Section 405IAC5-21.7-8. Eligibility period

   (a) Ongoing eligibility for CMHW services is dependent upon the member continuing to meet eligibility and needs-based criteria for the CMHW services program.

  (b) A member shall be eligible to receive CMHW services, as documented in the plan of care, for up to a twelve (12) month period, as long as eligibility and needs-based criteria continue to be met.

  (c) Administration of the office-approved behavioral assessment tool must occur every six (6) months from the date of last administration of the tool to evaluate a member's level of need and response to CMHW services.

  (d) The office-approved wraparound facilitator must complete a face-to-face reevaluation of the member at least every twelve (12) months with input and participation from the child and family team, including the member and the member's family.

  (e) The face-to-face evaluation of the member shall include, but is not limited to, the following:

(1) Administration of the office-approved behavioral assessment tool to determine whether the member continues to meet the level of need and the needs-based criteria for CMHW services.

(2) Evaluation of the member's response to CMHW services and progress towards meeting treatment goals on the plan of care.

(3) Evaluation of the member's strengths, needs, and functional impairments.

(4) Documentation that the member continues to meet the following eligibility criteria as defined in 405 IAC 5-21.7-5:

(A) Financial criteria.

(B) Target group eligibility.

(C) Needs-based criteria.

(5) The proposed updated plan of care and the crisis plan for office review and approval.

  (f) The office reviews the evaluation findings to assess and determine a member's continued eligibility for CMHW services.

  (g) The office shall notify the wraparound facilitator regarding the results of the review determination and the member's continued eligibility for services, which may include the following:

(1) Approval of the member for continued enrollment in CMHW services, if the member continues to meet CMHW services' eligibility and needs-based criteria.

(2) Denial of the member's enrollment in CMHW services if the eligibility criteria or the needs-based criteria are not met.

(3) Approval of the plan of care for continued CMHW services.

  (h) The wraparound facilitator shall notify the member and the member's family regarding the office's determination of CMHW services eligibility as follows:

(1) By providing an eligibility determination form that documents the office's eligibility determination of approval or denial of the child for CMHW services.

(2) By providing the family with information regarding the fair hearings and appeals process.

  (i) If the member no longer meets the level of need, or is otherwise deemed ineligible for CMHW services, the wraparound facilitator and team shall work together with the member and the member's family to develop and implement a transition plan. The transition plan shall assist the member in moving from CMHW services to community-based services appropriate for the member's current level of need. (Office of the Secretary of Family and Social Services; 405 IAC 5-21.7-8; filed Dec 18, 2013, 11:13 a.m.: 20140115-IR-405130211FRA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA)