Institution for Mental Disease a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases.
Institution for Mental Disease. (IMD) In accordance with 42 CFR 438.3(e)(2), the Plan may cover services or settings in lieu of services or settings covered under the State Plan, including short-term stays no more than 15 days in a calendar month in an Institution for Mental Disease (IMD) for members ages 21 to 64. For Indiana Health Coverage Programs (IHCP) members enrolled in Hoosier Healthwise, MCEs can authorize stays in an IMD for mental health, behavioral health and substance use disorder inpatient services in lieu of other settings under the Medicaid State Plan. IHCP will follow the definition in accordance with 42 CFR 435.1010 for establishing eligible IMD providers. Identified providers will be provided to the MCE. The Plan may not require or create incentives for the member to receive services in an IMD versus a setting covered under the State Plan. In accordance with 42 CFR 435.1010, an IMD “means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. Whether an institution is an institution for mental diseases is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such. An institution for Individuals with Intellectual Disabilities is not an institution for mental diseases.” This may include a hospital providing psychiatric or substance use disorder inpatient care or a sub-acute facility providing psychiatric or substance use disorder crisis residential services. If the member’s IMD stay exceeds 15 days in a calendar month and the member has been ordered to a state operated facility for treatment but is awaiting placement in a state hospital, the member will be disenrolled from the Plan and enrolled in fee-for-service. The Plan shall ensure the member is properly transitioned and there is not a break in coverage. For stays exceeding 15 days in a calendar month where the member is not awaiting placement in a state hospital, the member will remain enrolled in the Plan and the Plan will continue to provide care coordination services and reimburse all covered services. Additionally, for these stays, the State shall recover the entire monthly capitation payment for the member. The Plan must submit data related to IMD stays as outlined in the MCE Reporting Manual. Th...
Institution for Mental Disease. (IMD) Pending CMS approval, FSSA reserves the right to alter the coverage and length of stay restrictions in this section. The Contractor will cover short term stays in an Institution for Mental Diseases (IMD) for serious mental illness (SMI) and substance use disorder (SUD) under the State’s §1115 SMI and SUD demonstration authorities. IHCP will follow federal guidance in accordance with 42 CFR 435.1010 as well as any additional criteria established by the State’s §1115 waivers used to distinguish qualified IMD providers. EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK The Contractor will cover short term inpatient stays for serious mental illness (SMI) in a qualified Institution for Mental Disease (IMD) for members aged 21 to 64 and is required to maintain an average length of stay not to exceed 30 days for all IMD stays for SMI. A maximum of 60 days can be approved, if medically necessary, for short term IMD stays for SMI. The Contractor will cover short term inpatient stays for substance use disorder (SUD) in a qualified Institution for Mental Diseases (IMD) for members aged 21 to 64 for up to 15 days in a calendar month as medically necessary for individuals with substance use disorder. If a member’s IMD stay exceeds 15 days in a calendar month and the member is awaiting placement in a state operated facility (SOF) for treatment, the member will be disenrolled from the plan and enrolled in fee for service. For stays exceeding 15 days in a calendar month in which the member is not awaiting placement in a SOF, the member will remain enrolled with the Contractor and the state shall recover the entire monthly capitation payment for the member. The Contractor will cover short term residential stays for substance use disorder (SUD) in a qualified Institution for Mental Diseases (IMD) for members aged 21 to 64 and is required to maintain an average length of stay not to exceed 30 days for all residential IMD stays for SUD. The Contractor shall actively track and coordinate the care of members receiving care in an IMD. Anticipating and planning for a member’s successful discharge should begin immediately upon a member’s entry into an IMD. Lists of qualified IMD providers under both §1115 waivers will be provided to the Contractor. The Contractor may not require or create incentives for the member to receive services in an IMD versus a setting covered under the State Plan. In accordance with 42 CFR 435.1010, an IMD is generally defined as “a hospital, nursing f...
Institution for Mental Disease. (IMD) Pending CMS approval, FSSA reserves the right to alter the coverage and length of stay restrictions in this section. The Contractor will cover short term stays in an Institution for Mental Diseases (IMD) for serious mental illness (SMI) and substance use disorder (SUD) under the State’s §1115 SMI and SUD demonstration authorities. IHCP will follow federal guidance in accordance with 42 CFR 435.1010 as well as any additional criteria established by the State’s §1115 waivers used to distinguish qualified IMD providers. EXHIBIT 1.E
Institution for Mental Disease. (IMD) The Contractor may cover short term stays in an Institution for Mental Disease (IMD) for members age 21 to 64 with an average length of stay of 30 days and maximum length of stay of 60 days. For Indiana Health Coverage Programs (IHCP) members enrolled in Hoosier Healthwise, MCEs can authorize stays in an IMD for mental health, behavioral health and substance use disorder inpatient services under the State’s 1115 waiver. IHCP will follow the definition in accordance with 42 CFR 435.1010 for establishing eligible IMD providers. Identified IMD providers will be provided to the MCE. The Plan may not require or create incentives for the member to receive services in an IMD versus a setting covered under the State Plan. In accordance with 42 CFR 435.1010, an IMD “means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. Whether an institution is an institution for mental diseases is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such. An institution for Individuals with Intellectual Disabilities is not an institution for mental diseases.” This may include a hospital providing psychiatric or substance use disorder inpatient care or a sub-acute facility providing psychiatric or substance use disorder crisis residential services. The Plan must submit data related to IMD stays as outlined in the MCE Reporting Manual. The proposed services and settings will be reimbursable and subject to the requirements contained in 42 CFR part 438.
Institution for Mental Disease. (IMD) The Contractor will cover short term stays in an Institution for Mental Diseases (IMD) for serious mental illness (SMI) and substance use disorder (SUD) under the State’s §1115 SMI and SUD demonstration authorities. IHCP will follow federal guidance in accordance with 42 CFR 435.1010 as well as any additional criteria established by the State’s §1115 waivers used to distinguish qualified IMD providers. In accordance with 42 CFR 457.1201(e) and 42 CFR 438.3(e)(2)(i)-(iii), the State has determined that treatment in an IMD is a medically appropriate and cost-effective substitute for the behavioral health service covered under the State Plan in other settings. Contractors may, but are not required, to use an IMD in lieu of other behavioral health services. The Contractor is prohibited from requiring an enrollee to access behavioral health services at an IMD. The State will make monthly capitation payments to the Contractor to cover short term EXHIBIT 1 SCOPE OF WORK – HEALTHY INDIANA PLAN inpatient stays for serious mental illness (SMI) in a qualified Institution for Mental Disease (IMD) for members aged 21 to 64 and is required to maintain an average length of stay not to exceed 30 days for all IMD stays for SMI. A maximum of 60 days can be approved, if medically necessary, for short term IMD stays for SMI. The Contractor will cover short term inpatient stays for SUD in a qualified Institution for Mental Diseases (IMD) for members aged 21 to 64 for up to 15 days in a calendar month as medically necessary for individuals with SUD. If a member’s IMD stay exceeds 15 days in a calendar month and the member is awaiting placement in a state operated facility (SOF) for treatment, the member will be disenrolled from the plan and enrolled in fee for service. For stays exceeding 15 days in a calendar month in which the member is not awaiting placement in a SOF, the member will remain enrolled with the Contractor and the state shall recover the entire monthly capitation payment for the member. The Contractor will cover short term crisis residential stays for substance use disorder (SUD) in a qualified Institution for Mental Diseases (IMD) for members aged 21 to 64 and is required to maintain an average length of stay not to exceed 30 days for all residential IMD stays for SUD. The Contractor shall actively track and coordinate the care of members receiving care in an IMD. Anticipating and planning for a member’s successful discharge should begin immediately upon ...
Institution for Mental Disease. (a) “Institution for mental disease (IMD)” means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases or substance abuse problems, including medical attention, nursing care, and related health care services.
