Section 405 IAC 5-21.7-2 - DefinitionsAuthority: IC 12-8-6.5-5; IC 12-15
Affected: IC 12-13-7-3; IC 12-29; IC 25-23.6-10.5; IC 25-27.5-5
Sec. 2.
(a) The definitions in this section apply throughout this rule.(b) "Access site" means a office-approved agency that will provide CMHW services applicants and families the following: (1) Information about CMHW services and eligibility criteria.(2) Assistance in applying for CMHW services.(3) Linkage to the most appropriate services, based upon an applicant's identified needs.(c) "Applicant" refers to a child who is assessed for meeting eligibility criteria for enrollment in CMHW services.(d) "Behavioral health assessment tool" means a state designated, individually appropriate assessment tool that is:(1) approved by the office; and(2) administered by a qualified individual who is trained and certified by the office to administer the tool.(e) "Behavioral recommendation" means a recommended intensity of behavioral health services that is derived from administration of the office-approved behavioral health assessment tool, as follows:(1) The recommendation is based on an algorithm derived from the patterns of assessment ratings, in multiple life domains, from administration of the assessment tool with the applicant or member and family member.(2) This algorithm does the following: (A) Implements the criteria for a level of need.(B) Indicates the appropriate intensity of behavioral health services recommended for the member.(f) "Child and family wraparound team" or "team" means a wraparound treatment team or support team developed as follows:(1) By a member enrolled in CMHW services and the member's family.(2) To assist a member and the member's family in developing and implementing an individualized plan of care.(g) "Child mental health wraparound" or "CMHW" services mean intensive, home and community-based, behavioral health wraparound services and interventions that meet the following requirements: (1) The services are recommended by a physician or other licensed professional, within the scope of his or her practice.(2) The services and interventions are intended for the: (A) treatment of a mental health disability; and(B) restoration of a member's best possible functional level.(3) The services include clinical and supportive behavioral health services provided for eligible members who are: (A) living with their family in the community; and(B) at risk of an out-of-home placement, due to their mental illness and the disruptive patterns of their behavior.(4) The services are provided in accordance with wraparound principles and a system of care philosophy.(h) "CMHW service provider" means a service provider or agency that: (1) has successfully completed CMHW services provider authorization and training; and(2) meets all qualifications and standards required by the office.(i) "Corrective action" means an action imposed upon the provider by the office for noncompliance with CMHW services policies and procedures.(j) "Crisis plan" means a plan of action prepared by the member, the member's family, and the team that specifies the following: (1) Potential crises the member may experience.(2) The planned interventions and resources available to the member and family to assist in deescalating a crisis situation.(k) "DMHA" refers to the Indiana division of mental health and addiction, which is responsible for operating the CMHW services program. For purposes of this rule, use of the term "the DMHA" includes the following:(1) Staff hired by the DMHA.(2) An entity under contract with the DMHA to provide a service or to complete administrative tasks or functions assigned by the DMHA and required under this rule.(l) "Eligibility determination form" means the written notice provided to the access site, documenting an office determination regarding the meeting of eligibility for level of need and participation in the CMHW services program by an applicant or member. The access site shall share this information with the applicant or member, including the following information that accompanies the eligibility determination form: (1) Approval or denial of the applicant's or member's level of care or eligibility to participate in the CMHW services program.(2) CMHW services approved or denied by the office.(3) The effective dates and reasons for the action or actions taken.(4) The applicant's or member's appeal and fair hearing rights and procedural information.(m) "Family" refers to the legal guardian or caretaker responsible for the care of a member.(n) "Licensed professional" means any of the following persons: (1) A licensed psychiatrist.(2) A licensed physician.(3) A licensed psychologist or a psychologist endorsed as a health service provider in psychology (HSPP).(4) A licensed clinical social worker (LCSW).(5) A licensed mental health counselor (LMHC).(6) A licensed marriage and family therapist (LMFT).(7) A licensed clinical addiction counselor (LCAC), as defined under IC 25-23.6-10.5.(o) "Member" means a person receiving CMHW services.(p) "Plan of care" means the individualized treatment plan that integrates all components and aspects of care, including services that are deemed medically necessary or clinically indicated and all medical and behavioral support services and interventions needed to assist the member in the following: (1) To remain in the home or community.(2) To function at the highest level of independence possible.(3) To achieve treatment goals.(q) "Qualified professional" means a provider who is a licensed professional as defined in this subsection or supervised by a licensed professional.(r) "Qualifying SED work experience" means work directly with the SED population in a way that builds functional skills, such as the following:(1) Group counseling, one-on-one counseling, provision of skills training, or provision of therapeutic recreational activities.(2) The provision of therapeutic foster care, or work in a capacity that may not involve mental health care, but where the work is targeted at a defined SED population.(3) Experience in case management, therapy, or skills training, in conjunction with a mental health center is also considered as qualifying SED work experience.(s) "Seriously emotionally disturbed" or "SED" refers to severe functional impairments due to a mental illness, as defined in 440 IAC 8-2-4.(t) "System of care" refers to a comprehensive spectrum of mental health and other necessary services that are organized into a coordinated network to meet the multiple and changing needs of children and their families, and includes the following concepts regarding care delivery: (1) Family-driven and child-guided.(2) Individualized and community-based.(3) Culturally and linguistically competent.(u) "Unpaid caregiver" means a person, family member, neighbor, friend, co-worker, or companion who provides uncompensated care, training, guidance, companionship, or support to an enrolled CMHW services member.(v) "Wraparound facilitator" means an individual who facilitates and supervises the delivery of wraparound services for a CMHW services member.(w) "Wraparound model of service delivery" means a practice model that is a team-based process for planning and implementing formal and informal services, interventions, and supports for children with complex needs. Services are provided in a manner that is consistent with and guided by a system of care philosophy that builds on the collective action of a committed group of family, friends, community, professionals, and cross-system supports mobilizing resources and talents from a variety of sources resulting in the creation of a plan of care that is the best fit for the family vision and story, team mission, strengths, underlying needs, resources, and strategies.Office of the Secretary of Family and Social Services; 405 IAC 5-21.7-2; filed Dec 18, 2013, 11:13 a.m.: 20140115-IR-405130211FRAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAErrata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA