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BPHC SERVICE PROGRAM
The BPHC program offers one service called Behavioral & Primary Healthcare Coordination (BPHC) and consists of the coordination of healthcare services to manage the healthcare needs of eligible recipients. This includes logistical support, advocacy and education to assist individuals in navigating the healthcare system and activities that help recipients gain access to needed physical and behavioral health services needed to manage their health conditions.
The BPHC program is not designed to meet all of an individual’s needs, but merely to assist in the coordination of services for the eligible recipient. BPHC recipients are eligible for Medicaid and therefore eligible to receive all Medicaid covered services for which they qualify to meet their complex needs.
The BPHC program will provide eligible individuals with help in managing their physical and behavioral health. Community mental health centers will provide services such as help in scheduling appointments with doctors, coaching on communicating more effectively with doctors and following instructions on medications or other doctor recommendations.
Behavioral & Primary Healthcare Coordination (BPHC) consists of coordination of healthcare services to manage the healthcare needs of the individual. BPHC includes logistical support, advocacy and education to assist individuals in navigating the healthcare system. BPHC consists of activities that help recipients gain access to needed health (physical and behavioral health) services, manage their health conditions such as adhering to health regimens, scheduling and keeping medical appointments, obtaining and maintaining a primary medical provider and facilitating communication across providers. This includes direct assistance in gaining access to services, coordination of care within and across systems, oversight of the entire case, and linkage to appropriate services. BPHC includes: (1) assessment of the eligible recipient to determine service needs; (2) development of an individualized integrated care plan (IICP); (3) referral and related activities to help the recipient obtain needed services; (4) monitoring and follow-up; and (5) evaluation. BPHC does not include direct delivery of medical, clinical, or other direct services.
To be eligible for BPHC, an individual must meet the following target group criteria:
Based on the behavioral health clinical evaluation, referral form, supporting documentation and FSSA/DMHA approved behavioral health assessment tool results, the applicant must meet all of the following needs-based criteria:
To be eligible for BPHC, an individual must reside in a setting which meets federal setting requirements for home and community-based services (HCBS). Each setting must be assessed independently to determine if an applicant resides in a community-based setting.
An individual must have countable income below 300% FPL which is $2,918 per month (as of April 2014). These income limits are updated annually when the federal government releases the new FPL standards. Annual updates can be accessed in the Federal Register located at www.federalregister.gov/ upon publication. They are typically published in late January and become effective for Indiana Medicaid eligibility determinations in March or April. There are certain income disregards that may be applied that may lower countable income. For example, if there are children or other qualifying dependents in the individual’s household, an individual’s income may be higher; specifically, a $361 per qualifying individual deduction may be applied. There is no asset limit for the program. Determination of financial eligibility is conducted by the Division of Family Resources (DFR).