405 IAC 5-21.5-15 - Psychiatric assessment and intervention

Authority: IC 12-15

Affected: IC 12-13-7-3

Sec. 15.

The services reimbursable as psychiatric assessment and intervention services are face-to-face and nonface-to-face activities that are designed to provide psychiatric assessment, consultation, and intervention services to members. Requirements for psychiatric assessment and intervention services shall be as follows:

(1) Services may be provided for members eighteen (18) years and older with a history of multiple hospitalizations and severe challenges in maintaining independent living within the community. Services may be prior authorized for members less than eighteen (18) years of age.

(2) Providers must meet any of the following qualifications:

(A) A physician.

(B) An AHCP.

(3) Programming standards shall be as follows:

(A) Service delivery may include both face-to-face and certain nonface-to-face activities.

(B) Psychiatric assessment services are intensive and must be available twenty-four (24) hours per day, seven (7) days per week, and with emergency response.

(C) Services must include, but are not limited to, the following:

(i) Symptom assessment and intervention to observe, monitor, and care for the physical, nutritional, behavioral health, and related psychosocial issues, problems, or crises manifested in the course of a member's treatment.

(ii) Monitoring a member's medical and other health issues that are either directly related to a mental health disorder or a substance related disorder, or to the treatment of the disorder.

(iii) Consultation on assessment, service planning, and implementation with other members of the member's treatment team, the member's family, and nonprofessional caregivers.

(D) The member is the focus of the service.

(E) Documentation must support how the service benefits the member.

(F) Services must demonstrate movement toward or achievement of member treatment goals identified in the individualized integrated care plan.

(G) Service goals must be rehabilitative in nature.

(4) Exclusions shall be as follows:

(A) Medication management activities provided in a clinic setting that may be reimbursed under the clinic option.

(B) Services that may be reimbursed under the clinic option.

Notes

405 IAC 5-21.5-15

Office ofthe Secretary of Family and Social Services; 405 IAC 5-21.5-15; filed May 27, 2010, 9:15 a.m.: 20100623-IR-405100045FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA