in-20260729-IR-405260257FNA: ADULT MENTAL HEALTH HABILITATION

TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES Notice of First Public Comment Period LSA Document #26-257 ADULT MENTAL HEALTH HABILITATION PURPOSE OF NOTICE The Office of Medicaid Policy and Planning (OMPP) is soliciting public comment on amending and repealing rules at 405 IAC 5-21.6 regarding adult mental health habilitation. ADDITIONAL DOCUMENTS Regulatory Analysis: 20260729-IR-405260257RAA Notice of Public Hearing: 20260729-IR-405260257PHA CITATIONS AFFECTED: 405 IAC 5-21.6 AUTHORITY: IC 12-8-6.5-5; IC 12-15 OVERVIEW Basic Purpose and Background The adult mental health habilitation program offers services as an alternative for individuals who have achieved maximum benefit from Medicaid rehabilitation option services, and whose needs can be better met through habilitation. The proposed rule clarifies definitions, updates outdated language, and adds references to telehealth services throughout. The implementation costs of the proposed rule are not expected to exceed the threshold set in IC 4-22-2-22.7(c)(6). For purposes of IC 4-22-2-28.1, small businesses affected by this rulemaking may contact the Small Business Regulatory Coordinator: For purposes of IC 4-22-2-28.1, the Small Business Ombudsman designated by IC 5-28-17-6 is: Resources available to regulated entities through the small business ombudsman include the ombudsman's duties stated in IC 5-28-17-6, specifically IC 5-28-17-6(9), investigating and attempting to resolve any matter regarding compliance by a small business with a law, rule, or policy administered by a state agency, either as a party to a proceeding or as a mediator. REQUEST FOR PUBLIC COMMENT OMPP is soliciting public comment on the proposed rule. Comments may be submitted in one of the following ways: COMMENT PERIOD DEADLINE All comments must be postmarked or time-stamped not later than August 28, 2026. The rule, Regulatory Analysis, appendices referenced in the Regulatory Analysis, and materials incorporated by reference (if applicable) are on file at the Family and Social Services Administration, 402 West Washington Street, Room W451, Indianapolis, Indiana and are available for public inspection. Copies of the rule, Regulatory Analysis, and appendices referenced in the Regulatory Analysis are available at the Family and Social Services Administration office. If OMPP does not receive substantive comments during the public comment period or public hearing, the rule may be adopted with text that is the same as or does not substantially differ from the text of the proposed rule published in this notice. PROPOSED RULE Sec. 2. (a) The definitions in this section apply throughout this rule. (b) "Adult mental health habilitation" or "AMHH" services refers to medical or remedial services recommended by a physician or other licensed professional, within the scope of his or her their practice, for the habilitation of a mental health disability and the restoration or maintenance of an individual's best possible functional level. Services are clinical and supportive behavioral health services that are provided for individuals, families, or groups of adult persons who: (c) "AMHH behavioral health habilitation services" include the following: (d) “Approved DMHA behavioral health assessment tool” means the state designated assessment tool administered by a qualified individual who is trained and DMHA certified to administer the tool to assist in determining the level of need and functional impairment of an applicant or a member. (d) (e) "Authorized health care professional" or "AHCP" means any of the following persons: (e) (f) "Detoxification services" means services or activities that are provided to a member during his or her their withdrawal from alcohol and other addictive drugs, while under the direct supervision of a physician or clinical nurse specialist. (f) (g) "DMHA" means the division of mental health and addiction. (g) (h) "Habilitation services" means activities that are designed to assist members in acquiring, retaining, and improving the following skills necessary to reside successfully in a community setting: (h) (i) "Individualized integrated care plan" or "IICP" means a treatment plan that: (i) (j) "Level of need" means a recommended intensity of behavioral health services based on a pattern of a member's needs, as determined by using a standardized an approved DMHA behavioral health assessment tool. (j) (k) "Licensed professional" means any of the following persons: (k) (l) "Medicaid rehabilitation services" means any medical or remedial service recommended by a physician or other licensed practitioner of the healing arts, within the scope of that individual's practice under state law, for: (l) (m) "Nonprofessional caregiver" means any individual who does not receive compensation for providing care or services to a member. (m) "Office-approved behavioral health assessment tool" means the state designated assessment tool administered by a qualified individual who is trained and office-certified to administer the tool in order to assist in determining the level of need and functional impairment of an applicant or a member. (n) "Other behavioral health professional" or "OBHP" means any of the following: (o) "Professional caregiver" means an individual who receives payment for providing services and supports to a member. (p) "Provider agency" means any office-approved DMHA-approved agency that meets the qualifications and criteria to become an AMHH provider agency, as required by this rule. (q) "Provider staff" means any an individual working under an office-approved a DMHA-approved AMHH provider agency that meets the qualifications and requirements mandated by the AMHH service being provided, as defined in this rule. (r) "Qualified behavioral health professional" or "QBHP" means any of the following: (s) "Skills training" means services or activities to further the reinforcement, management, adaptation, and retention of skills necessary for a member to live successfully in the community. (t) "State evaluation team" means the office DMHA independent evaluation team that will review and assess all evaluation information and supporting clinical documentation collected for AMHH applicants and members and will be responsible for making final determinations regarding the following: Sec. 3. (a) In order For an individual to receive services under this rule, an AMHH eligible provider agency, in collaboration with the individual seeking services, must submit an application in the manner required by the office DMHA. (b) Each applicant for AMHH services must receive a face-to-face, or through telehealth as outlined in IC 12-15-5-11, evaluation using the approved DMHA behavioral health assessment tool. (c) The application form and supporting documentation may include the following information about the applicant: (d) (c) An application must, at a minimum, include documentation indicating the following: (e) (d) Upon receipt of the application and supporting clinical documentation, the state evaluation team will assess the submitted information and determine whether or not the applicant meets the core eligibility criteria for receiving AMHH services. (f) (e) The responsibility for eligibility determination and approval of all proposed AMHH