Section 405 IAC 5-21.5-4 - Behavioral health counseling and therapyAuthority: IC 12-15
Affected: IC 12-13-7-3; IC 25-23.6-10.5
Sec. 4.
(a) The services reimbursable as individual or group behavioral health counseling and therapy consist of a series of time-limited, structured, face-to-face sessions that work toward the goals identified in the individualized integrated care plan. The service must be provided at the member's home or at other locations outside the clinic setting as follows:(1) Requirements for individual or group behavioral health counseling and therapy services shall be as follows:(A) Services may be provided for members of all ages.(B) Providers must meet the either of the following qualifications: (i) A licensed professional, except for a licensed clinical addiction counselor, as defined under IC 25-23.6-10.5.(2) Programming standards shall be as follows: (A) The service requires face-to-face contact.(B) The member is the focus of the service.(C) Documentation must support how the service benefits the member, including when services are provided in a group setting.(D) Services must demonstrate movement toward or achievement of member treatment goals identified in the individualized integrated care plan.(E) Service goals must be rehabilitative in nature.(F) When provided in a group setting, services must be provided in an age appropriate setting for a member less than eighteen (18) years of age.(3) Exclusions shall be as follows: (A) Services provided in a clinic setting and services provided as a part of school-based services are not billable under the MRO program, and must be billed to the clinic option.(B) Licensed clinical addiction counselors, as defined under IC 25-23.6-10.5, may not provide this service.(C) If medication management is a component of the service session, then medication training and support may not be billed separately for the same visit by the same provider.(b) The services reimbursable as family or couple behavioral health counseling and therapy consist of a series of time-limited, structured, and face-to-face sessions, with or without the member present, that work toward the goals identified in the individualized integrated care plan. The face-to-face interaction may be with family members or nonprofessional caregivers. The service must be provided at home or other locations outside the clinic setting as follows: (1) Requirements for family or couple behavioral health counseling and therapy services shall be as follows: (A) Services may be provided for members of all ages.(B) Providers must meet either of the following qualifications:(i) A licensed professional, except for a licensed clinical addiction counselor, as defined under IC 25-23.6-10.5.(C) Services may be delivered in an individual or group setting.(2) Programming standards shall be as follows:(A) The service requires face-to-face contact.(B) The member is the focus of the service.(C) Documentation must support how the service benefits the member, including when the member is not present and when services are provided in a group setting.(D) Services must demonstrate movement toward or achievement of member treatment goals identified in the individualized integrated care plan.(E) Service goals must be rehabilitative in nature.(F) When provided in a group setting, services must be provided in an age appropriate setting for a member less than eighteen (18) years of age.(3) Exclusions shall be as follows: (A) Services provided in a clinic setting and service provided as a part of school-based services are not billable under the MRO program, and must be billed to the clinic option.(B) Licensed clinical addiction counselors, as defined under IC 25-23.6-10.5, may not provide this service.(C) If medication management is a component of the service session, then medication training and support may not be billed separately for the same visit by the same provider.(D) Services may not be provided to professional caregivers.Office ofthe Secretary of Family and Social Services; 405 IAC 5-21.5-4; 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