Ind. Admin. Code tit. 440, r. 9-2-6 – Services to prevent unnecessary and inappropriate treatment and hospitalization and the deprivation of a person's liberty

Affected: IC 12-7-2; IC 12-24-12-10; IC 12-24-19-4; IC 12-26

Sec. 6. (a) Services to prevent unnecessary and inappropriate deprivation of a person's liberty include the following:

(1) Review of commitments and gatekeeping into and out of state-operated institutions.
(2) The range of community support program services and crisis service alternatives.
(3) Those administrative and supervisory functions that manage the care provided to make certain that each consumer receives appropriate care.

(b) A utilization management plan, which provides objective guidance that helps direct treatment, external to the clinician/consumer relationship, must be in place and include the following:

(1) The plan shall be an existing system that defines criteria for initiating a course of treatment, transition, and discharge.
(2) The plan shall be objective, documented, and external to individual clinicians.
(3) The plan shall cite published literature and research on which the system is based.
(4) Utilization management may consist of any of the following:
1. (A) Prior authorization manuals or systems.
2. (B) Evidence based treatment systems.
3. (C) Clinical pathways.
4. (D) American Society of Addiction Medicine criteria.
5. (E) Another system of linking need to care.
(5) A provider may contract for utilization management services.

(c) In addition to regular peer review, supervisor review, and treatment plan reviews, the provider shall have an ongoing process to evaluate the utilization of services.

(d) The utilization of services review shall include the following:

(1) The percentage of cases evaluated for each modality of treatment.
(2) The ongoing system of treatment evaluation.
(3) Samples of reports from the previous year's treatment review.

(e) The provider shall train staff on the use of the utilization management system and keep records regarding the training.

(Division of Mental Health and Addiction; 440 IAC 9-2-6; filed Nov 30, 2001, 10:58 a.m.: 25 IR 1139; readopted filed Apr 7, 2008, 3:40 p.m.: 20080507-IR-440070745RFA; readopted filed Aug 11, 2014, 11:21 a.m.: 20140910-IR- 440140240RFA; readopted filed Nov 9, 2020, 3:09 p.m.: 20201209-IR-440200502RFA)