405 IAC 5-21.5-7 - Behavioral health level of need redetermination
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 7.
(a) The
services reimbursable as behavioral health level of need redetermination are
services associated with the DMHA approved assessment tool required to
determine level of need, assign an MRO service package, and make changes to the
individualized integrated care plan.
(b) The redetermination requires face-to-face
contact with the member and may include face-to-face or telephone collateral
contacts with family members or nonprofessional caretakers, which result in a
completed redetermination.
(c)
Requirements for behavioral health level of need redetermination services shall
be as follows:
(1) Services may be provided
for members of all ages.
(2)
Services must be provided by individuals meeting DMHA training competency
standards for the use of the DMHA-approved assessment tool.
(3) The DMHA assessment tool must be
completed at least every six (6) months for the purpose of determining the
continued need for MRO services.
(4) Reassessment may occur when there is a
significant event or change in member status.
(5) Exclusions shall be as follows:
(A) MRO redetermination should not be
duplicative of assessments available with clinic option services.
(B) This service may not be billed as part of
the initial bio-psychosocial assessment when a member is entering
treatment.
Notes
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