405 IAC 5-21.5-13 - Peer recovery services
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 13.
The services reimbursable as peer recovery services are face-to-face, structured, scheduled activities that promote socialization, recovery, self-advocacy, development of natural supports, and maintenance of community living skills. Requirements for peer recovery services shall be as follows:
(1) Services may be provided
for members eighteen (18) years of age and older. Services may be provided for
members age sixteen (16) or seventeen (17) with prior authorization. Services
shall not be provided to or for a member less than sixteen (16) years of
age.
(2) Services must be provided
by individuals meeting DMHA training and competency standards for certified
recovery specialists. Individuals providing peer recovery services must be
under the supervision of a licensed professional or a QBHP.
(3) Programming standards shall be as
follows:
(A) Services must be identified in
the individualized integrated care plan and must correspond to specific
treatment goals.
(B) Services must
be provided face-to-face and include the following components:
(i) Assisting members with developing
individualized integrated care plans and other formal mentoring activities
aimed at increasing the active participation of members in person-centered
planning and delivery of individualized services.
(ii) Assisting members with the development
of psychiatric advanced directives.
(iii) Supporting members in problem solving
related to reintegration into the community.
(iv) Education and promotion of recovery and
anti-stigma activities.
(C) Documentation must support how the
service specifically benefits the member.
(D) The member is the focus of the
treatment.
(E) Services must
demonstrate movement toward or achievement of member treatment goals identified
in the individualized integrated care plan.
(F) Service goals must be rehabilitative in
nature.
(G) Services must be
provided in an age appropriate setting for a member eighteen (18) years of age
and under receiving services.
(4) Exclusions shall be as follows:
(A) Services that are purely recreational or
diversionary in nature, or have no therapeutic or programmatic content, may not
be reimbursed.
(B) Interventions
targeted to groups are not billable as peer recovery services.
(C) Activities that may be billed under
skills training and development or case management services are not billable
under peer recover services.
(D)
Services are not reimbursable for members less than sixteen (16) years of
age.
Notes
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