Section 405 IAC 5-21.6-15 - Care coordination servicesAuthority: 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.(b) For purposes of this section, care coordination includes the following services: (3) Referral and linkage.(4) Monitoring and follow-up.(c) Provider staff delivering services under this section must meet one (1) of the following qualifications: (1) A licensed professional.(d) Agency staff providing services must provide:(1) direct assistance in gaining access to necessary medical, social, educational, and other services; and(2) referrals to services, activities, or contacts necessary to ensure that the IICP: (A) is effectively implemented; and(B) adequately addresses the mental health or addiction needs, or both, of the eligible member.(e) The following services may be provided under the care coordination services identified under subsection (b): (1) A needs assessment consists of identifying the member's needs for any medical, educational, social, or other services. Specific assessment activities necessary to form a complete needs assessment of the member may include:(A) documenting the member's history;(B) identifying the member's needs;(C) completing related documentation; or(D) gathering information from other sources, such as: (2) The IICP development activities include the development of a written IICP based upon the information collected through the needs assessment phase. The IICP shall identify the habilitation activities and assistance needed to accomplish the member's objectives.(3) Referral and linkage include activities that help link the member with: (B) social service providers;(C) educational providers; and(D) other programs and services that are capable of providing habilitative services that meet the member's needs.(4) Monitoring and follow-up activities:(A) include making contacts necessary to ensure that the IICP is effectively implemented and adequately addresses the needs of the member; and(B) may include activities and contacts with the following individuals:(ii) Family members or others who have a significant relationship with the member.(iii) Nonprofessional caregivers.(5) Evaluation activities include face-to-face contact with the member at least every ninety (90) days for the following reasons:(A) To ensure the IICP is effectively implemented and adequately addresses the member's needs.(B) To determine if the services are consistent with the IICP and any changes to the IICP.(C) To make changes or adjustments to the IICP in order to meet the member's ongoing needs.(D) To evaluate or reevaluate the member's progress toward achieving the IICP's objectives.(f) The time devoted to formal supervision between the care coordinator and the licensed supervisor to review the member's care and treatment shall be:(1) an included care coordination activity;(2) documented accordingly in the member's clinical record; and(3) billed under only one (1) provider staff member.(g) The following services are not reimbursable under this section: (1) The direct delivery of medical, clinical, or other direct services.(2) Services provided in a group setting, including, but not limited to, the following: (A) Training in daily living skills.(B) Training in work or social skills.(C) Grooming and other personal services.(D) Training in housekeeping, laundry, and cooking.(E) Transportation services.(F) Individual, group, or family therapy services.(G) Crisis intervention services.(3) Services that go beyond assisting a member in gaining access to needed services including, but not limited to, the following: (B) Balancing the member's checkbook.(C) Traveling to and from appointments with a member or members.Office of the Secretary of Family and Social Services; 405 IAC 5-21.6-15; filed Dec 16, 2013, 9:11 a.m.: 20140115-IR-405130183FRAFiled 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