Section 440 IAC 4.3-2-4 - ApplicationAuthority: IC 12-21-2-3; IC 12-21-2-8; IC 12-21-5-1.5
Affected: IC 12-7-2-40.6
Sec. 4.
(a) The division shall establish and publish annually the schedule setting out when applications will be accepted by the division for managed care providers to serve specific populations.(b) Any organization applying for certification as a managed care provider shall file an application with the division on a form required by the division.(c) The application submitted by the applicant must contain the following: (1) Evidence of the entity's federal and state nonprofit status.(2) A copy of the applicant's articles of incorporation and all amendments.(3) A copy of all bylaws regulating the conduct of the internal affairs of the applicant.(4) A copy of the financial plan of the applicant, including the following: (A) A projection of anticipated operating results for at least three (3) years.(B) A statement of the sources of working capital and any other sources of funding and provisions for contingencies.(5) Identification of the populations the applicant intends to serve.(6) A description of the organizational structure of the applicant.(7) The location of all operational sites of the applicant.(8) Proof of current accreditation by an approved accrediting agency.(9) A list of governing board members and executive staff.(10) A statement of understanding from the board president and chief executive officer that these rules have been read and understood.(11) Proof of general liability insurance coverage as required in this article.(12) A copy of the applicant's criteria and performance expectations for quality assurance of the applicant and for monitoring its subcontractors regarding consumer rights and confidentiality.(13) A copy of the most recent financial audit, including a balance sheet of assets and liabilities of the applicant, which shall be prepared by an independent certified accountant.(14) A copy of the applicant's contracts with other agencies that demonstrate the applicant's ability to provide, either directly or through subcontracting, the continuum of care as defined in IC 12-7-2-40.6.(15) A copy of the applicant's procedures for addressing complaints made by consumers, or their representatives, regarding the applicant agency or the applicant's subcontractors.(16) A copy of the applicant's procedures to monitor its subcontractors regarding all contract issues, including the following:(A) Quality assessment and utilization review.(B) Screening and eligibility of the consumers.(C) The assurance of the integration of all parts of the continuum of care into each individual's treatment.(17) Other materials as requested by the division to assist in the evaluation of the application.(d) The division shall: (1) complete the review of the application for certification as a managed care provider; and(2) respond to the applicant; within sixty (60) days.(e) If the division determines that the application does not meet the requirements set forth in this rule, the division shall deny the application. The applicant may not reapply to become a managed care provider until the next scheduled application period. Division of Mental Health and Addiction; 440 IAC 4.3-2-4; filed Oct 11, 1996, 2:00 p.m.: 20 IR 755; errata, 20 IR 959; filed Mar 13, 2000, 7:44 a.m.: 23 IR 1987; readopted filed May 10, 2001, 2:30 p.m.: 24 IR 3235; readopted filed Apr 7, 2008, 3:40 p.m.: 20080507-IR-440070745RFA; Readopted filed 8/11/2014, 11:21 a.m.: 20140910-IR-440140240RFAReadopted filed 11/9/2020, 3:09 p.m.: 20201209-IR-440200502RFA