Common use of Institution for Mental Disease Clause in Contracts

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. The proposed services and settings will be reimbursable and subject to the requirements contained in 42 CFR part 438.

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 HealthwiseHIP, 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. The proposed services and settings will be reimbursable and subject to the requirements contained in 42 CFR part 438.

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 HealthwiseCare Connect, 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. The proposed services and settings will be reimbursable and subject to the requirements contained in 42 CFR part 438.

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 facilityacility, 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. The proposed services and settings will be reimbursable and subject to the requirements contained in 42 CFR part 438.