Section 405 IAC 5-21.6-4 - EligibilityAuthority: 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.(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:(iii) Basic living skills.(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.(b) For purposes of this section, the following definitions apply:(1) "Assistance" means any kind of support given, due to a mental health condition or disorder, including, but not limited to, the following: (2) "Significant" means an assessed need for immediate or intensive action due to a serious or disabling need.Office of the Secretary of Family and Social Services; 405 IAC 5-21.6-4; 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