services included in the IICP is retained by the state evaluation team in order to prevent a conflict of interests. (g) (f) Any approval or denial of services under this rule will be communicated to the: Sec. 4. (a) An applicant may be eligible for participation in the AMHH services program if the applicant meets all of the following core criteria: (b) For purposes of this section, the following definitions apply: Sec. 5. (a) A member who is approved to receive AMHH services under this rule shall be is eligible for such those services for up to a twelve (12) month period, three hundred sixty (360) days, as long as eligibility and needs-based criteria continue to be met. (b) A reevaluation will be conducted at least every twelve (12) months three hundred sixty (360) days and shall must include the following: (c) The state evaluation team will review and assess the renewal application and reevaluation results to determine whether the member continues to meet AMHH eligibility. (d) Any approval or denial of eligibility and services under this rule will be communicated to the: Sec. 7. (a) For an AMHH service to be reimbursable under this rule, the service must: (b) The following services, as defined in section 2(c) of this rule, are covered under the AMHH services program according to the coverage criteria, limitations, and procedures specified in this rule: (c) The following services will not be covered and are not eligible for reimbursement under this rule: Sec. 8. (a) The services reimbursable as adult day services consist of community-based group programs designed to meet the needs of adults with significant behavioral health impairments as identified in a member's IICP. These comprehensive, nonresidential programs provide health, wellness, social, and therapeutic activities. The day services are delivered in a structured, supportive environment and provide the member with supervision, support services, and personal care, as required by the member's IICP. (b) Adult day services may include any of the following services as they relate to the member's IICP: (c) Provider staff of adult day services must meet any of the following qualifications: (d) The agency staff member providing adult day services must receive supervision by a licensed professional, as defined in section 2(k) of this rule. (e) Medication administration provided as an adult day service must be delivered within the individual's scope of practice, as defined by federal and state law, by an agency staff member who meets one (1) of the following qualifications: (f) A certified dietitian providing nutritional assessment and planning as a part of the adult day service must meet the qualifications in IC 25-14.5. (g) Adult day service standards include all of the following requirements: (h) Services provided in a residential setting are not reimbursable as adult day services under this rule. Sec. 9. (a) The services available as home and community-based habilitation and support services are intended to: (b) The services may be reimbursable as either of the following: (c) The services reimbursable under individual or any other subcategory of the service with the member present must meet the following requirements: (d) The services reimbursable under either a family setting or as a couple, with or without the member present, must meet the following requirements: (e) Agency staff must meet any of the following qualifications to provide services under this section: (f) Home and community-based habilitation and support service standards include the following: (g) The following services are not reimbursable under this section: Sec. 11. (a) The services reimbursable as therapy and behavioral support services include the following: (b) Services provided to a member must be: (c) Services provided must meet the following requirements: (d) Provider staff delivering services under this subsection must meet one (1) of the following qualifications: (e) Therapy and behavioral support service standards include the following: (f) The services are not reimbursable under this section if provided in a clinic setting. Sec. 12. (a) The services reimbursable as addiction counseling services include the following: (b) Services shall must meet the following standards: (c) Services under this section may be provided to adult members with: (d) All services may be provided in an individual or group setting, but the member must always be the focus of addiction counseling. (e) Provider staff delivering services under this section must meet one (1) of the following qualifications: (f) The following services are not reimbursable under this section: Sec. 15. (a) The services reimbursable as care coordination services consist of services that assist a member in gaining access to needed medical, social, educational, and other services, including the following: (b) For purposes of this section, care coordination includes the following services: (c) Provider staff delivering services under this section must meet one (1) of the following qualifications: (d) Agency staff providing services must provide: (e) The following services may be provided under the care coordination services identified under subsection (b): (f) The time devoted to formal supervision between the care coordinator and the licensed supervisor to review the member's care and treatment shall be: is: (g) The following services are not reimbursable under this section: Sec. 16. (a) The services reimbursable as medication training and support services include the following: (b) The following services are reimbursable and must be provided face-to-face, or through telehealth as outlined in IC 12-15-5-11, in either an individual or a group setting: (c) A provider agency may receive reimbursement for training family members or nonprofessional caregivers to perform the activities identified in this section. (d) When provided to family members or other nonprofessional caregivers, the service: (e) Medication training and support may also include the following services that are not required to be provided face-to-face, or through telehealth as outlined in IC 12-15-5-11, with the member: (f) Services provided that are not face-to-face, or through telehealth as outlined in IC 12-15-5-11, with the member must meet the following standards: (g) When provided in a clinic setting, medication training and support may compliment, but not duplicate, activities associated with medication management activities available under the Medicaid clinic option. (h) When provided in a residential treatment setting, medication training and support may include components of medication management services as defined under the Medicaid clinic option. (i) Provider staff delivering services under this section must meet one (1) of the following qualifications: (j) The services under this section must be provided within the practitioner's scope of practice as defined by federal and state law. (k) The following services are not reimbursable under this section: Documents Incorporated by Reference: None Received by Publisher Small Business Regulatory Coordinator: Kimberly Swope-Gruzinsky, Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning, Indiana Government Center South, 402 West Washington Street, Room W374, Indianapolis, IN 46204, (317) 232-6685, Kimberly.swope-gruzinsky@fssa.in.gov