Section 405 IAC 5-21.6-2 - DefinitionsAuthority: 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.(c) "AMHH behavioral health habilitation services" include the following: (2) Home and community-based habilitation and support.(4) Therapy and behavior support services.(5) Addiction counseling.(6) Peer support services.(7) Supported community engagement services.(9) Medication training and support.(d) "Authorized health care professional" or "AHCP" means any of the following persons:(1) A physician assistant with authority to prescribe, dispense, and administer drugs and medical devices or services under an agreement with a supervising physician and subject to the requirements of IC 25-27.5-5.(2) A nurse practitioner or clinical nurse specialist, with prescriptive authority and performing duties within the scope of that person's license and under the supervision of, or under a supervisory agreement with, a licensed physician pursuant to IC 25-23-1.(e) "Detoxification services" means services or activities that are provided to a member during his or her withdrawal from alcohol and other addictive drugs, while under the direct supervision of a physician or clinical nurse specialist.(f) "DMHA" means the division of mental health and addiction.(g) "Habilitation services" means activities that are designed to assist members in acquiring, retaining, and improving the following skills necessary to reside successfully in a community setting:(h) "Individualized integrated care plan" or "IICP" means a treatment plan that: (1) integrates all components and aspects of care that are: (A) deemed medically necessary;(B) clinically indicated; and(C) provided in the most appropriate setting to achieve the member's goals;(2) includes all indicated medical and support services needed by the member in order to: (A) remain in the community;(B) function at the highest level of independence possible; and(C) achieve goals identified in the IICP;(3) is developed for each member;(4) is developed with the member; and(5) reflects the member's desires and choices.(i) "Level of need" means a recommended intensity of behavioral health services based on a pattern of a member's needs, as determined by using a standardized assessment tool.(j) "Licensed professional" means any of the following persons: (1) A licensed psychiatrist.(2) A licensed physician.(3) A licensed psychologist or a psychologist endorsed as a health service provider in psychology (HSPP).(4) A licensed clinical social worker (LCSW).(5) A licensed mental health counselor (LMHC).(6) A licensed marriage and family therapist (LMFT).(7) A licensed clinical addiction counselor (LCAC), as defined under IC 25-23.6-10.5.(k) "Medicaid rehabilitation services" means any medical or remedial service recommended by a physician or other licensed practitioner of the healing arts, within the scope of that individual's practice under state law, for:(1) maximum reduction of physical or mental health disability; and(2) restoration to a member's best possible level of functioning.(l) "Nonprofessional caregiver" means any individual who does not receive compensation for providing care or services to a member.(m) "Office-approved behavioral health assessment tool" means the state designated assessment tool administered by a qualified individual who is trained and office-certified to administer the tool in order to assist in determining the level of need and functional impairment of an applicant or a member.(n) "Other behavioral health professional" or "OBHP" means any of the following: (1) An individual with an associate's or bachelor's degree, or equivalent behavioral health experience: (A) meeting minimum competency standards set forth by a behavioral health service provider; and(B) supervised by either a licensed professional or a QBHP.(2) A licensed addiction counselor, as defined under IC 25-23.6-10.5, supervised by either a licensed professional or a QBHP.(o) "Professional caregiver" means an individual who receives payment for providing services and supports to a member.(p) "Provider agency" means any office-approved agency that meets the qualifications and criteria to become an AMHH provider agency, as required by this rule.(q) "Provider staff" means any individual working under an office-approved AMHH provider agency that meets the qualifications and requirements mandated by the AMHH service being provided, as defined in this rule.(r) "Qualified behavioral health professional" or "QBHP" means any of the following: (1) An individual who has had at least two (2) years of clinical experience treating persons with mental illness under the supervision of a licensed professional, with such experience occurring after the completion of a master's degree or doctoral degree, or both, in any of the following disciplines from an accredited university: (A) Psychiatric or mental health nursing, plus a license as a registered nurse in Indiana.(C) Rehabilitation counseling.(2) An individual who: (A) is under the supervision of a licensed professional;(B) is eligible for and working towards professional licensure; and(C) has completed a master's or doctoral degree, or both, in any of the following disciplines from an accredited university:(i) Social work from a university accredited by the Council on Social Work Education.(iii) Mental health counseling.(iv) Marital and family therapy.(3) A licensed, independent practice, school psychologist under the supervision of a licensed professional.(4) An authorized health care professional (AHCP) who is one (1) of the following: (A) A physician assistant with the authority to prescribe, dispense, and administer drugs and medical devices or services under an agreement with a supervising physician and subject to the requirements of IC 25-27.5-5.(B) A nurse practitioner or clinical nurse specialist, with prescriptive authority, performing duties within the scope of that person's license and under the supervision of, or under a supervisory agreement with, a licensed physician pursuant to IC 25-23-1.(s) "Skills training" means services or activities to further the reinforcement, management, adaptation, and retention of skills necessary for a member to live successfully in the community.(t) "State evaluation team" means the office independent evaluation team that will review and assess all evaluation information and supporting clinical documentation collected for AMHH applicants and members and will be responsible for making final determinations regarding the following:(1) Eligibility of applicants for AMHH services.(2) Authorization for AMHH services for eligible members.(3) Continued eligibility determination for AMHH members.(4) Appropriate service delivery to AMHH members, as a result of conducting quality improvement reviews of AMHH service provider agencies.Office of the Secretary of Family and Social Services; 405 IAC 5-21.6-2; 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