(3) Monitoring of weight, blood glucose
				level, and blood pressure.
(4)
				Medication administration.
(5)
				Nutritional assessment and planning provided by a certified
				dietitian.
(6) Individual or group
				exercise training.
(7)
				Reinforcement of established skills and may include activities of daily
				living.
(8) Other social
				activities.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-9 - Home and community-based habilitation and support services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 9.
(a) The
				services available as home and community-based habilitation and support
				services are intended to:
(1) provide skills
				training to reinforce established skills (and may include activities of daily
				living);
(2) assist in the
				management, adaptation, and retention of skills necessary to support the
				member's needs; and
(3) assist the
				member to gain an understanding of the self-management of behavioral and
				medical health conditions.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-10 - Respite care services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 10.
(a) The
				services reimbursable as respite care services are provided to a member who is:
(1) unable to care for himself or herself;
				and
(2) living with a
				nonprofessional caregiver.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-11 - Therapy and behavioral support services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 11.
(a) The
				services reimbursable as therapy and behavioral support services include the
				following:
(1) Services provided in an
				individual or a group setting.
(2)
				Services provided to family members or other nonprofessional caregivers in an
				individual or group setting, with or without the member present.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-12 - Addiction counseling services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 12.
(a) The
				services reimbursable as addiction counseling services include the following:
(1) Services provided to the member either
				individually or in a group setting.
(2) Services provided to family members or
				other nonprofessional caregivers in an individual or group setting, with or
				without the member present.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-13 - Peer support services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 13.
(a) The
				services reimbursable as peer support services must be:
(1) provided face-to-face;
(2) structured; and
(3) scheduled activities that promote all of
				the following:
(A) Socialization.
(B) Recovery.
(C) Self-advocacy.
(D) Development of natural
				supports.
(E) Maintenance of
				community living skills.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-14 - Supported community engagement services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 14.
(a) Services
				reimbursable as supported community engagement services must meet the following
				requirements:
(1) Be provided face-to-face
				with the member in an individual setting.
(2) Consist of services that engage a member
				in meaningful community involvement in activities such as volunteerism or
				community service.
(3) Consist of
				services aimed at developing skills and opportunities that lead to improved
				integration of the member into the community through increased community
				engagement.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-15 - Care coordination services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 15.
(a) The
				services reimbursable as care coordination services consist of services that
				assist a member in gaining access to needed medical, social, educational, and
				other services, including the following:
(1)
				Direct assistance in gaining access to services.
(2) Coordination of care.
(3) Oversight of the member's care in the
				AMHH services program.
(4) Linkage
				of the member to appropriate services.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-16 - Medication training and support services

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 16.
(a) The
				services reimbursable as medication training and support services include the
				following:
(1) Services provided to the member
				in an individual or in a group setting.
(2) Services provided to family members or
				other nonprofessional caregivers in an individual or a group setting with or
				without the member present.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-17 - AMHH provider agency requirements

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23-1-1; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 17.
(a) In order
				to provide AMHH services under this rule, a provider must be authorized by the
				office as an AMHH services provider agency.
(b) Provider agencies under this rule must
				attest that the individual provider staff member delivering an AMHH service
				meets the service-specific provider requirements and qualifications as defined
				within this rule.
(c) The office
				has deemed state-certified community mental health centers (CMHCs) as being in
				good standing as office-approved AMHH services provider agencies.
(d) Any provider wishing to apply to become
				an AMHH provider agency must:
(1) complete an
				AMHH provider agency application; and
(2) submit the application to the office for
				review and consideration.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-18 - Fair hearings and appeals

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 18.
(a) Any of
				the following may appeal an action by the office state evaluation team and
				request an administrative hearing:
(1) An
				applicant.
(2) A member of services
				under this rule.
(3) A duly
				authorized representative of the following:
(A) An applicant.
(B) A member.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.6 - Adult Mental Health Habilitation Services Program › Section 21.6-19 - Complaints and grievances

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 19.
(a) Any of
				the following shall have the right to file a written complaint or a written
				grievance with the state or the office:
(1) An
				applicant.
(2) A member.
(3) A duly authorized representative or
				representatives of an applicant or a member.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-1 - General provisions

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 1.
(a) This rule
				provides child mental health wraparound (CMHW) services, which are intensive,
				home and community-based intervention services provided according to a systems
				of care philosophy within a wraparound model of service delivery.
(b) The CMHW service program includes the
				delivery of coordinated, highly individualized wraparound services and
				interventions that do the following:
(1)
				Address the member's unique needs.
(2) Build upon the strengths of the member
				and the member's family or support group.
(3) Assist the member and the member's family
				in achieving positive outcomes in their lives.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-2 - Definitions

Current through July 10, 2024
Authority: IC 12-8-6.5-5; IC 12-15
Affected: IC 12-13-7-3; IC 12-29; IC 25-23.6-10.5; IC
				  25-27.5-5
Sec. 2.
(a) The
				definitions in this section apply throughout this rule.
(b) "Access site" means a office-approved
				agency that will provide CMHW services applicants and families the following:
(1) Information about CMHW services and
				eligibility criteria.
(2)
				Assistance in applying for CMHW services.
(3) Linkage to the most appropriate services,
				based upon an applicant's identified needs.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-3 - Applicants and the application process

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 3.
(a) The
				purpose of the application process is to provide families with a means to
				explore whether their child may be eligible for and benefit from CMHW
				services.
(b) A referral
				application for CMHW services must be made in the manner required by the
				office.
(c) Access sites, which are
				office-approved CMHW service agencies, provide a local point of access in order
				for applicants and their families to complete the CMHW services application
				process that includes the following:
(1)
				Completion of the CMHW services application.
(2) A face-to-face evaluation and
				administration of the behavioral health assessment tool to assist the office in
				determining whether an applicant meets the eligibility and needs-based criteria
				for enrollment in CMHW services.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-4 - Independent assessment and evaluation

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 4.
(a) Each
				applicant completing the application process for CMHW services shall undergo a
				face-to-face assessment and evaluation by an access site.
(b) The purpose of the assessment and
				evaluation is to determine whether an applicant meets the CMHW services
				eligibility and needs-based criteria.
(c) The assessment shall include
				administration of the office-approved behavioral assessment tool in order to:
(1) assess an applicant's strengths, needs,
				and functional impairment or impairments; and
(2) assist in determining an applicant's
				level of need for CMHW services, based upon the assessment results and
				algorithm for a behavioral recommendation.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-5 - Eligibility and needs-based criteria

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 5.
(a) To be
				enrolled in the CMHW services program, the applicant must meet the following
				target group eligibility criteria:
(1) The
				applicant meets age criteria, which is six (6) through seventeen (17) years of
				age.
(2) The applicant meets the
				criteria for two (2) or more American Psychiatric Association's Diagnostic and
				Statistical Manual of Mental Disorders-IV-TR (or subsequent revision)
				diagnoses.
(3) The applicant does
				not meet any of the following CMHW services exclusionary criteria:
(A) Primary substance abuse
				disorder.
(B) Primary or secondary
				pervasive developmental disorder (autism spectrum disorder).
(C) Primary attention deficit hyperactivity
				disorder.
(D) Intellectual
				disability or disabilities.
(E)
				Dual diagnosis of serious emotional disturbance and intellectual
				disabilities.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-6 - Individualized plan of care

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 6.
(a) The plan
				of care is an individualized treatment plan that integrates all components and
				aspects of care, including services, interventions, and supports that are
				deemed medically necessary or clinically indicated.
(b) The plan of care must include all
				indicated medical and behavioral support services needed by a member in order
				to assist the member in the following:
(1)
				Remaining in the home or community.
(2) Functioning at the highest level of
				independence possible.
(3)
				Achieving treatment goals.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-7 - Member freedom of choice

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 7.
The member and the member's family have freedom of choice
				  regarding the following aspects of CMHW service delivery:
(1) Determining who will participate in the
				team.
(2) Identifying the plan of
				care goals and the method for achieving those goals.
(3) Selecting the CMHW services, as supported
				by the member's assessment and level of need that will be included in the plan
				of care.
(4) Choosing the
				office-certified CMHW service provider or providers who will provide, oversee,
				and monitor implementation of the plan of care.
(5) Changing the CMHW service provider or
				providers at any time during the member's enrollment in the CMHW services
				program.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-8 - Eligibility period

