Section 440 IAC 4.3-2-3 - Requirements for regular certificationAuthority: IC 12-21-2-3; IC 12-21-2-8; IC 12-21-5-1.5
Affected: IC 12-7-2-40.6; IC 12-27
Sec. 3.
(a) Regular certification is on a three (3) year cycle, commencing with the certification that is effective July 1, 2000, including the following: (1) Regular certification is granted for one (1) year and may be renewed for two (2) additional one-year periods.(2) An entity that becomes regularly certified after the first year of the cycle shall be certified for one (1) year and may be renewed for one (1) additional year.(3) An entity that becomes regularly certified after the second year of the cycle shall be certified for one (1) year.(b) To be certified and retain certification as a managed care provider, the provider must do the following:(1) For the services in the continuum of care provided by the entity, maintain accreditation from an approved accrediting agency as follows: (A) A managed care provider who primarily provides centralized administrative services must be accredited as a network for behavioral care services.(B) A managed care provider who primarily provides direct care services shall be accredited either as a network for behavioral care services or as a provider of behavioral care services.(2) Require all subcontractors to have written policies and enforce these policies to support and protect the fundamental human, civil, constitutional, and statutory rights of each consumer. Each managed care provider, including its subcontractors, shall do the following: (A) Give a written statement of rights under IC 12-27 to each consumer. The statement shall include the toll free consumer service line number and the telephone number for Indiana protection and advocacy.(B) Document that staff provides both a written and an oral explanation of these rights to each consumer.(3) Require all subcontractors to maintain compliance with health, fire, and safety codes as prescribed by federal and state law.(4) Provide, either directly or through subcontracting with another entity, the continuum of care, as defined in IC 12-7-2-40.6, for the populations to be served under the certification.(5) Demonstrate the administrative and financial capacity to continue successful operations as a viable entity, including the following: (A) An audit of the financial operations of the managed care provider shall be performed annually by an independent certified public accountant. The audit, including the management letter, shall be forwarded to the division within six (6) months of the end of the entity's fiscal year.(B) The managed care provider shall purchase and maintain general liability insurance in the minimum amount of five hundred thousand dollars ($500,000) for bodily injury and property damage.(6) Comply with the policies and procedures of the division in enrolling consumers eligible for financial support by the state.(7) Meet the requirements of the managed care provider contract with the division.(c) A certified managed care provider must do the following: (1) Provide information to the division regarding the following: (A) The number and characteristics of consumers served.(C) Financial information associated with the provision of these services.(2) Participate in and meet the requirements of the division's quality assurance program.(3) Provide information related to services or the operation of the organization as required by the division.(4) Submit the accreditation report within fifteen (15) days of its receipt from the accrediting agency.(d) A managed care provider must notify the division, in writing, of any of the following within thirty (30) days after the occurrence: (1) Change in location of an operational site.(2) The date of the accreditation survey and the name of the accrediting agency to provide accreditation.(3) Change in the accreditation status.(4) The initiation of bankruptcy proceedings.(5) Adverse action against the entity as the result of the violation of health, fire, or safety codes as prescribed by federal, state, and local law.(6) Documented violation of the rights of an individual being treated for mental illness under IC 12-27.(7) Change in the entities with which the managed care provider or its subcontractors contract.(8) Change in the services provided by the managed care provider or its subcontractors.(e) The division reserves the right to require a managed care provider to apply for recertification when there is a substantive change in the operation of the managed care provider.(f) The division shall maintain and provide all managed care providers with a list of approved accrediting agencies annually. Division of Mental Health and Addiction; 440 IAC 4.3-2-3; filed Oct 11, 1996, 2:00 p.m.: 20 IR 754; filed Mar 13, 2000, 7:44 a.m.: 23 IR 1986; readopted filed May 10, 2001, 2:30 p.m.: 24 IR 3235; readopted filed Apr 7, 2008, 3:40 p.m.: 20080507-IR-440070745RFA; Readopted filed 8/11/2014, 11:21 a.m.: 20140910-IR-440140240RFAReadopted filed 11/9/2020, 3:09 p.m.: 20201209-IR-440200502RFA