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• Medicaid certified state institutions, or portions thereof, under the direction of the Indiana Family and Social Services Administration, Division of Mental Health (note section 2422.10.05) • Public residential care institutions such as county homes • Any other type of privately owned group living arrangement such as a foster home or group home • Former inmates with freedom of movement, (i.e.: halfway house, work release, etc.) even if there is a curfew in effect, are prohibited from certain locations and sleep in a lock down facility. These residents still have the freedom of movement during the day hours and would qualify for Medicaid. • Home detention or electronic monitoring in a private home • Out of State TBI facilities which are Medicaid certified (note section 2406.20.10.05).

2422.10.05 RESIDENTS OF PSYCHIATRIC FACILITIES Residents of psychiatric facilities (public or private) may be eligible for Medicaid under the conditions specified below.

A psychiatric facility, or institution for mental diseases (IMD) as referred to in federal regulations, is defined as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care to persons with mental diseases, including medical care, nursing care, and related services.87 Individuals residing in an IMD, as defined above, can be eligible for MA, if they are: • Age 65 or older; or • Under age 21 Eligibility for MA does not automatically mean that claims for inpatient psychiatric hospital and psychiatric residential treatment facility services will be reimbursed. These claims are subject to prior authorization requirements. Refer to section 2422.10.10.

Additionally, if a recipient is receiving approved inpatient services prior to age 21, coverage continues until services are no longer required or the recipient reaches age 22, whichever comes first.88

2422.10.10 Certification of Need/Inpatient Psychiatric Care For individuals under the age of 21 or aged 65 and older to be eligible for Medicaid reimbursement of inpatient psychiatric hospital and psychiatric residential treatment facility services, an approved prior authorization (PA) , is required. The PA contractor determines whether a PA request is approved, based on medical necessity and administrative criteria.