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Indiana Administrative Code (Last Updated: December 20, 2016) |
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Title 405. OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES |
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Article 405IAC5. MEDICAID SERVICES |
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Rule 405IAC5-21.7. Child Mental Health Wraparound Services |
Section 405IAC5-21.7-5. Eligibility and needs-based criteria
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(a) To be enrolled in the CMHW services program, the applicant must meet the following target group eligibility criteria:
(1) The applicant meets age criteria, which is six (6) through seventeen (17) years of age.
(2) The applicant meets the criteria for two (2) or more American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-IV-TR (or subsequent revision) diagnoses.
(3) The applicant does not meet any of the following CMHW services exclusionary criteria:
(A) Primary substance abuse disorder.
(B) Primary or secondary pervasive developmental disorder (autism spectrum disorder).
(C) Primary attention deficit hyperactivity disorder.
(D) Intellectual disability or disabilities.
(E) Dual diagnosis of serious emotional disturbance and intellectual disabilities.
(b) In addition to meeting the target group eligibility criteria, the applicant must also meet CMHW services needs-based criteria, which include the following:
(1) The applicant is experiencing significant emotional or functional impairments, or both, that impact the level of functioning at home or in the community, as a result of a mental illness, and supported by a behavioral recommendation of a 4, 5, or 6 from the administered office-approved behavioral assessment tool.
(2) The applicant that meets a 4, 5, or 6 behavioral recommendation on the behavioral assessment tool must also demonstrate dysfunctional patterns of behavior due to one (1) or more of the following behavioral or emotional needs identified on the behavioral assessment tool:
(A) Adjustment to trauma.
(B) Psychosis.
(C) Debilitating anxiety.
(D) Conduct problems.
(E) Sexual aggression.
(F) Fire-setting.
(3) The applicant demonstrates significant needs in at least one (1) of the family or caregiver areas, as indicated on the office-approved behavioral assessment tool, which results in a negative impact on the applicant's mental illness:
(A) Mental health.
(B) Supervision issues.
(C) Family stress.
(D) Substance abuse.
(4) The applicant does not meet any of the following exclusionary criteria:
(A) The applicant is at imminent risk of harm to himself or herself or to others.
(B) The applicant is identified as feasibly unable to receive intensive community-based services without compromising his or her safety, or the safety of others.
(Office of the Secretary of Family and Social Services; 405 IAC 5-21.7-5; filed Dec 18, 2013, 11:13 a.m.: 20140115-IR-405130211FRA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; errata filed Nov 1, 2016, 9:36 a.m.: 20161109-IR-405160493ACA)