Authority: IC 12-8-6.5-5; IC 12-15

Affected: IC 12-13-7-3; IC 12-29; IC 25-23-1-1; IC 25-23.6-10.5; IC 25-27.5-5

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.

(b) Each applicant for AMHH services must receive a face-to-face evaluation using the:

1. (1) office-approved behavioral health assessment tool; and
2. (2) application form developed by the office.

(c) The application form and supporting documentation may include the following information about the applicant:

1. (1) Current and historical health status.
2. (2) Behavioral health issues.
3. (3) Functional needs.

(d) An application must, at a minimum, include documentation indicating the following:

1. (1) The applicant is requesting the service or services listed on the proposed IICP submitted with the application.
2. (2) The applicant chose, from a randomized list of eligible AMHH service providers in the applicant's community, a provider to deliver the office authorized AMHH services under this rule.

(e) 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) 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) Any approval or denial of services under this rule will be communicated to the:

1. (1) applicant or the applicant's authorized representative; and
2. (2) referring provider agency.

(Office of the Secretary of Family and Social Services; 405 IAC 5-21.6-3; filed Dec 16, 2013, 9:11 a.m.: 20140115-IR-405130183FRA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; readopted filed Jul 28, 2022, 2:21 p.m.: 20220824-IR-405220205RFA; readopted filed May 30, 2023, 11:54 a.m.: 20230628-IR-405230292RFA)