Section 405 IAC 5-21.5-13 - Peer recovery servicesAuthority: 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.(4) Exclusions shall be as follows: (A) Services that are purely recreational or diversionary in nature, or have no therapeutic or programmatic content, may not be reimbursed.(B) Interventions targeted to groups are not billable as peer recovery services.(C) Activities that may be billed under skills training and development or case management services are not billable under peer recover services.(D) Services are not reimbursable for members less than sixteen (16) years of age.Office ofthe Secretary of Family and Social Services; 405 IAC 5-21.5-13; filed May 27, 2010, 9:15 a.m.: 20100623-IR-405100045FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA