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

Affected: IC 12-7-2-40.6; IC 12-13-7-3; IC 12-15-2-3.5; IC 12-29-2; 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, a BPHC eligible provider agency, in collaboration with the applicant, must submit an application in the manner required by the office.

(b) Each applicant for BPHC services must receive a face-to-face evaluation using both 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 should include the following information about the applicant:

1. (1) Health status.
2. (2) Current living situation.
3. (3) Family functioning.
4. (4) Vocational or employment status.
5. (5) Social functioning.
6. (6) Living skills.
7. (7) Self-care skills.
8. (8) Capacity for decision making.
9. (9) Potential for self-injury or harm to others.
10. (10) Substance use or abuse.
11. (11) Need for assistance managing a medical condition.
12. (12) Medication adherence.

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

1. (1) The applicant is an active member in the planning and development of the IICP.
2. (2) The applicant is requesting the services listed on the proposed IICP submitted with the application.
3. (3) The applicant has chosen, from a randomized list of eligible BPHC service providers in the applicant's community, a provider to deliver the office authorized BPHC 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 needs-based and target group eligibility criteria for receiving BPHC services.

(f) For those applicants who are not Medicaid enrolled at the time of application for BPHC services, a Medicaid application must be submitted in the manner set forth in 405 IAC 2-1.1 for a Medicaid eligibility determination.

(g) The state evaluation team retains responsibility for the following:

1. (1) Determining whether an applicant meets the needs-based and target group eligibility criteria for BPHC services.
2. (2) Approving all proposed BPHC services included in the IICP.

(h) Any approval or denial of eligibility for 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 5-21.8-3; filed Apr 8, 2014, 12:41 p.m.: 20140507-IR-405130530FRA; 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)