405 IAC 5-21.5-9 - Child and adolescent intensive resiliency services
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 9.
(a) The
services reimbursable as child and adolescent intensive resiliency services
(CAIRS) are time-limited, nonresidential services provided to children or
adolescents in a clinically supervised setting that provides an integrated
system of individual, family, and group interventions based on an
individualized integrated care plan.
(b) Services are designed to alleviate
emotional or behavioral problems. Services are curriculum-based with goals that
include reintegration into age appropriate community settings.
(c) The requirements for CAIRS shall be as
follows:
(1) Services may be provided for
members at least five (5) years of age and less than eighteen (18) years of age
with severe emotional disturbance who:
(A)
need structured therapeutic and rehabilitative services;
(B) have significant impairment in day-to-day
personal, social, or vocational functioning;
(C) do not require acute stabilization,
including inpatient or detoxification services; and
(D) are not at imminent risk of harm to self
or others.
(2) Services
may be provided to members eighteen (18) years of age and older and less than
twenty-one (21) years of age with prior authorization.
(d) Services may be provided in a facility
provided by a school district.
(e)
Providers must meet any of the following qualifications:
(1) A licensed professional.
(2) A QBHP.
(3) An OBHP.
(f) Programming standards shall be as
follows:
(1) Services must be authorized by a
physician or an HSPP.
(2) Direct
services must be supervised by a licensed professional.
(3) Services are provided in close
coordination with the educational program provided by a local school
district.
(4) Clinical oversight
must be provided by a licensed physician, who is on-site weekly and available
to program staff when not physically present.
(5) Member goals and a transitional plan must
be designed to reintegrate the member into the school setting.
(6) Therapeutic services include clinical
therapies, psycho-educational groups, and rehabilitative activities.
(7) A weekly review and update of the
member's progress is prepared and is documented in the member's clinical
record.
(8) Services must be
provided in an age appropriate setting for a member eighteen (18) years of age
and under.
(9) The member is the
focus of the service.
(10)
Documentation must support how the service benefits the member, including when
provided in a group setting.
(11)
Services must demonstrate movement toward or achievement of member treatment
goals identified in the individualized integrated care plan.
(12) Service goals must be rehabilitative in
nature.
(13) Services must be
provided in an age appropriate setting for members less than eighteen (18)
years of age receiving services.
(g) Exclusions from reimbursement shall be as
follows:
(1) Services for members less than
five (5) years of age.
(2) Services
without a prior authorization for members eighteen (18) years of age and older,
but less than twenty-one (21) years of age.
(3) Services that are purely recreational or
diversionary in nature or have no therapeutic or programmatic
content.
(4) Formal educational or
vocational services.
(5) CAIRS will
not be reimbursed for a member who receives both CAIRS and adult intensive
rehabilitative services on the same day.
(6) CAIRS will not be reimbursed for a member
who receives both CAIRS and individual or group skills training and development
on the same day.
Notes
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No prior version found.