Current through July 10, 2024
Authority: IC 12-8-6.5-5; IC 12-15
Affected: IC 12-13-7-3; IC 12-29; IC 25-23.6-10.5; IC
				  25-27.5-5
Sec. 8.
(a) Ongoing
				eligibility for CMHW services is dependent upon the member continuing to meet
				eligibility and needs-based criteria for the CMHW services program.
(b) A member shall be eligible to receive
				CMHW services, as documented in the plan of care, for up to a twelve (12) month
				period, as long as eligibility and needs-based criteria continue to be
				met.
(c) Administration of the
				office-approved behavioral assessment tool must occur every six (6) months from
				the date of last administration of the tool to evaluate a member's level of
				need and response to CMHW services.
(d) The office-approved wraparound
				facilitator must complete a face-to-face reevaluation of the member at least
				every twelve (12) months with input and participation from the child and family
				team, including the member and the member's family.
(e) The face-to-face evaluation of the member
				shall include, but is not limited to, the following:
(1) Administration of the office-approved
				behavioral assessment tool to determine whether the member continues to meet
				the level of need and the needs-based criteria for CMHW services.
(2) Evaluation of the member's response to
				CMHW services and progress towards meeting treatment goals on the plan of
				care.
(3) Evaluation of the
				member's strengths, needs, and functional impairments.
(4) Documentation that the member continues
				to meet the following eligibility criteria as defined in
				405 IAC 5-21.7-5:
(A) Financial criteria.
(B) Target group eligibility.
(C) Needs-based criteria.
(5) The proposed updated plan of
				care and the crisis plan for office review and approval.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-9 - Coverage requirements and limits

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 9.
(a) In order
				for a service provider to be reimbursed for providing a CMHW service to an
				eligible member, the service must be provided in the manner established by this
				section.
(b) In order to be
				eligible for reimbursement, a covered CMHW service shall meet the following
				criteria:
(1) Be documented on the member's
				office-approved plan of care.
(2)
				Be supported by the member's level of need, as documented in the most recent
				assessment of the member.
(3) Be
				provided by an office-certified CMHW service provider meeting all required
				service-specific qualifications and standards.
(4) Be provided within the scope and
				limitations for the service as approved by the office.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-10 - Provider certification and application process

Current through July 10, 2024
Authority: IC
				  12-8-6.5-5; IC 12-15
Affected: IC
				  12-13-7-3; IC 12-29; IC
				  25-23.6-10.5; IC
				  25-27.5-5
Sec. 10.
(a) Only an
				office-certified individual or agency enrolled as a provider of CMHW services
				may be reimbursed for providing a CMHW service to an eligible member.
(b) A CMHW service provider must be
				authorized by the office according to the specific qualifications for and
				standards of the service that the provider or agency is eligible to provide, as
				further defined in section 11 of this rule.
(c) An office-authorized service provider
				must be classified as one (1) of the following types of CMHW service provider:
(1) An accredited agency provider, which is
				defined as a provider employed by an accredited agency meeting the following
				requirements:
(A) The provider is authorized
				by the office as a community mental health center (CMHC) or has been accredited
				by one (1) of the following nationally recognized accrediting bodies:
(i) The Accreditation Association for
				Ambulatory Health Care (AAAHC).
(ii) The American Council for Accredited
				Certification (ACAC).
(iii) The
				Commission on Accreditation of Rehabilitation Facilities (CARF).
(iv) The Council on Accreditation
				(COA).
(v) The Joint Commission on
				Accreditation of Healthcare Organizations (JCAHO).
(vi) The National Committee for Quality
				Assurance (NCQA).
(vii) The
				Utilization Review Accreditation Commission (URAC).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 21.7 - Child Mental Health Wraparound Services › Section 21.7-11 - Provider authorization and service provider qualifications

Current through July 10, 2024
Authority: IC 12-8-6.5-5; IC 12-15
Affected: IC 12-13-7-3; IC 12-17-12; IC 12-17.2-4; IC
				  12-17.2-5; IC 12-29; IC 25-23.6; IC 25-27.5-5; IC 25-33-1; IC 31-27-3; IC
				  31-27-4
Sec. 11.
(a) In
				addition to meeting CMHW service standards required for the provider
				authorization process, as defined in section 10 of this rule, the service
				provider must also meet service-specific qualifications, based upon the
				specific CMHW service for which the provider is seeking office authorization to
				deliver.
(b) A wraparound
				facilitation service provider must meet the following qualifications and
				standards:
(1) The provider must be employed
				by an office-authorized accredited agency.
(2) The provider must qualify as an other
				behavioral health professional (OBHP), as defined in
				405 IAC 5-21.5-1, who has one (1)
				of the following:
(A) A bachelor's degree with
				two (2) or more years of clinical experience.
(B) A master's degree in social work,
				psychology, counseling, nursing, or other mental health-related field, with two
				(2) or more years of clinical experience.
(3) The provider must complete the following
				office-required service provider training and certifications:
(A) CMHW services orientation.
(B) Child and adolescent needs and strengths
				assessment tool certification.
(C)
				Wraparound practitioner certification, provided, however, that the facilitator
				shall have eighteen (18) months after the starting date to complete the
				certification.
(D) Cardiopulmonary
				resuscitation (CPR) certification.